ORIGINAL ARTICLE

Role of polymerase chain reaction and immunocytochemistry in the cytological assessment of lymphoid proliferations

L Venkatraman¹, M A Catherwood², A Patterson¹, T F Lioe³, W G McCluggage¹ and N H Anderson¹

¹ Department of Histopathology, Royal Victoria Hospital, Belfast, UK
² Department of Haematology, Level C, Belfast City Hospital, Belfast, UK
³ Department of Histopathology, Belfast City Hospital, UK

Correspondence to:
Correspondence to:
L Venkatraman
Department of Histopathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BL; Lakshmi.Venkatraman{at}bll.n-i.nhs.uk

Background: Fine-needle aspiration cytology (FNAC) is used as a screening test to evaluate lymphadenopathy. The combined use of genetic analysis and flow cytometry for immunophenotyping has increased the accuracy of diagnosis and correct categorisation of lymphomas on cytological preparations.

Aim: To show the utility of immunocytochemistry and polymerase chain reaction (PCR) in the evaluation of cytological preparations of lymph nodes.

Methods: Fine needle aspirates were obtained from 33 patients (initial presentation, n = 27; recurrence, n = 6). Routine examination was undertaken using immunocytochemistry and DNA PCR to detect clonality and specific translocations. The cytodiagnosis and subclassification of lymphoma was correlated with histological diagnosis in the available follow-up biopsies.

Results: 14 patients had a cytological diagnosis of non-Hodgkin’s lymphoma (NHL), 4 had suspected NHL, 2 had atypical lymphoid proliferation and 13 had reactive hyperplasia. A World Health Organization (WHO) subtype was suggested in 8 patients. Incorporating the results of immunoglobulin heavy chain (IgH) and T-cell receptor (TCR) gene rearrangements enabled diagnosis of lymphoma in 17 patients, including 5 of the 6 patients suspected to have NHL or an atypical lymphoid proliferation. Identification of the translocations t (14;18) and t (2;5) helped WHO categorisation in 3 of the patients. The cytological findings were confirmed in 12 out of the 13 patients for whom histological follow-up was available. Seven of the 18 lymphoma patients were managed without a subsequent biopsy. We made one false–positive diagnosis of B-cell NHL on cytology.

Conclusion: The use of immunocytochemistry and PCR is valuable in the definitive diagnosis and subtyping of malignant lymphomas on cytological preparations. The use of these techniques may avoid lymph node biopsies in some cases and allow definitive treatment based on aspirate findings alone.

Abbreviations: DLBCL, diffuse large B cell lymphoma; FISH, fluorescence in situ hybridisation; FNA, fine-needle aspiration; FNAC, fine-needle aspiration cytology; IgH, immunoglobulin heavy chain; IgL, immunoglobulin light chain; NHL, non-Hodgkin’s lymphoma; PBS, phosphate-buffered saline; PCR, polymerase chain reaction; TCR, T cell receptor; WHO, World Health Organization

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