Authors: Shyam Lata Jain, Pritika Kushwaha, Richa Gupta

Maulana Azad Medical College, New Delhi, INDIA

• The WHO/ REAL classification of Non-Hodgkins lymphoma (NHL) is based on the

morphology, immunology and cytogenetic analysis.

• Fine needle Aspiration cytology (FNAC) with Flow Cytometric Immunophenotyping

(FC) has shown promising results in the diagnosis and subtyping of NHL with high

sensitivity and specificity.

To evaluate the efficacy of FC as an adjunct to FNAC in the diagnosis and

subclassification of NHL in clinico-cytologically suspected cases.

• 61 patients clinically and/cytologically diagnosed /suspected of NHL were evaluated.

• Age & gender - 4-77 years, M >F, Site- Cx LAP, followed by generalized LAP

• FC was performed in all cases with a panel of antibodies (CD3, CD2, CD 4, CD5,

CD8, CD7, CD10, CD19, CD20, CD23, CD45, κ and λ).

• FNAC findings and FC were compared; subtyping of NHL was performed and the

results were further correlated with histopathological diagnosis in all cases.

1. Combined FNAC-FC, aided in the definitive diagnosis of NHL in 47/61 cases (77%)

2. Combined FNAC-FC helped to sub-classify accurately 43/61 cases (70.49%).

3. Majority of the cases were of B-NHL (75.9%) and; the most frequent subtype was

DLBCL (46.51%) followed by SLL (30.23%); single case of Mantle cell lymphoma.

4. Histopathology was considered as the gold standard:

• For the accurate diagnosis of NHL: sensitivity, specificity, PPV, NPV and diagnostic

accuracy was found to be 86.96%, 100%, 100% 14.29% and 87.23% respectively and;

• For the subclassification of NHL: sensitivity, specificity, PPV NPV and diagnostic

accuracy was found to be 80.43%, 100%, 100% 10% and 80.85% respectively.

DLBCL: A) FNAC; B) Histopathology; C&D) Flow Cytometry: CD19 gated cells showing CD20 +, kappa +

Mantle cell Lymphoma: A) FNAC; B) Histopathology; C&D) Flow Cytometry: CD19 gated cells showing CD5 + / CD23 - and

kappa+

1.Diagnosis of NHL by FNAC-FC 2. Sub classification of NHL by FNAC-FC

1. Senjug P, Ostović KT, Miletić Z, Loncarić CT, Stoos-Veić T, Gizdić B, et al. The accuracy of fine needle aspiration cytology and flow cytometry in evaluation of nodal and extranodal sites in patients with suspicion of lymphoma. Coll Antropol. 2010;34(1):131–7. 2. Demurtas A, Accinelli G,

Pacchioni D, Godio L, Novero D, Bussolati G, et al. Utility of flow cytometry immunophenotyping in fine-needle aspirate cytologic diagnosis of Non-Hodgkin lymphoma: A series of 252 cases and review of the literature. Appl Immunohistochem Mol Morphol. 2010;18(4): 311–22. 3. Zeppa P,

Marino G, Troncone G, Fulciniti F, De Renzo A, Picardi M, et al. Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-Hodgkin lymphoma: a critical review of 307 cases with technical suggestions. Cancer. 2004;102(1):55–65

• FNAC-FC: when used in conjunction, provides fairly accurate and reliable diagnosis, also

helps in subclassification of NHL that correlates well with histopathology considering as a

gold standard. It also helps to differentiate reactive lesions from lymphoma in cases where

FNAC alone may fail.

• FNAC-FC should be preferred in the diagnosis of NHL as a first line of investigation

provided that the centre is updated with complete and extended panel of antibodies.

STUDY Sensitivity Specificity PPV NPV

Zeppa et al (2004) 93% 100% 100% 91%

Demurtas et al (2010) 97% 94% - -

Senjug et al (2010) 94.9% 100% - -

Present study 84.62% 100% 100% 14.29%

AUTHOR Sensitivity Specificity PPV NPV

Dey et al (2006) 83.8% - - -

Bangerter etal (2007) 85.6% 100% 100% 55.6 %

Senjug et al (2010) 79.1% 85.7% 97.1% 40 %

Present study 76.9% 100% 100% 10 %

A

A

DCB

SLL: A) FNAC; B) Histopathology; C&D) Flow Cytometry: CD19 gated cells showing dual CD5+ / CD23+ and kappa +

DCB

A DCB