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Cytologic criteria for subclassification of Hodgkin's disease using fine-needle aspiration
A T Moriarty1, E R Banks, T Bloch
1Department of Pathology, Indiana University School of Medicine, Indianapolis.
Insights
Fine-needle aspiration (FNA) can diagnose Hodgkin's disease (HD), but subtyping remains challenging. Quantifying Reed-Sternberg cells helps identify lymphocyte-depleted HD but not other subtypes.
Area of Science:
- Oncology
- Pathology
- Cytopathology
Background:
- Hodgkin's disease (HD) diagnosis increasingly utilizes fine-needle aspiration (FNA).
- Established criteria for subtyping HD into nodular sclerosis (NS), mixed-cellularity (MC), lymphocyte-depleted (LD), and lymphocyte-predominant (LP) via FNA are lacking.
- Accurate subtyping is crucial for appropriate patient management and treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of FNA in subclassifying Hodgkin's disease.
- To determine if quantitative analysis of Reed-Sternberg (RS) cells can differentiate HD subtypes.
- To assess the utility of fibrosis and RS variants in subtyping.
Main Methods:
- Retrospective review of FNA cases of Hodgkin's disease with confirmatory surgical biopsies over a 5-year period.
- Quantitative analysis of Reed-Sternberg (RS) cells in cytologic specimens.
- Statistical analysis using analysis of variance (ANOVA) to compare RS cell counts across subtypes.
- Qualitative assessment of fibrosis and RS variants.
Main Results:
- Lymphocyte-depleted (LD) HD showed the highest mean number of RS cells (51).
- Nodular sclerosis (NS) and mixed-cellularity (MC) HD had similar, lower mean RS cell counts (7 and 6, respectively).
- Fibrosis and RS variants were not reliable indicators for subtyping HD.
- Only one case of lymphocyte-predominant (LP) HD was identified, precluding statistical analysis.
Conclusions:
- Quantitation of RS cells can aid in identifying lymphocyte-depleted (LD) Hodgkin's disease (HD).
- Distinguishing between nodular sclerosis (NS) and mixed-cellularity (MC) HD based solely on RS cell counts is unreliable.
- Fine-needle aspiration (FNA) is suitable for diagnosing HD, staging, and assessing chemotherapy efficacy, but subtyping should still rely on histologic examination of excised lymph nodes.
Abstract:
Hodgkin's disease (HD) is increasingly being evaluated by fine-needle aspiration (FNA); however, criteria to subclassify HD into its four subtypes--nodular sclerosis (NS), mixed-cellularity (MC), lymphocyte-depleted (LD), and lymphocyte-predominant (LP)--has not been established. In order to evaluate criteria for subclassification, all FNA cases of HD obtained over a 5-yr period at Indiana University Medical Center that had confirmatory surgical biopsies were reviewed. The number of Reed-Sternberg (RS) cells was quantitated in each cytologic case and statistically analyzed by subgroup, using analysis of variance (ANOVA). LD had the highest mean (means) number of RS cells (means = 51) with NS and MC having similar means (means = 7 and 6, respectively). Only one case of LP was identified and therefore could not be analyzed statistically. Fibrosis and the presence of RS variants were qualitatively assessed and were not helpful in distinguishing the subtypes of HD. Although the quantitation of RS cells may be used to identify LD types of Hodgkin's disease, MC and NS cannot be separated reliably on this criterion alone. Although FNA can be used to diagnose HD, stage a patient, or assess efficacy of chemotherapy, subtyping of HD should still be done on histologic sections of excised lymph nodes.
