Fine Needle Aspiration Not Helpful, Cost Effective; May Mislead

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Journal of Clinical Oncology, Vol 22, No 15 (August 1), 2004: pp.

3046-3052

© 2004 American Society of Clinical Oncology

Utility of Fine-Needle Aspiration As a Diagnostic Technique in

Lymphoma

T. Hehn, M. Grogan, P.

From the Departments of Medicine and Pathology and the Arizona Cancer

Center, University of Arizona, Tucson, AZ

Address reprint requests to P. , MD, Arizona Cancer

Center, 1515 N Ave, PO Box 245024, Tucson, AZ 85724-5024

PURPOSE: To evaluate, from a clinician's perspective, the sensitivity

and specificity of fine-needle aspiration (FNA) as a technique for

the diagnosis of lymphoma.

PATIENTS AND METHODS: Medical records of 470 new patients seen in one

lymphoma specialist's clinic from January 1998 through December 2002

were reviewed. Ninety-nine (21%) of the 470 patients underwent a

total of 115 FNA procedures, which were assessed by more than 70

different pathologists in 32 different pathology departments.

Subsequent excisional biopsies were performed in 67 of these patients

and interpreted by a single hematopathology group without independent

review.

RESULTS: Of 115 FNA procedures, 93 were completed for the initial

evaluation of lymphoma and 22 were done for assessment of relapsed

disease. Of the 93 FNA attempts at initial diagnosis, only 27 (29%)

were given a specific and complete histologic diagnosis using an

accepted classification system (Working Formulation, Revised European-

American Classification of Lymphoid Neoplasms, WHO). For the 22 FNAs

done for recurrent disease, only nine (41%) were classified using an

accepted system. Sixty-seven (72%) of the 93 FNAs performed for the

evaluation of initial disease had subsequent excisional biopsies.

Among these paired comparisons, only eight (12%) of 67 FNA diagnoses

were correlated with the subsequent excisional biopsy diagnosis.

Immunophenotyping was completed on 24 of the 67 paired FNAs. Seven of

the 24 FNAs with immunophenotyping (29%) were correlated with

subsequent histology on excisional biopsy. Only one (2%) of 43 FNA

diagnoses, based on morphology alone, was correlated with subsequent

excisional biopsy diagnosis.

CONCLUSION: Overall, FNA for lymphoma diagnosis is not helpful, not

cost effective, and in addition may misguide treatment.