细针和芯针活组织检查在原因不明淋巴结肿大诊断中的应用

niwanmao

在该文章中，作者利用细针或芯针活检组织，发现流式在反应性淋巴组织增生及B-NHL中准确率分别为100％和95％，但在5例HD中，准确率只有20％。
Fine needle aspiration and core needle biopsy in the diagnosis of lymphadenopathy of unknown aetiology

Abstract
The clarification of enlarged lymph nodes is a common issue in clinical routine. By now, open surgery with complete lymph node extirpation, followed by histopathology, is considered as standard. We investigated the value of fine needle aspiration (FNA) and core needle biopsy (CNB) when supporting the conventional morphology by immunotyping.
In total, 101 lymph nodes (reactive, n＝19; lymphoma, n＝46; metastatic, n＝36) were examined. CNB specimens were sufficient for unequivocal diagnosis by histopathology in 95 %. The FNA cytology allowed a correct diagnosis in 49 %. When supported by immunocytology, the success rate improved to 72 %. By accepting “suspicious of” as correct diagnosis, the ratio increased to 91 %. Additional use of flow cytometry in 46 samples minimized the “suspicious of” diagnoses and increased the proportion of unequivocal diagnoses in FNA specimens to 87 %. Flow cytometry allowed a correct subtyping in 20 of 21 B cell lymphoma but recognised only one of five Hodgkin lymphoma. All eight reactive samples were correctly diagnosed by flow cytometry. In summary, CNB allows a reliable clarification of an unclear lymphadenopathy. FNA is a powerful first diagnostic approach, especially if cytology is supported by immunocytology. The most substantial contribution of flow cytometry in FNA is the discrimination between reactive lymphadenopathy and B cell lymphoma.

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niwanmao

针对上文提到流式细胞术在HD只有20％的诊断准确率，Jonathan R.等人在10月份的刊物中提出了不同的意见，他们认为利用6色或9色流式，可更好的提高诊断敏感度和特异度。对于典型HD，CD4＋T细胞的增高伴CD45和CD7的表达增高，往往有着很强的提示意义。
Immunophenotyping of classical Hodgkin’s lymphoma by flow cytometry
Jonathan R. Fromm & Brent L. Wood
Received: 1 October 2012 / Accepted: 12 October 2012

Dear Editor,
Metzgeroth and coworkers recently published an evaluation of the utility of fine needle aspiration and core biopsy for the diagnosis of lymphadenopathy of unknown etiology [1], including an evaluation of the utility of immunophenotyping these two specimen types by both immunocytochemistry and flow cytometry. With regard to the evaluation of Hodgkin’s lymphoma by these methods, the authors conclude that flow cytometry “seems to be ineligible for the detection of Hodgkin’s lymphoma” [1].
In our experience, while the neoplastic population (the Hodgkin’s Reed–Sternberg cell) of classical Hodgkin’s lymphoma (CHL) cannot be detected by flow cytometry assays designed to detect B and T cell non-Hodgkin’s lymphoma, six- [2] and nine-color [3] reagent combinations are available to detect these cells with high diagnostic sensitivity and specificity. These assays can be used to immunophenotype fine-needle aspirates, core-needle biopsies, and excisional biopsies. We have also recently immunophenotyped CHL in aspirated pleural fluid.
“Conventional” flow cytometry for T cell processes can also be useful in suggesting a diagnosis of CHL [4, 5]. A reactive expansion of CD4-positive T cells with increased expression of CD45 and CD7 is a characteristic of CHL [6], and this population is only occasionally identified in non- Hodgkin’s lymphomas and reactive lymphadenopathies (unpublished data). Therefore, flow cytometry can provide a wealth of diagnostic information regarding the diagnosis of CHL.

Conflict of interest
The authors declare that they have no conflict of interest.

References
1. Metzgeroth G, Schneider S, Walz C, Reiter S, Hofmann WK, Marx A, Hastka J (2012) Fine needle aspiration and core needle biopsy in the diagnosis of lymphadenopathy of unknown aetiology. Ann Hematol 91:1477–1484
2. Fromm JR, Wood BL (2010) A six-color flow cytometry tube for immunophenotyping classical Hodgkin lymphoma in lymph nodes. Cytometry B Clin Cytom 78B:395
3. Fromm JR, Thomas A, Wood BL (2009) Flow cytometry can diagnose classical Hodgkin lymphoma in lymph nodes with high sensitivity and specificity. Am J Clin Pathol 131:322–332
4. Seegmiller AC, Karandikar NJ, Kroft SH, McKenna RW, Xu Y (2009) Overexpression of CD7 in classical Hodgkin lymphomainfiltrating T lymphocytes. Cytometry B Clin Cytom 76:169–174
5. Bosler DS, Douglas-Nikitin VK, Harris VN, Smith MD (2008) Detection of T-regulatory cells has a potential role in the diagnosis of classical Hodgkin lymphoma. Cytometry B Clin Cytom 74:227–235
6. Fromm JR, Thomas A, Wood BL (2010) Increased expression of T cell antigens on T cells in classical Hodgkin lymphoma. Cytometry B Clin Cytom 78:387–388