4583 Eus fna combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma.

Abstract

AIM: To determine the yield of EUS FNA in patients with mediastinal and intraabdominal LN in whom the suspicion of lymphoma is raised. METHODS: From 1994 through 1999, 42 patients (19M, 23F) with LN on imaging studies or mucosal lesions on endoscopy suspicious for lymphoma underwent EUS. In sixteen patients (11 lymphomas and 5 benign disease), material collected at EUS FNA was submitted for flow cytometry and/or IC. Final diagnosis was based on clinical follow-up, repeat imaging studies and/or surgical findings. The mean follow-up in benign and lymphoma patients were respectively 21.7 and 5.7 months.RESULTS: A total of 22 patients with lymphoma and 15 with benign disease underwent EUS FNA of LN (5 gastric lymphoma patients did not have EUS FNA). Fifty-six LNs were examined (34 lymphoma, 22 benign). 13 patients had primary gastrointestinal lymphoma with LNs: esophageal (1), gastric (9), pancreas (2), and duodenum (1) and 9 patients had non gastrointestinal lymphoma: mediastinal (7) and intraabdominal (2). Benign LN: mediastinal (9) or intraabdominal (6). The median length of LNs in lymphoma and benign cases were 15 mm and 18 mm (p=0.8). Hypoechoic LNs were more likely in lymphoma cases (53% vs. 28%, p=0.02). The mean number of needle passes in lymphoma and benign cases were 5.8 and 5.0 (p=0.6). The sensitivity, specificity and accuracy of EUS FNA ± flow cytometry/IC for lymphoma were 73% (16/22 lymphomas), 93% (14/15 benign) and 81%. In 8 patients who had failed prior biopsy procedures, EUS FNA diagnosed lymphoma in 6. Flow cytometry/IC were positive for lymphoma in 10 of 11 cases (7 of these had negative cytology) whereas cytology without flow cytometry/IC was positive in 6 out of 11 cases (91% vs 55%, p=0.19). Flow cytometry/IC was negative for lymphoma in 5/5 patients with benign disease. CONCLUSION: EUS FNA provides diagnostic cytology specimens for lymphoma. The standard use of flow cytometry/IC in patients with suspected lymphoma improves the yield of EUS FNA and may influence diagnostic workup and treatment decisions. AIM: To determine the yield of EUS FNA in patients with mediastinal and intraabdominal LN in whom the suspicion of lymphoma is raised. METHODS: From 1994 through 1999, 42 patients (19M, 23F) with LN on imaging studies or mucosal lesions on endoscopy suspicious for lymphoma underwent EUS. In sixteen patients (11 lymphomas and 5 benign disease), material collected at EUS FNA was submitted for flow cytometry and/or IC. Final diagnosis was based on clinical follow-up, repeat imaging studies and/or surgical findings. The mean follow-up in benign and lymphoma patients were respectively 21.7 and 5.7 months.RESULTS: A total of 22 patients with lymphoma and 15 with benign disease underwent EUS FNA of LN (5 gastric lymphoma patients did not have EUS FNA). Fifty-six LNs were examined (34 lymphoma, 22 benign). 13 patients had primary gastrointestinal lymphoma with LNs: esophageal (1), gastric (9), pancreas (2), and duodenum (1) and 9 patients had non gastrointestinal lymphoma: mediastinal (7) and intraabdominal (2). Benign LN: mediastinal (9) or intraabdominal (6). The median length of LNs in lymphoma and benign cases were 15 mm and 18 mm (p=0.8). Hypoechoic LNs were more likely in lymphoma cases (53% vs. 28%, p=0.02). The mean number of needle passes in lymphoma and benign cases were 5.8 and 5.0 (p=0.6). The sensitivity, specificity and accuracy of EUS FNA ± flow cytometry/IC for lymphoma were 73% (16/22 lymphomas), 93% (14/15 benign) and 81%. In 8 patients who had failed prior biopsy procedures, EUS FNA diagnosed lymphoma in 6. Flow cytometry/IC were positive for lymphoma in 10 of 11 cases (7 of these had negative cytology) whereas cytology without flow cytometry/IC was positive in 6 out of 11 cases (91% vs 55%, p=0.19). Flow cytometry/IC was negative for lymphoma in 5/5 patients with benign disease. CONCLUSION: EUS FNA provides diagnostic cytology specimens for lymphoma. The standard use of flow cytometry/IC in patients with suspected lymphoma improves the yield of EUS FNA and may influence diagnostic workup and treatment decisions.