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Best Practice No 185. Cytological and molecular diagnosis of lymphoma
1g.kocjan@ucl.ac.uk
Insights
Molecular pathology enhances lymphoma diagnosis. Fine needle aspiration cytology (FNAC), combined with immunocytochemistry and molecular analyses, offers precise disease definition and prognostic insights, potentially reducing the need for tissue biopsies.
Area of Science:
- Oncology
- Pathology
- Molecular Biology
Background:
- The cell's role in lymphoma diagnosis is increasingly recognized with molecular pathology advancements.
- Fine needle aspiration cytology (FNAC) is a primary investigation for lymphadenopathy.
- Conventional cytomorphology has limitations in lymphoma diagnosis.
Purpose of the Study:
- To review molecular changes characteristic of specific lymphomas.
- To explore current technologies for detecting these molecular changes in cytological material.
- To emphasize the integration of molecular diagnostics in lymphoma management.
Main Methods:
- Review of scientific literature on molecular pathology in lymphoma.
- Analysis of immunocytochemical and molecular techniques applicable to cytological samples.
- Discussion of technological advancements in molecular detection.
Main Results:
- Molecular pathology provides precise disease definition and prognostic information for lymphomas.
- Immunocytochemistry and molecular analyses supplement conventional FNAC.
- Specific molecular alterations are characteristic of particular lymphoma subtypes.
Conclusions:
- Future lymphoma diagnosis and management protocols should integrate FNAC with immunocytochemistry and molecular investigations.
- Molecular diagnostics improve lymphoma classification and treatment prediction.
- Selected cases of lymphadenopathy may be diagnosed without tissue biopsy.
Abstract:
With the advances in molecular pathology, the cell as a morphological and functional unit has become essential in the diagnosis of lymphoma. Conventional staining, preparation, and interpretation of cells, as seen in fine needle aspiration cytology (FNAC), often used as a first line investigation of lymphadenopathy, is being supplemented with an array of immunocytochemical and molecular analyses, aimed not only at a more precise disease definition, but also at recognising factors that can predict prognosis and response to treatment. Accepting the pitfalls of conventional cytomorphology, this review looks at molecular changes characteristic to particular lymphomas and explores the currently available technology for their detection, with particular reference to cytological material. Future protocols for the diagnosis and management of patients with lymphadenopathy should include FNAC as an initial investigation, followed by immunocytochemistry and molecular investigations. Tissue biopsy, the conventional method of diagnosis, may be avoided in selected cases.
