Ultrasound-guided FNA cytology combined with flow cytometry in the diagosis of suspected or recurrent lymphoma

Background: The role of fine-needle aspiration cytology (FNAC) in the diagnosis of primary and recurrent lymphoma is well established, but unfortunately its sensitivity and specificity varies widely. The aim of this study was to assess the usefulness highresolution ultrasound (US), US-guided FNAC and flow cytometry (FC) in the diagnosis of primary and recurrent lymphoma. Patients and Methods: From the database of patients who undergo neck US and US-guided FNAC for the evaluation of neck lymphadenopathy, we extracted data on all the patients who underwent FNAC with FC for suspicious lymphoma, excluding those with indeterminate Results: Overall, 106 patients underwent this procedure, and data on age, gender, US, FNAC and FC results, and site of lymphadenopathy was recorded. There were 61 women (57.5%) and 45 men (42.5%) with a median age of 55 years (range 18-79 years). All patients underwent surgery and subsequent histopathological examination of the removed lymph node. Results: Final pathology showed the presence of a primary or recurrent lymphoma in 62 (58.5%) patients, and a benign disease in 44 (41.5%) patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were: 93.5%, 88.6%, 92.1%, 90.7% and 92.0% for US (OR¼113.1, 95% CI 28.6-47.8); 87.1%, 93.2%, 94.7%, 83.7% and 90.0% for US-guided FNAC (OR¼92.2, 95% CI 23.0-369.5); 83.4%, 95.4%, 96.3%, 80.8% and 89.0% for FC (OR¼109.2, 95% CI 22.7-525.8). There were 5, 3, and 2 false-positive results, and 4, 8, and 10 false-negative results with US, FNAC, and FC, respectively. The combination of US, FNAC and FC reached 96.8% sensitivity, 95.4% specificity, and 96.0% accuracy. The area under the receiver operating characteristic (ROC) curve was 0.81 (95% CI 0.73-0.89).Conclusions: All patients with suspicious lymphoadenopathy on US should undergo US-guided FNAC with FC before surgical excision of the lymph node, due to the high accuracy of such a combination of minimally invasive procedures. References: Mehra M, Tamhane A and Eloubeidi MA. EUS-guided FNA combined with flow cytometry in the diagnoses of suspected or recurrent intrathoracic or retroperitoneal lymphoma. Gastrointest Endosc 62:508-513, 2005.