Fine-needle aspiration cytology and flow cytometric immunophenotyping in diagnosis and classification of non-Hodgkin lymphoma in comparison to histopathology

This prospective study aimed to compare the value of fine needle aspiration (FNA) cytology (FNAC) and flow cytometric immunophenotyping (FCI) with histopatopathology (HP) in the diagnosis and classification of non-Hodgkin lymphoma (NHL). Twenty-nine excised lymph nodes suspected of NHL were evaluated using FNAC, FCI, and HP. Specimens were divided into two equal parts; one for HP and the other for FNAC and FCI. Results were compared in terms of diagnosis (malignant, benign or reactive, and metastatic) and NHL class. With combined FNAC/FCI, 11 (37.9%) cases were diagnosed as NHL, 11 cases (37.9%) as reactive lymph node, six cases (20.6%) as Hodgkin's lymphoma, and one case (3.4%) as metastasis. HP revealed nine cases (31%) of NHL, five cases (17.2%) of reactive lymph nodes and all the diagnosed metastatic and Hodgkin's lymphoma. Considering histology as a gold standard method in diagnosis, the sensitivity, specificity, PPV and NPV of FNAC/FCI in differentiate malignant and benign lesion were 73.9%, 83.3%, 94.4%, and 45.5%, respectively and in differentiate NHL from others were 75%, 93.8%, 90%, and 83.3%, respectively. Cytology and HP in addition to FCI and HP are significantly different from determination of NHL lesions point of view (P = 0.001 and P < 0.0001, respectively). However, FCI can be considered as an adjunctive method for Cytology especially because Cytology is not competent enough to differentiate between benign lesions and Lymphoma. Additionally, FCI is shown to be an accurate method in classifying NHL.     

Diagnostic impact of core-needle biopsy on fine-needle aspiration of non-Hodgkin lymphoma

We retrospectively reviewed 74 fine-needle aspiration (FNA) cases of presumptive non-Hodgkin lymphoma (NHL). All the cases had cytology and core-needle biopsy and 53 cases had concurrent flow cytometric analysis. FNA (cytology and flow cytometry) and core-needle biopsy were evaluated independently. FNA was diagnostic of diffuse large B-cell lymphoma (DLBL) in 25% (13/53) of cases and small B-cell NHL in 15% (8/53) of cases, whereas core-needle biopsy was diagnostic of DLBL in 37% (27/74) of cases and small B-cell NHL in 8% (6/74) of cases. Subclassification of small B-cell NHL was reached in 3/6 cases by core-needle biopsy. Insufficient cases were observed in both FNA (47%; 25/53) and core-needle biopsy (28%; 21/74) groups. With the combination of FNA and core-needle biopsy, diagnostic cases of DLBL increased to 43% (32/74) and insufficient samples were reduced to 16% (12/74). There was no clear advantage in the diagnosis and classification of small B-cell NHL by adding core-needle biopsy to FNA (14%; 10/74). We conclude that core-needle biopsy is a useful adjunct to FNA in the diagnosis of DLBL and shall be encouraged. In small B-cell NHL, core-needle biopsy does not add to the diagnostic ability of FNA. Cases insufficient for diagnosis may be seen in both core-needle biopsy and FNA. A combined approach reduces the number of insufficient cases and is recommended in routine FNA practice.     

Fine‐needle aspiration with flow cytometric immunophenotyping for primary diagnosis of intra‐abdominal lymphomas

