title: Molecular clonality assessment shows high performance to predict malignant B-cell non-Hodgkin's lymphoma using cytological smears.
abstract: OBJECTIVE
  Molecular PCR-based clonality analysis is helpful for identification of monoclonal B-cell or T-cell populations and to distinguish malignant lymphoma from reactive lymphoid hyperplasia. Typically, clonality assessment on fine-needle aspiration cytology (FNAC) requires freshly obtained aspirates, but the collection and processing of these samples are often challenging in daily practice. In this study, we assessed the routine diagnostic value of the EuroClonality/BIOMED-2 assay for B-cell clonality on air-dried archived Giemsa-stained smears.
  
  
  METHODS
  This study comprised a retrospective analysis of a consecutive diagnostic cohort of 192 FNAC samples from 184 patients with at least 2-year follow-up. The results from the clonality assay were integrated with cytomorphological assessment and evaluated for their accuracy in detecting malignant disease. EuroClonality expert re-evaluation was performed for all cases with ambiguous results and for cases in which the diagnosis did not match the follow-up data.
  
  
  RESULTS
  The clonality assay showed a high accuracy of 93% for detection of malignancy, with a sensitivity of 93% and a specificity of 92%. All 64 cases with monoclonal Ig heavy chain (IGH)/Ig kappa chain (IGK) rearrangements were confirmed malignant by histology or clinical follow-up. Expert re-evaluation changed the definite diagnosis for five cases (3%), mainly because of low signals or no proper duplicate results. We discuss and elucidate all cases for which the clonality results did not match the disease follow-up.
  
  
  CONCLUSIONS
  This study showed that EuroClonality/BIOMED-2 assay can successfully be performed on cytological Giemsa-stained smears and inclusion in daily practice can assist in better identification of malignant lymphoma.
authors.affiliation: Pathologie DNA, Nieuwegein, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Roepman
authors.affiliation: Pathologie DNA, Nieuwegein, The Netherlands.
authors.forename: Cecile-Marie
authors.initials: CM
authors.lastname: Boots
authors.affiliation: Pathologie DNA, Nieuwegein, The Netherlands.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Scheidel
authors.affiliation: Pathologie DNA, Nieuwegein, The Netherlands.
authors.forename: Tobias
authors.initials: T
authors.lastname: Sprong
authors.affiliation: Pathologie DNA, Nieuwegein, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Bruin
authors.affiliation: Department of Hematology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Okke
authors.initials: O
authors.lastname: de Weerdt
authors.affiliation: Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Patricia J T A
authors.initials: PJ
authors.lastname: Groenen
authors.affiliation: Pathologie DNA, Nieuwegein, The Netherlands.
authors.forename: J Alain
authors.initials: JA
authors.lastname: Kummer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes / Q000473:pathology*; D044963:Biopsy, Fine-Needle; D002648:Child; D015331:Cohort Studies; D005260:Female; D015321:Gene Rearrangement; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D007145:Immunoglobulin kappa-Chains / Q000235:genetics*; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D019310:Pseudolymphoma / Q000175:diagnosis* / Q000235:genetics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D007143:Immunoglobulin Heavy Chains; D007145:Immunoglobulin kappa-Chains
keywords: DNA; IMMUNOGLOBULIN; LYMPH NODE PATHOLOGY; LYMPHOMA; MOLECULAR PATHOLOGY