Citomorfološka i imunocitokemijska analiza u dijagnostici T i B nodalnih i Hodgkinovih limfoma Cytomorphologic and immunocytochemical analyses in nodal T- and B-cell and Hodgkin´s lymphoma diagnostics

摘要

Introduction: According to the World Health Organization classification of lymphoid neoplasms, it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. In theory, this enables cytomorphology, not just pathology, to serve as a primary morphologic method in evaluation of lymphoma patients. ----- Aim: To assess the efficacy and reproducibility of FNA and immunocytochemistry based lymphoma diagnostics, estimate usefulness in diagnosing T-, B-cell or Hodgkin´s lymphoma, and classify it upon the WHO classification. ----- Patients and methods: Specimens of 250 biopsy proven lymphoma patients, newly recognized or with relapsing disease, in whom FNA preceded other procedures were included in the study, regardless of it´s adequacy. Smears were stained with May - Grőnwald Giemsa, and immunocytochemical analyses were performed; those diagnosed as lymphoma were classified according to WHO classification. Two blindly performed consecutive cytomorphological analyses, indicated as cytomorphologist A and B, were compared with histopathology. Data obtained were submitted to ROC analysis, χ2 or Fischer exact test along with descriptive statistical methods. ----- Results: Eleven samples were found inadequate by each cytomorphologist, in six patients histopathologically diagnosed as cHL, in five as DLBCL and in one as CLL/SLL. Compared with histopathologic diagnoses exact agreement in lymphoma subtype was reached in 197/239 (82.4%) patients. Cytomorphologist A diagnosed B-cell lymphomas with 99.2% sensitivity and 99.0% specificity; T-cell lymphomas with 95.8% sensitivity and 98.4% specificity; 80 Hodgkin´s lymphoma with 95.0% sensitivity and 98.8% specificity. Cytomorphologist B diagnosed B-cell lymphomas with 100% sensitivity and 99.0% specificity; T-cell lymphomas with 100% sensitivity and 98.9% specificity; Hodgkin´s lymphoma with 95.0% sensitivity and 100% specificity. Statistically significant difference (p≤0.05) was found comparing histopathologic and cytomorphologic diagnoses in some subtypes of B and T-cell lymphomas (NMZL, FL, ALCL), but not comparing diagnoses between two cytomorphologists. ROC analysis (confidence interval 95%) proved high reliability of the method. ----- Conclusion: FNA, corroborated with immunocytochemistry, is an accurate method in the diagnosing T-, B-cell and Hodgkin`s lymphoma, as well as in lymphoma subtypes with characteristic cytomorphologic picture, such as CLL/SLL, BL, precursor T-cell lymphoma, PTCL and MF progressing to lymph node. High rate of consensus diagnoses between two cytomorphologists indicates reproducibility of the method.