Skip to main content
SpringerLink
Log in

Neue Aspekte zur Feinnadelpunktion von Lymphknoten

New aspects in fine needle biopsies of the lymph nodes

  • Schwerpunkt: Zytologie
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Zytologie der Lymphknoten ist eine kostengünstige, den Patienten wenig belastende, schnelle und aussagekräftige Abklärungsmethode der Ursachen von Lymphadenopathien.

Fragestellung

Stellenwert der Feinnadelpunktion (FNP) in der Abklärung von Lymphknotenschwellungen.

Material und Methoden

Analyse der Ursachen der kontrovers diskutierten Schwachstellen in Bezug auf die Aussagekraft der Lymphknotenzytologie. Vorstellung der diagnostischen Gruppen der Lymphknotenzytologie gemäß des Sydney-Systems.

Ergebnisse

Die technischen Aspekte der Entnahme des Zellmaterials aus dem Lymphknoten anlässlich einer Feinnadelpunktion mit anschließender Anfertigung der Direktausstriche mit guter Fixation und der Triage für die Zusatzuntersuchungen stellen für einige Punkteure eine Herausforderung dar. Am gemäß der klinischen und bildgebenden Situation korrekt triagierten Punktat kann unter Berücksichtigung der klinischen Differenzialdiagnose das gesamte Spektrum an Zusatzuntersuchungen der modernen Pathologie angewendet werden. Die Diagnosen der Punktate der Lymphknoten können entsprechend des kürzlich vorgeschlagenen Sydney-Systems in 5 Gruppen unterteilt werden: nicht ausreichend/nicht diagnostisch, benigne, atypisch, suspekt und maligne. Weitergehende Präzisierung der diagnostischen Aspekte und Empfehlungen zum weiteren Vorgehen sollen in zytologischen Berichten festgehalten werden.

Schlussfolgerungen

Die Optimierung der Entnahmemethoden und der technischen Aspekte der Lymphknotenpunktionen wie auch die Anwendung der Zusatzuntersuchungen steigern die Aussagekraft der Punktionen von Lymphknoten erheblich. Die vorgesehene Einführung der diagnostischen Gruppen für die Berichterstattung der Lymphknotenpunktate kann den Austausch mit den klinischen Fächern vereinheitlichen und vereinfachen.

Abstract

Background

The cytology of lymph nodes is a cost-effective method with a short turnaround time and low risk to patients that delivers valuable information on the cause of the lymphadenopathies.

Objectives

To discuss the value of lymph node cytology in the diagnosis of lymph node swellings.

Methods

Analysis of the causes of the controversially discussed aspects of lymph node cytology. Presentation of the diagnostic groups of lymph node cytology according to the Sydney system.

Results

The technical aspects of lymph node sampling during fine needle biopsy, as well as the subsequent preparation of the correctly fixed direct smears and the triage of the sample for the auxiliary studies, may pose a significant challenge for some puncturers. The whole spectrum of modern pathologic auxiliary studies can be applied to correctly triaged cytologic samples. The diagnoses of fine needle biopsies of the lymph nodes can be divided into five groups according to the recently proposed Sydney reporting system: insufficient/non-diagnostic, benign, atypical, suspicious, and malignant. Further details concerning the diagnosis as well as recommendations on how to proceed are additionally included in cytologic reports.

Conclusions

The improvement of lymph node sampling as well as the technical aspects of the sample handling, including the application of auxiliary studies, considerably increase the diagnostic value of fine needle biopsy of the lymph nodes. Wide implementation of the usage of the diagnostic groups for reporting fine needle biopsies of the lymph nodes can standardize reporting and improve communication with other clinical specialists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. AbuSalah MAH, Gan SH, Al-Hatamleh MAI et al (2020) Recent advances in diagnostic approaches for Epstein-Barr virus. Pathogens 9(3):226

    Article  CAS  Google Scholar 

  2. Al-Abbadi MA, Barroca H, Bode-Lesniewska B et al (2020) A proposal for the performance, classification, and reporting of lymph node fine-needle aspiration cytopathology: the Sydney system. Acta Cytol 64:306–322

    Article  Google Scholar 

  3. Bardales RH (2014) The interventional cytopathologist. Springer, Berlin

    Book  Google Scholar 

  4. Barroca H, Bode-Lesniewska B, Cozzolino I et al (2019) Management of cytologic material, preanalytic procedures and biobanking in lymph node cytopathology. Cytopathology 30:17–30

    Article  Google Scholar 

  5. Chen L, Li Y, Gao X et al (2021) High diagnostic accuracy and safety of endoscopic ultrasound-guided fine-needle aspiration in malignant lymph nodes: a systematic review and meta-analysis. Dig Dis Sci 66:2763–2775

    Article  Google Scholar 

  6. Conrad R, Yang SE, Chang S et al (2018) Comparison of cytopathologist-performed ultrasound-guided fine-needle aspiration with cytopathologist-performed palpation-guided fine-needle aspiration: a single institutional experience. Arch Pathol Lab Med 142:1260–1267

    Article  Google Scholar 

  7. Cui XW, Jenssen C, Saftoiu A et al (2013) New ultrasound techniques for lymph node evaluation. World J Gastroenterol 19:4850–4860

    Article  Google Scholar 

  8. Dimaggio PJ, Kutler DI, Cohen MA et al (2015) Cytopathologist-performed ultrasonography-guided fine-needle aspiration of head and neck lesions: the Weill Cornell experience. J Am Soc Cytopathol 4:313–320

    Article  Google Scholar 

  9. Dueber J, Pang JC, Lew M et al (2015) Value of ultrasound guidance in cytopathologist-performed fine-needle aspirations of palpable lesions. J Am Soc Cytopathol 4:195–202

