Image-guided lymph node fine-needle aspiration: the Johns Hopkins Hospital experience

Susan Shyu; Ankit Rajgariah; Carla Saoud; Nicholas Rogers; Syed Z Ali

doi:10.1016/j.jasc.2021.04.004

Image-guided lymph node fine-needle aspiration: the Johns Hopkins Hospital experience

J Am Soc Cytopathol. 2021 Nov-Dec;10(6):543-557. doi: 10.1016/j.jasc.2021.04.004. Epub 2021 May 3.

Authors

Susan Shyu¹, Ankit Rajgariah¹, Carla Saoud¹, Nicholas Rogers¹, Syed Z Ali²

Affiliations

¹ Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
² Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: Sali@jhmi.edu.

PMID: 34088642
DOI: 10.1016/j.jasc.2021.04.004

Abstract

Introduction: Although the diagnostic utility of lymph node fine-needle aspiration (FNA) is well established in the evaluation of metastatic malignancy, its value in the diagnosis of lymphoma is more controversial; yet, there is a growing trend among practitioners towards less-invasive procedures such as FNA and core needle biopsy (CNB). The guidelines recently published by the American Society for Clinical Pathology/College of American Pathology (CAP) regarding the workup of lymphoma include recommendations on the value and limitations of FNA.

Materials and methods: We reviewed 1237 image-guided lymph node aspirates from 695 procedures (410 nodes from 360 ultrasound [US]-guided cases, 799 from 309 endobronchial ultrasound [EBUS], 25 from 23 endoscopic ultrasound [EUS], and 3 from 3 computed tomography [CT]).

Results: The majority (40 of 46, 87%) of lymph nodes suspected of lymphomatous involvement were aspirated under ultrasound. Core needle biopsy [CNB] was obtained for 41 (89%) lymph nodes, including all 40 US specimens. Flow cytometry (FC) was performed on 37 (80%) aspirates; aspirates without FC were from patients who had a history of Hodgkin lymphoma, or showed granulomata or non-hematologic malignancy onsite. Thirty-one (67%) lymph nodes were sent for review by hematopathology. Forty-two (91%) lymph node FNA/CNB yielded actionable diagnoses. Seventeen of 241(7%) cases aspirated for other indications (14 US, 3 EBUS) were involved by a lymphoproliferative process. All were reviewed by hematopathology. All 14 US cases had FC and CNB.

Conclusion: Our institutional approach towards lymph node cytopathology for lymphoma workup appears to be in accordance with the new CAP guidelines, and demonstrates a potential triage and workflow model for lymph node FNA specimens that allows for accurate diagnosis in cases where lymphoma is a consideration.

Keywords: Cytopathology; Fine-needle aspiration; Flow cytometry; Image-guided; Lymph nodes.

MeSH terms

Adult
Aged
Aged, 80 and over
Biopsy, Fine-Needle*
Female
Humans
Image-Guided Biopsy*
Lymph Nodes / pathology*
Male
Middle Aged
Sensitivity and Specificity
Ultrasonography, Interventional / methods*