Mousa A Al-Abbadi1, Helena Barroca2, Beata Bode-Lesniewska3, Maria Calaminici4, Nancy P Caraway5, David F Chhieng6, Immacolata Cozzolino7, Mats Ehinger8, Andrew S Field9,10,11, William R Geddie12,13, Ruth L Katz14, Oscar Lin15, L Jeffrey Medeiros16, Sara E Monaco17, Arvind Rajwanshi18, Fernando C Schmitt19, Philippe Vielh20, Pio Zeppa21. 1. Department of Pathology, Microbiology and Forensic Medicine, the University of Jordan, Amman, Jordan. 2. Serviço de Anatomia Patológica, Hospital S João-Porto, Porto, Portugal. 3. Pathologie Institut Enge, Zurich, Switzerland. 4. Department of Cellular Pathology, Barts Health NHS Trust and Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom. 5. Department of Anatomic Pathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 6. Department of Pathology, University of Washington Medical Center, Seattle, Washington, USA. 7. Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy. 8. Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden. 9. University of NSW Medical School, Sydney, New South Wales, Australia. 10. University of Notre Dame Medical School, Sydney, New South Wales, Australia. 11. Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia. 12. University Health Network, UHN, Toronto, Ontario, Canada. 13. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. 14. Tel HaShomer Hospital, Tel Aviv, Israel. 15. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 16. Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 17. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 18. Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 19. Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal. 20. Medipath and American Hospital of Paris, Paris, France. 21. Department of Medicine and Surgery, Università degli Studi di Salerno, Fisciano, Salerno, Italy, pzeppa@unisa.it.
Abstract
BACKGROUND: The evaluation of lymph nodes (LN) by fine-needle aspiration cytology (FNAC) is routinely used in many institutions but it is not uniformly accepted mainly because of the lack of guidelines and a cytopathological diagnostic classification. A committee of cytopathologists has developed a system of performance, classification, and reporting for LN-FNAC. METHODS: The committee members prepared a document that has circulated among them five times; the final text has been approved by all the participants. It is based on a review of the international literature and on the expertise of the members. The system integrates clinical and imaging data with cytopathological features and ancillary techniques. The project has received the endorsement and patronage of the International Academy of Cytology and the European Federation of the Cytology Societies. RESULTS: Clinical, imaging, and serological data of lymphadenopathies, indications for LN-FNAC, technical procedures, and ancillary techniques are evaluated with specific recommendations. The reporting system includes two diagnostic levels. The first should provide basic diagnostic information and includes five categories: inadequate/insufficient, benign, atypical lymphoid cells of undetermined/uncertain significance, suspicious, and malignant. For each category, specific recommendations are provided. The second diagnostic level, when achievable, should produce the identification of specific benign or malignant entities and additional information by utilizing ancillary testing. CONCLUSION: The authors believe that the introduction of this system for performing and reporting LN-FNAC may improve the quality of the procedure, the report, and the communication between cytopathologists and the clinicians. This system may lead to a greater acceptance and utilization of LN-FNAC and to a better interdisciplinary understanding of the results of this procedure.
BACKGROUND: The evaluation of lymph nodes (LN) by fine-needle aspiration cytology (FNAC) is routinely used in many institutions but it is not uniformly accepted mainly because of the lack of guidelines and a cytopathological diagnostic classification. A committee of cytopathologists has developed a system of performance, classification, and reporting for LN-FNAC. METHODS: The committee members prepared a document that has circulated among them five times; the final text has been approved by all the participants. It is based on a review of the international literature and on the expertise of the members. The system integrates clinical and imaging data with cytopathological features and ancillary techniques. The project has received the endorsement and patronage of the International Academy of Cytology and the European Federation of the Cytology Societies. RESULTS: Clinical, imaging, and serological data of lymphadenopathies, indications for LN-FNAC, technical procedures, and ancillary techniques are evaluated with specific recommendations. The reporting system includes two diagnostic levels. The first should provide basic diagnostic information and includes five categories: inadequate/insufficient, benign, atypical lymphoid cells of undetermined/uncertain significance, suspicious, and malignant. For each category, specific recommendations are provided. The second diagnostic level, when achievable, should produce the identification of specific benign or malignant entities and additional information by utilizing ancillary testing. CONCLUSION: The authors believe that the introduction of this system for performing and reporting LN-FNAC may improve the quality of the procedure, the report, and the communication between cytopathologists and the clinicians. This system may lead to a greater acceptance and utilization of LN-FNAC and to a better interdisciplinary understanding of the results of this procedure.