Cytomorphology in conjunction with immunophenotypic characterization is becoming increasingly used for the primary diagnosis of non‐Hodgkin's lymphomas (NHL). This combination is especially advantageous for the diagnosis of intra‐abdominal and intrathoracic lymphomas, since unlike superficial lesions, open biopsy of deep‐seated tissues is more invasive and more costly, and is associated with a higher risk. We report the cytologic and immunophenotypic features of intra‐abdominal NHL obtained by fine‐needle aspiration (FNA). Twenty‐two cases of intra‐abdominal lesions obtained by image‐guided FNA where flow cytometry was also performed were reviewed. Of the 22 studied cases, 7 were classified as large‐cell lymphoma, 5 as follicular center‐cell lymphoma, 2 as small noncleaved‐cell lymphoma, 2 as lymphoplasmacytoid lymphoma, one as small lymphocytic lymphoma, and one as marginal‐zone lymphoma. In the remaining 4 cases where the immunophenotypic pattern was not definitive, the cytomorphologic features were of small cleaved cells in 3 cases and of mixed small cleaved and large cells in one case. We successfully classified 9 of the 10 patients on whom histologic confirmation was obtained. The successful primary classification of most intra‐abdominal non‐Hodgkin's lymphomas can be done with a combination of cytology and flow cytometry, and this can be the initial approach in patients with deep‐seated lesions. Diagn. Cytopathol. 1999;21:98–104. © 1999 Wiley‐Liss, Inc.     

The role of flow cytometric immunophenotyping in improving the diagnostic accuracy in referred fine-needle aspiration specimens

Flow cytometric (FCM) immunophenotyping has an important role in the diagnostic work up of fine-needle aspiration (FNA) specimens obtained from lymphoid lesions. The objective of the present study was to evaluate the feasibility of this method with respect to referred FNA specimens. One hundred and two FNA specimens referred to our laboratory for FCM analysis during the last 3 years were studied. Specimens were sent, accompanied by cytological smears, from 11 distant hospitals by ordinary mail. The evaluation of potential B-cell monoclonality, the main diagnostic issue to be resolved using FCM, was possible in 86 of these 102 cases. The remaining 16 samples could not be analyzed or adequately interpreted because of sparse or necrotic material. A monoclonal B-cell population was found in 17/86 satisfactory cases, of which 16 were histologically confirmed. Eight cases contained cells positive for the epithelial marker Ber-EP4 and were diagnosed accordingly as carcinomas. FCM analysis of specimens obtained with a clinical question of Hodgkin lymphoma or T-cell lymphomas did not yield definitive data. The time lapse between sampling and analysis (12-84 hr) did not affect the results. This probably was due to the fact that all aspirates were taken in Roswell Park Memorial Institute (RPMI) cell medium, supplemented with 50% fetal calf serum. In conclusion, this retrospective study establishes that it is possible, in the majority of cases, to refer FNA material for FCM immunophenotyping by mail, and that results regarding B-cell clonality in the case of small-cell lymphomas are reliable also after a transportation period of 3-4 days. Carcinoma may be similarly diagnosed and a diagnosis of lymphoma may be excluded in reactive proliferations. Cases with only a few atypical cells or specimens from patients suspected of having Hodgkin lymphoma or T-cell lymphomas are not suitable for analysis by FCM.     

Large B-cell lymphomas: fine-needle aspiration plays an important role in initial diagnosis of cases which are falsely negative by flow cytometry

Large B-cell lymphomas (LBCLs) have significant false-negative results when immunophenotyped by flow cytometry (FC). To clarify the role fine-needle aspiration (FNA) in reducing this false-negative rate, 28 cases ultimately diagnosed as LBCL that had FNA as part of the workup and a negative FC were identified. We examined their clinical and cytologic features, in comparison with cases of LBCL with FNAs that were positive by FC. In 24/28 FC-negative cases (86%) a cytologic diagnosis of suspicious or positive for malignancy was rendered. We conclude that cytologic analysis is more sensitive than FC in the diagnosis of malignancy in FNA of LBCL, particularly in aspirates with low cellularity and/or low viability. Examination of cytospin preparations of the actual material analyzed by FC may provide an indication that an FC result is falsely negative. It is important to recognize the potential of false-negativity by FC of LBCLs when interpreting FNAs with features suggesting lymphoma.     