    Article  Google Scholar 

  10. Fassunke J, Ball M, Engels M (2020) Molecular diagnostics of cytological specimens. Pathologe 41:39–45

    Article  Google Scholar 

  11. Fritzsche FR, Bode PK, Moch H et al (2010) Determination of the Her-2/neu gene amplification status in cytologic breast cancer specimens using automated silver-enhanced in-situ hybridization (SISH). Am J Surg Pathol 34:1180–1185

    Article  Google Scholar 

  12. Garady C, Saieg MA, Ko HM et al (2014) Epstein-Barr virus encoded RNA detected by in situ hybridization using cytological preparations. Cytopathology 25:101–107

    Article  CAS  Google Scholar 

  13. Grohs HK (1988) The interventional cytopathologist. A new clinician/pathologist hybrid. Am J Clin Pathol 90:351–354

    Article  CAS  Google Scholar 

  14. Gupta P, Gupta N, Kumar P et al (2021) Assessment of risk of malignancy by application of the proposed Sydney system for classification and reporting lymph node cytopathology. Cancer Cytopathol 129:701–718

    Article  Google Scholar 

  15. Jakowski JD, Dinardo LJ (2015) Advances in head and neck fine-needle aspiration and ultrasound technique for the pathologist. Semin Diagn Pathol 32:284–295

    Article  Google Scholar 

  16. Jin M, Wakely PE Jr (2018) Lymph node cytopathology: essential ancillary studies as applied to lymphoproliferative neoplasms. Cancer Cytopathol 126(Suppl 8):615–626

    Article  Google Scholar 

  17. Manzo JL, Cuda J, Pantanowitz L et al (2018) Clinical trial cytology: use of on-site evaluation of small biopsy and FNA samples for clinical trials and biomarker research studies. Cancer Cytopathol. https://doi.org/10.1002/cncy.22001

    Article  PubMed  Google Scholar 

  18. Rollins SD, Elshenawy Y (2019) Images for the interventional cytopathologist: salivary gland ultrasound and cytology. Cancer Cytopathol 127:675–679

    Article  Google Scholar 

  19. Ronchi A, Montella M, Zito Marino F et al (2021) Cytologic diagnosis of metastatic melanoma by FNA: a practical review. Cancer Cytopathol. https://doi.org/10.1002/cncy.22488

    Article  PubMed  Google Scholar 

  20. Schmid S, Tinguely M, Cione P et al (2011) Flow cytometry as an accurate tool to complement fine needle aspiration cytology in the diagnosis of low grade malignant lymphomas. Cytopathology 22:397–406

    Article  CAS  Google Scholar 

  21. Schmitt F, Barroca H (2012) Role of ancillary studies in fine-needle aspiration from selected tumors. Cancer Cytopathol 120:145–160

    Article  CAS  Google Scholar 

  22. Schmitt FC (2011) Molecular cytopathology and flow cytometry: pre-analytical procedures matter. Cytopathology 22:355–357

    Article  CAS  Google Scholar 

  23. Sundling KE, Kurtycz DFI (2019) Standardized terminology systems in cytopathology. Diagn Cytopathol 47:53–63

    Article  Google Scholar 

  24. Torres Rivas HE, Villar Zarra K, Pérez Pabón LA et al (2021) Ultrasound-guided fine-needle aspiration of superficial lymphadenopathy performed by Interventional pathologists: the applicability of the Sydney system from 2 years of experience and 363 cases. Acta Cytol 65(6):453–462

    Article  CAS  Google Scholar 

  25. Vigliar E, Acanfora G, Iaccarino A et al (2021) A novel approach to classification and reporting of lymph node fine-needle cytology: application of the proposed Sydney system. Diagnostics (Basel) 11(8):1314

    Article  CAS  Google Scholar 

  26. Wu M, Shroyer KR (2017) Strategies for building a successful ultrasound guided FNA practice in department of pathology – experience at a university hospital. Diagn Cytopathol 45:878–882

    Article  Google Scholar 

  27. Zarra VK, Torres Rivas HE, Rollins SD et al (2019) Systematized protocol for interventional pathology reports. Pathology report paradigm for pathologist-performed ultrasound guided fine needle aspiration (USFNA) and ultrasound guided core needle biopsy (USCNB). Rev Esp Patol 52:163–166

    Google Scholar 

  28. Zeppa P, Cozzolino I, Caraway NP et al (2020) Announcement: the international system for reporting lymph node cytopathology. Acta Cytol 64:299–305

    Article  Google Scholar 

  29. Zhang S, Gong Y (2013) From cytomorphology to molecular pathology: maximizing the value of cytology of lymphoproliferative disorders and soft tissue tumors. Am J Clin Pathol 140:454–467

    Article  Google Scholar 

  30. Zito Marino F, Rossi G, Brunelli M et al (2017) Diagnosis of anaplastic lymphoma kinase rearrangement in cytological samples through a fluorescence in situ hybridization-based assay: cytological smears versus cell blocks. Cancer Cytopathol 125:303–312

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zytopathologie, Pathologie Institut Enge, Hardturmstr. 133, 8005, Zürich, Schweiz

    Beata Bode-Lesniewska

  2. Universität Zürich, Zürich, Schweiz

    Beata Bode-Lesniewska

Authors
  1. Beata Bode-Lesniewska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Beata Bode-Lesniewska.

Ethics declarations

Interessenkonflikt

B. Bode-Lesniewska gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Schwerpunktherausgeber

L. Bubendorf, Basel, Schweiz

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bode-Lesniewska, B. Neue Aspekte zur Feinnadelpunktion von Lymphknoten. Pathologe 43, 109–116 (2022). https://doi.org/10.1007/s00292-021-01044-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-021-01044-2

Schlüsselwörter

Keywords

Search

Navigation