Background: Fine needle aspiration (FNA) is commonly used as a diagnostic tool for the evaluation of lymphoproliferative diseases. Cytomorphology alone is often insufficient for the diagnosis and subclassification of lymphoma; therefore, flow cytometry (FC) plays an important role in the characterization of lymphoproliferative disorders. This study reviews our experience with FC on liver FNA at the Johns Hopkins Hospital. Methods: 2,424 liver FNAs performed over a 21-year period were reviewed for clinical FC data (n = 74) or a subsequent diagnosis of lymphoma in the liver without FC data (n = 40). Results: In our study, 114 cases (4.7%) were included out of the 2,424 liver FNAs performed during the study period. Lymphoma was diagnosed 79 times. Cytomorphology alone was diagnostic of lymphoma in 45 cases, and in 33 cases both the cytomorphology and the FC were consistent with a diagnosis of lymphoma. Neither FC nor cytomorphology were diagnostic of lymphoma on 1 specimen. In 39 cases, FC had negative results on a lesion suspicious for lymphoma based on cytomorphology. In several nonlymphoma cases, FC provided information that allowed further subclassification of the neoplasm. Conclusion: FC is a useful adjuvant diagnostic test for liver FNAs performed on patients with lymphoproliferative disorders.

Wee A: Fine needle aspiration biopsy of hepatocellular carcinoma and hepatocellular nodular lesions: role, controversies, and approach to diagnosis. Cytopathology 2011;22:287-305.
Stewart CJR, Coldewey J, Stewart IS: Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions. J Clin Pathol 2002;55:93-97.
Noronha V, Shafi N, Obando A, Kummar S: Primary non-Hodgkin's lymphoma of the liver. Crit Rev Oncol Hematol 2005;53:199-207.
Levy AD: Malignant liver tumors. Clin Liver Dis 2002;6:147-164.
Demurtas A, Accinelli G, Pacchioni D, Godio L, Novero D, Bussolati G, Palestro G, Papotti M, Stacchini A: Utility of flow cytometry immunophenotyping in fine-needle aspirate cytologic diagnosis of non-Hodgkin lymphoma: a series of 252 cases and review of the literature. Appl Immunohistochem Mol Morphol 2010;18:311-322.
Swerdlow S, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW (eds): WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Albany, WHO Publications Center, 2008, pp 310.
Levitt S, Cheng L, Du Puis M, Layfield L: Fine needle aspiration diagnosis of malignant lymphoma with confirmation by immunoperoxidase staining. Acta Cytol 1985;29:895-902.
Oertel J, Oertel B, Kastner M, Lobek H, Huhn D: The value of immunocytochemical staining of lymph node aspirates in diagnostic cytology. Br J Haematol 1988;70:307-316.
Tani EM, Christensson B, Porwit A, Skoog L: Immunocytochemical analysis and cytomorphological diagnosis on fine needle aspirates of lymphoproliferative diseases. Acta Cytol 1988;32:209-215.
Pilotti S, Di Palma S, Alasio L, Bartoli C, Rilke F: Diagnostic assessment of enlarged superficial lymph nodes by fine needle aspiration. Acta Cytol 1993;37:853-866.
Mathiot C, Decaudin D, Klijanienko J, et al: Fine-needle aspiration cytology combined with flow cytometry immunophenotyping is a rapid and accurate approach for the evaluation of suspicious superficial lymphoid lesions. Diagn Cytopathol 2006;34:472-478.
Dunphy CH, Ramos R: Combining fine-needle aspiration and flow cytometric immunophenotyping in evaluation of nodal and extranodal sites for possible lymphoma: a retrospective review. Diagn Cytopathol 1997;16:200-206.
Young NA, Al-Saleem TI, Ehya H, et al: Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma. Cancer Cytopathol 1998;84:252-261.
Zardawi IM, Jain S, Bennet G: Flow-cytometric algorithm on fine-needle aspirates for the clinical workup of patients with lymphadenopathy. Diagn Cytopathol 1998;19:274-278.
Nicol TL, Silberman M, Rosenthal DL, et al: The accuracy of combined cytopathologic and flow cytometric analysis of fine-needle aspirates of lymph nodes. Am J Clin Pathol 2000;114:18-28.
Meda BA, Buss DH, Woodruff RD, et al: Diagnosis and subclassification of primary and recurrent lymphoma. The usefulness and limitations of combined fine-needle aspiration cytomorphology and flow cytometry. Am J Clin Pathol 2000;113:688-699.
Siebert JD, Weeks LM, List LW, et al: Utility of flow cytometry immunophenotyping for the diagnosis and classification of lymphoma in community hospital clinical needle aspiration/biopsies. Arch Pathol Lab Med 2000;124:1792-1799.
Liu K, Stern RC, Rogers RT, et al: Diagnosis of hematopoietic processes by fine-needle aspiration in conjunction with flow cytometry: a review of 127 cases. Diagn Cytopathol 2001;24:1-10.
Dong HY, Harris NL, Preffer FI, et al: Fine-needle aspiration biopsy in the diagnosis and classification of primary and recurrent lymphoma: a retrospective analysis of the utility of cytomorphology and flow cytometry. Mod Pathol;14:472-481.
Zeppa P, Marino G, Troncone G, et al: Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-Hodgkin lymphoma. A critical review of 307 cases with technical suggestions. Cancer 2004;102:55-65.
Mourad WA, Tulbah A, Shoukri M, et al: Primary diagnosis and REAL/WHO classification of non-Hodgkin's lymphoma by fine-needle aspiration: cytomorphologic and immunophenotypici approach. Diagn Cytopathol 2003;28:191-195.
Sigstad E, Dong HP, Davidson B, et al: The role of flow cytometric immunophenotyping in improving the diagnostic accuracy in referred fine-needle aspiration specimens. Diagn Cytopathol 2004;31:159-163.
Laane E, Tani E, Bjorklund E, et al: Flow cytometric immunophenotyping including Bcl-2 detection on fine needle aspirates in the diagnosis of reactive lymphadenopathy and non-Hodgkin's lymphoma. Cytometry B 2005;64:34-42.
Caraway NP: Strategies to diagnose lymphoproliferative disorders by fine-needle aspiration by using ancillary studies. Cancer 2005;105:432-442.
Jorgensen JL: State of the art symposium: flow cytometry in the diagnosis of lymphoproliferative disorders by fine-needle aspiration. Cancer 2005;105:443-451.
Dey P: Role of ancillary techniques in diagnosing and subclassifying non-Hodgkin's lymphomas on fine needle aspiration cytology. Cytopathology 2006;17:275-287.
Hanson CA: Fine-needle aspiration and immunophenotyping. A role in diagnostic hematopathology? Am J Clin Pathol 1994;101:555-556.
Wakely PE: Fine-needle aspiration cytopathology in diagnosis and classification of malignant lymphoma: accurate and reliable? Diagn Cytopathol 2000;22:120-125.
Cha C, Chen H, Westra WH, Udelsman R: Primary thyroid lymphoma: can the diagnosis be made solely by fine-needle aspiration? Ann Surg Oncol 2002;9:298-302.
Collins KA, Geisinger KR, Raab SS, Silverman JF: Fine needle aspiration biopsy of hepatic lymphomas: cytomorphology and ancillary studies. Acta Cytol 1996;40:257-262.
Raab SS, Silverman JF, McLeod DL, Geisinger KR: Fine needle aspiration cytology of extramedullary hematopoiesis. Diagn Cytopathol 1993;9:522-526.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.