title: The value of fluorescence in situ hybridization and polymerase chain reaction in the diagnosis of B-cell non-Hodgkin lymphoma by fine-needle aspiration.
abstract: BACKGROUND
  Molecular genetic analyses have been predicted to improve the diagnostic accuracy of fine-needle aspiration of B-cell non-Hodgkin lymphoma.
  
  
  OBJECTIVE
  To determine the value of routine molecular genetic assays, polymerase chain reaction (PCR) and fluorescence in situ hybridization (FISH), in the diagnosis of B-cell non-Hodgkin lymphoma by fine-needle aspiration (FNA).
  
  
  METHODS
  A multiparametric method, including cytology, flow cytometry, PCR, and FISH, was prospectively evaluated in the diagnosis of B-cell non-Hodgkin lymphoma by FNA. Aspirates from 30 consecutive patients with suspected hematolymphoid malignancies were collected. All aspirates were triaged through a uniform program including cell-size analysis, B- and T-cell clonality studies, flow cytometric immunophenotyping, and bcl-1 and bcl-2 gene rearrangements by PCR and FISH. After completion of FNA evaluations, FNA results were compared with diagnoses from prior or subsequent surgical biopsies.
  
  
  RESULTS
  Monoclonal B-cell populations were detected in 18 of 20 B-cell non-Hodgkin lymphomas by flow cytometry and PCR. bcl-1 gene rearrangement was detected in 2 of 2 cases of mantle cell lymphoma. bcl-2 rearrangement was detected in 5 cases including 4 of 4 low-grade follicular lymphomas and 1 transformed follicular lymphoma. By incorporating the results of molecular genetic and ancillary diagnostics, a definitive classification was reached in 12 cases of B-cell non-Hodgkin lymphoma by FNA, including all cases of low-grade follicular lymphoma (4/4) and mantle cell lymphoma (2/2) and approximately 50% of small lymphocytic lymphoma (2/4) and large B-cell lymphoma (4/8). Ten of the 12 cases with a final classification reached by FNA had either prior or follow-up surgical biopsies, and all 10 cases showed agreement between the diagnoses rendered on FNA and surgical biopsies.
  
  
  CONCLUSIONS
  With proper handling and management of specimens, FNA can routinely provide samples adequate for molecular genetic studies, in addition to cytomorphology and flow cytometry, making it possible to consistently render accurate and definitive diagnoses in a subset of B-cell non-Hodgkin lymphomas. By incorporating FISH and PCR methods, FNA may assume an expanded role for the primary diagnosis of B-cell non-Hodgkin lymphoma.
authors.affiliation: Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Safley
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Buckley
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Creager
authors.forename: Rajesh C
authors.initials: RC
authors.lastname: Dash
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Dodd
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Goodman
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Jones
authors.forename: Anand S
authors.initials: AS
authors.lastname: Lagoo
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Stenzel
authors.forename: Weihua
authors.initials: W
authors.lastname: Wang
authors.forename: Bill
authors.initials: B
authors.lastname: Xie
authors.forename: Jerald Z
authors.initials: JZ
authors.lastname: Gong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis / Q000639:trends; D005260:Female; D005434:Flow Cytometry / Q000639:trends; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods / Q000639:trends*; D016393:Lymphoma, B-Cell / Q000175:diagnosis*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000639:trends; D016133:Polymerase Chain Reaction / Q000379:methods / Q000639:trends*; D011446:Prospective Studies