Flow-cytometric algorithm on fine-needle aspirates for the clinical workup of patients with lymphadenopathy

Diagn Cytopathol. 1998 Oct;19(4):274-8. doi: 10.1002/(sici)1097-0339(199810)19:4<274::aid-dc9>3.0.co;2-a.


To analyze the value and limitations of flow cytometry (FCM) in the investigation of patients with lymphadenopathy, a retrospective study of 196 patients, referred for fine-needle aspiration (FNA) cytology, was carried out in Canberra, Australian Capital Territory, Australia, between 1992-1997. Complete cytological, flow-cytometric, and outcome (clinical and histological) data were available on all the cases. The FNA appearances were read in conjunction with FCM findings. The following cytological categories were recognized: benign, 78 cases (39.8%); indeterminate, 9 cases (4.6%); and malignant, 109 cases (55.6%). None of the 78 cytologically benign cases had malignant outcome. All 109 cytologically malignant cases had malignant histology, and 8/9 of the cytologically indeterminate FNAs had malignant histology. The cytologically malignant category contained 106 B-cell lymphomas and three T-cell lymphomas. All 65 B-cell lymphomas with K light chain predominance had K/L ratio greater than 3/1, and all 34 B-cell lymphomas with L light chain predominance had an L/K ratio greater than 2/1. Clonality was therefore established for K/L and L/K at 3/1 and 2/1, respectively. When K/L and L/K ratios were below these figures (7 cases), other parameters, including the proportion of CD20 and the dual expression of CD19/CD10 and CD20/CD5, were used to determine the nature of the aspirate. In the B-cell lymphomas without demonstrable light chain restriction, CD20 positivity in excess of 85%, CD19/CD10 positivity of more than 18%, or CD20/CD5 positivity greater than 35% were independently diagnostic of B-cell lymphoma. In the T-cell lymphomas, greater than 90% of the cells were T cells, and aberrant T-cell antigen expression with loss of at least one pan-T-cell antigen was detected. In conclusion, the sensitivity of diagnosis of malignancy, false-negative rate, and predictive value of malignant diagnosis with combined FNA cytology and FCM were 99%, 0%, and 100%, respectively.

MeSH terms

  • Algorithms
  • Antigens, CD19 / analysis
  • Antigens, CD20 / analysis
  • Biopsy, Needle*
  • CD5 Antigens / analysis
  • Flow Cytometry*
  • Humans
  • Immunoglobulin kappa-Chains / analysis
  • Immunoglobulin lambda-Chains / analysis
  • Immunophenotyping
  • Lymphatic Diseases / pathology*
  • Lymphoma, B-Cell / diagnosis
  • Lymphoma, B-Cell / immunology
  • Lymphoma, B-Cell / pathology
  • Lymphoma, T-Cell / diagnosis
  • Lymphoma, T-Cell / immunology
  • Lymphoma, T-Cell / pathology
  • Neprilysin / analysis
  • Retrospective Studies


  • Antigens, CD19
  • Antigens, CD20
  • CD5 Antigens
  • Immunoglobulin kappa-Chains
  • Immunoglobulin lambda-Chains
  • Neprilysin