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Fine-needle aspiration cytology of hematopoietic lesions from multiple sites
J F Silverman1, D L McLeod, H K Park
1Department of Clinical Pathology, East Carolina University School of Medicine, Greenville, NC 27858.
Insights
Fine-needle aspiration (FNA) cytology accurately diagnoses benign and malignant hematopoietic disorders. This study highlights FNA
Area of Science:
- Hematology
- Cytopathology
- Oncology
Background:
- Hematopoietic lesions encompass a range of benign and malignant conditions.
- Accurate diagnosis is crucial for effective patient management.
- Fine-needle aspiration (FNA) is a minimally invasive diagnostic technique.
Purpose of the Study:
- To evaluate the diagnostic utility and accuracy of FNA cytology in identifying benign and malignant hematopoietic disorders.
- To assess the role of ancillary studies in refining FNA diagnoses.
- To determine the range of hematopoietic lesions diagnosable by FNA across various anatomical sites.
Main Methods:
- Retrospective review of 130 FNA biopsies from 118 patients.
- Analysis of diagnostic outcomes: malignant, benign, and atypical.
- Application of immunocytochemistry and electron microscopy as ancillary techniques.
Main Results:
- 74% malignant, 35% benign, and 8% atypical diagnoses were identified.
- FNA was used for primary diagnosis in 50% of malignant cases and recurrence confirmation in the rest.
- High diagnostic accuracy was observed, with no false-positive or false-negative diagnoses when confirmed by surgical biopsy.
Conclusions:
- FNA cytology is a clinically valuable tool for diagnosing hematopoietic disorders.
- The technique demonstrates high accuracy across diverse anatomical locations, including extranodal sites.
- Ancillary studies significantly enhance the specificity and accuracy of FNA diagnoses.
Abstract:
We reviewed 130 fine-needle aspiration (FNA) biopsies from 118 patients with a variety of benign and malignant hematopoietic lesions. There were 74 (57%) malignant, 45 (35%) benign, and 11 (8%) atypical diagnoses. Immunocytochemistry of the aspirated material was performed in 47 (36%) and electron microscopy in 4 (3%) of the cases. FNA cytology was utilized to make a primary hematopoietic malignant diagnosis in approximately half of the cases and to confirm recurrence in the remainder. The malignant cases included non-Hodgkin's lymphoma. Hodgkin's disease, medullary and extramedullary plasmacytoma, and granulocytic sarcoma. Forty-two malignant cases had either previous or follow-up surgical biopsy with no false-positive diagnoses. Of the 11 atypical cases, seven had surgical confirmation with five malignant and two benign diagnoses. The benign hematopoietic lesions correctly identified included acute and chronic lymphadenitis, granulomatous processes, and eosinophilic granuloma. Only 5 of the 45 benign FNA biopsies had surgical pathology follow-up, with no false-negative diagnoses. The most commonly aspirated sites were lymph nodes (71%), although hematopoietic lesions were correctly identified in a number of extranodal locations, including soft tissue (8%), abdominal viscera (6%), lungs (5%), mediastinum (2.5%), bone (3%), and thyroid, salivary gland, and breast (1.5% each). This study demonstrates the clinical utility and diagnostic accuracy of FNA cytology in the evaluation of benign and malignant hematopoietic disorders from multiple sites. Ancillary studies performed on the aspirated material aided in making a specific and accurate diagnosis.