Citologia aspirativa in patologia emo-linfoproliferativa

Flow cytometry (FC) is a useful adjunct to fine-needle aspiration cytology (FNC) in evaluating lymphoproliferative disorders. We present a critical review of 307 lymph nodal and extra lymph nodal lymphoproliferative disorders diagnosed by fine-needle cytology (FNC) and FC. FC was performed over a four-year period on 185 palpable and 122 impalpable nodal and extra nodal lymphoproliferative processes under ultrasound (US) or computed tomography (CT). FC was performed using the following fluoresceinated antibodies: CD3, CD4/8, CD2/CD7/CD3, CD5/CD10/CD19, CD19/κ/λ, FMC7/CD23/CD19, CD38/CD56/CD19, bcl-2. The series comprised 15 inadequate, 10 suspicious and 135 benign reactive hyperplasias (BRH), 70 primary non-Hodgkin lymphomas (NHL) and 77 relapses of NHL (rNHL). FC/FNC diagnoses of suspicious, NHL and rNHL were controlled either histologically or clinically or by the interphase fluorescence in situ hybridization (FISH) demonstration of t(11;14)(q13;q32) in two cases of mantle cell lymphoma (MCL). BRH were controlled by follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the FC/FNC diagnoses of NHL, rNHL and BRH were calculated as well as the identification of specific subtypes among the small-cell and medium size NHL. Statistical analysis showed 93% sensitivity, 100% specificity, 100% PPV and 91% NPV in NHL, rNHL and BRH discrimination; as for the subclassification of small cell and medium-size NHL: 63% sensitivity, 88% specificity, 95% PPV and 37% NPV were obtained. FC applied to FNC enhances the precision of cytological diagnosis in lymph-nodal and extra lymph-nodal lymphoproliferative disorders and allows further subclassification in more than half of the cases, thus avoiding invasive surgical biopsies in many patients.