Fine-needle aspiration diagnosis of Hodgkin lymphoma using current WHO classification--re-evaluation of cases from 1999-2004 with new proposals

With the advent of modern therapy, the differences in prognoses and treatment regimens among different subtypes of Hodgkin lymphoma (HL) have largely vanished. Stage and the presence of systemic symptoms are much more important than histologic subtypes as predictive factors. The current (2001) WHO classification markedly de-emphasizes spatial relationships as critical to the diagnosis of lymphoma and emphasizes cell morphology, immunophenotype, genetic features, and clinical information to define the disease states. This classification, thus, greatly enhances the capability of fine-needle aspiration (FNA) to accurately diagnose HL. We searched all the FNA cases in our institute in years 1999 through 2004 and found 42 cases, for which 13 were primarily diagnosed (31.0%), 2 were recurrent (4.8%), 5 were highly suspicious (11.9%), and 22 were suspicious (52.3%) for HL. On follow-up tissue biopsy, all the primarily diagnosed, recurrent, and highly suspicious cases were confirmed to be HL (100% agreement). For the 22 suspicious cases, 13 were HL (59.1%), 5 were other lymphomas (22.8%), 1 was lymphoma unclassifiable (4.5%), and 3 were reactive processes (13.6%). The effect of immunostains on the diagnosis of HL was examined, and its importance was emphasized. Analysis of demographic data and the distribution of HL subtypes demonstrate that the study sample is representative of the general HL patient population. On the basis of these results, we propose: (1) If the FNA diagnosis of HL is confirmed both by morphology and immunostains, no further tissue confirmation, subclassification and grading is necessary, and appropriate treatment regimens should follow. (2) The nodular lymphocyte predominant HL and classical HL can be differentiated by adequate immunostaining. (3) If a definitive diagnosis cannot be achieved by FNA, a second FNA or a tissue biopsy should be recommended.     

Cytodiagnosis of primary lymphoma of bone on fine-needle aspiration cytology specimens: review of 25 cases

Diagnosis of nodal lymphomas on fine-needle aspiration (FNA) cytologic specimens has been well established. However, cytodiagnosis of primary lymphoma of bone has not been well documented because of its rarity. We undertook a retrospective study of 25 cases of FNA cytologic specimens of primary lymphoma of bone. The slides were available for review in 20 cases; each case was evaluated with 15 cytologic features in conjunction with immunophenotyping and available surgical materials. Three diagnostic categories were assigned, including nondiagnostic (4/16%), suspicious (3/12%), and malignant (18/72%). Among the 18 malignant lymphoma, all were diagnosed on the basis of cytologic materials together with immunocytochemistry, except that two cases also relied on the cell blocks. The nondiagnostic and suspicious cases were subsequently confirmed to be malignant lymphoma on the surgical core biopsies. Of the 25 cases, 23 cases were large B-cell lymphoma, one follicular lymphoma large cell type, and one small lymphocytic lymphoma. False-positive or false-negative cases were not present in this study series. In conclusion, the vast majority of primary lymphoma of bone can be accurately diagnosed and classified on FNA cytologic specimens in conjunction with immunocytochemistry. The nondiagnostic and suspicious categories can be further reduced or eliminated by improving FNA techniques or by recommendation of surgical core biopsies together with other techniques such as flow cytometry and molecular analysis.     

Diagnosis of myeloid sarcoma involving salivary glands by fine-needle aspiration cytology and flow cytometry: report of four cases

Myeloid sarcoma involving salivary glands is extremely rare. Here, we report four cases of this rare occurrence, diagnosed by fine-needle aspiration biopsy. All of four patients had previous diagnoses of myeloid neoplasms. They presented with a solitary mass in the parotid or submandibular salivary gland. The cytological evaluation of the aspirates revealed scattered salivary gland acini admixed with dispersed atypical cells. In three cases, the atypical cells appeared to be heterogeneous, intermediate to large in size, and have folded nuclei with fine chromatin. In another case the atypical cells were monotonous and had round nuclei with fine chromatin. The myeloid lineage of the atypical cells was demonstrated by flow cytometric analysis. High clinical suspicion, careful cytological evaluation, and concurrent ancillary studies are essential for establishing a diagnosis of myeloid sarcoma.     

