Usefulness of high-resolution ultrasonography, fine-needle aspiration cytology, and flow cytometry in the diagnosis of primary and recurrent lymphoma

Background: The role of fine-needle aspiration cytology (FNAC) in the diagnosis of primary and recurrent lymphoma is well established, but unfortunately its sensitivity and specificity varies widely. The aim of this study was to assess the usefulness of high-resolution ultrasonography (US), fine-needle aspiration cytology (FNAC), and flow cytometry (FC) together in the diagnosis of primary and recurrent lymphoma. Patients and Methods: A series of 108 consecutive patients with suspicious neck adenopathy who underwent both US and US-guided FNAC with ancillary FC was reviewed. There were 66 women (61.1%) and 42 men (38.9%) with a median age of 60 years (range 20-81 years). All patients underwent surgery and subsequent histopathological examination of the removed lymph node. Results: Final pathology showed the presence of a primary or recurrent lymphoma in 72 (66.7%) patients, and a benign disease in 36 (33.3%) patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were the following: 88.9%, 72.2%, 86.5%, 76.4%, and 83.3% for US; 91.7%, 94.4%, 97.1%, 85.0%, and 92.6% for US-guided FNAC; 97.2%, 97.2%, 98.6%, 94.6%, and 97.2% for FC. No significant differences (p=NS) were found between US, FNAC and FC. There were one, two and ten false-positive results, and two, six and eight false-negative results with US, FNAC and FC, respectively. The combination of FNAC and FC was 98.6% sensitive, and the combination of US and FNAC was 94.4% sensitive. The combination of US, FNAC and FC was 98.6% sensitive with a specificity of 100%. Conclusions: All patients with suspicious neck adenopathy should undergo US-guided FNAC and ancillary FC before surgical excision of the lymph node due to the high sensitivity and specificity of such preoperative techniques in combination.