EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma,☆☆

https://doi.org/10.1067/mge.2001.112841Get rights and content

Abstract

Background: Limited information is available regarding the use of EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of lymphoproliferative disorders. The aim of this study was to evaluate the yield of this technique in the primary diagnosis of lymphoma. Methods: The records were reviewed of 38 consecutive patients with GI lesions and/or enlarged lymph nodes identified on imaging studies that raised a suspicion of lymphoma who underwent EUS-FNA of lymph nodes or the gut wall. Final diagnosis was based on clinical follow-up, imaging studies, or surgical findings. Results: Twenty-three patients with lymphoma and 15 patients with benign disease or reactive lymphadenopathy were identified. The overall sensitivity, specificity, and accuracy of EUS-FNA cytology with flow cytometry/immunocytochemistry (FC/IC) for the diagnosis of lymphoma were, respectively, 74%, 93%, and 81%. When comparing patients who had EUS-FNA with FC/IC versus those who had EUS-FNA without FC/IC, sensitivity was 86% versus 44% (p = 0.04), specificity was 100% versus 90% (not significant), and accuracy was 89% versus 68% (not significant). Conclusion: EUS-FNA can provide cytology specimens diagnostic for lymphoma. Selective use of FC/IC in patients with suspected lymphoma improves the yield of EUS-FNA and may guide diagnostic evaluation and treatment decisions. (Gastrointest Endosc 2001;53:485-91.)

Section snippets

Materials and methods

Thirty-eight consecutive patients (19 men and 19 women) with lymphadenopathy on imaging studies and/or GI mucosal lesions whose appearance suggested lymphoma underwent EUS from 1994 through 1999. The cases were divided into 2 groups according to their final diagnosis: lymphoma (23 patients) and benign diseases or reactive lymphadenopathy (15 patients). The cases originated from two different medical centers: Mayo Clinic, Rochester, Minnesota (7 patients) and St. Vincent Hospitals and Health

Results

Thirty-eight patients (19 women and 19 men) who underwent EUS-FNA were included: 23 patients with lymphoma and 15 with benign lymphadenopathy. Descriptive data for both groups are shown in Table 1.

. Patient characteristics

Empty CellLymphomaBenignp value
Site of primary lymphoma or lymphadenopathy
GI
Esophageal1
Gastric9
Pancreas2
Duodenum1
Non-GI
Mediastinal79
Intra-abdominal26
Both1
Mean age (y)66560.001
Hypoechoic LNs (%)53280.05
Mean long axis (mm) (range)20 (5-80)18 (7-41)0.8
Mean number of needle passes (range)6

Discussion

This study demonstrated that EUS-FNA combined with FC/IC can assist in the primary diagnosis of lymphoma and in differentiating benign disease from lymphoma. In patients undergoing EUS-FNA in whom cytology alone is insufficient to establish a diagnosis, flow cytometry was used to isolate and examine subpopulations of lymphocytes on the basis of their immunophenotypic characteristics. FC/IC phenotyping for immunoglobulin light chain restriction (κ/λ ratio of >3:1 or <1:2) or the presence of an

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    Reprint requests: Maurits J. Wiersema, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW Rochester, MN 55905.

    ☆☆

    Gastrointest Endosc 2001;53:485-91

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