T-cell-rich B-cell lymphoma (TCRBCL): limitations in fine-needle aspiration cytodiagnosis

Exclusive reports on fine needle aspiration (FNA) cytodiagnosis of T-cell-rich B-cell lymphoma (TCRBCL) are scarce in literature. This report reflects the diagnostic difficulties associated with cytodiagnosis of this rare variant of diffuse large B-cell lymphoma. The study is based on 11 cases with age ranging from 16 to 63 years and a median of 50 years. Male to female ratio was 6:5. Ten cases presented with lymphadenopathy and one had lymphadenopathy as well as extranodal solid tumor. The initial cytodiagnosis was suggestive of TCRBCL in one case, TCRBCL/Hodgkin's lymphoma (HL) in three cases, TCRBCL/HL/anaplastic large cell lymphoma (ALCL) in two cases, TCRBCL/ALCL in one case, and TCRBCL/non-Hodgkin lymphoma (NHL) T-cell/ALCL in one case. There was also a cytologically diagnosed HL case, which on review turned out to be HL/TCRBCL. Histopathological diagnosis was HL in all these nine cases. There were two histologically diagnosed TCRBCL cases during this period, with cytodiagnoses of NHL other than TCRBCL in one and HL in the other. While highlighting the difficulties associated with the cytodiagnosis of TCRBCL, this study conveys a word of caution that adequate immunocytochemical studies should be performed before diagnosing this rare neoplasm with a varied cytomorphology.     

Primary hepatic anaplastic large-cell lymphoma diagnosed by fine-needle aspiration biopsy

Anaplastic large-cell lymphoma (ALCL) presenting as primary hepatic lymphoma is exceedingly rare. Here, we report a case of primary hepatic ALCL, which was diagnosed by cytologic evaluation and concurrent immunohistochemical studies on the material obtained by fine-needle aspiration biopsy. The aspirate smears revealed many loosely dispersed, large atypical cells, some of them with kidney-/horseshoe-shaped and doughnut-shaped nuclei and abundant amphophilic cytoplasm. The nuclei in some of the other cells were often eccentrically located and appeared to be convoluted and even multilobulated. These large atypical cells displayed T-cell immunophenotype and were immunoreactive with CD30 antibody. The diagnosis was confirmed by a core-needle biopsy. This is the first case of primary hepatic ALCL reported in the English cytological literature.     

Indeterminate diagnosis in fine-needle aspiration of the pancreas: reasons and clinical implications

An indeterminate diagnosis made on fine-needle aspiration (FNA) samples of the pancreatic lesions can cause dilemmas in clinical management. We retrospectively analyzed FNA features of such lesions in 65 consecutive pancreatic FNAs from 56 lesions to learn more about the sources of uncertainty and their clinical implications. A definitive diagnosis based on follow-up information was available in 50 lesions. Radiologically, 39% of the lesions showed a cystic component, and 25% of the lesions were ill-defined. Cytologically, contributing factors included scant atypical cells, coexistence of gastrointestinal epithelium, pancreatitis, poor cellular preservation, and interpretation error. Repeat sampling, as requested by clinicians prior to treatment, was performed in 33 (66%) of the 50 lesions, leading to a definitive pathologic diagnosis in 20 (61%) lesions. Seventeen lesions were eventually resected, of which a definitive preoperative diagnosis was attempted in 12 lesions via repeat sampling and was successful in seven. We concluded that indeterminate cytologic diagnosis of a pancreatic lesion often needs to be pursued for optimal management. Although intrinsic natures of a lesion such as cystic component may contribute to insufficient sampling, diagnostic certainty can be improved by proper specimen handling, interpretation, and clinical and/or radiographic correlation.     

Diagnostic value of DNA flow cytometry combined with fine needle aspiration biopsy in lymphomas

The nuclear DNA content of cells from 45 malignant lymphomas and from 60 benign lymph nodes obtained by fine needle aspiration was analysed to investigate the diagnostic value of DNA flow cytometry combined with routine diagnostic cytology in lymphomas. DNA aneuploidy was found in 43 per cent of lymphomas of high grade malignancy (NCI Working Formulation) but only rarely in lymphomas of intermediate- or low-grade malignancy or in Hodgkin's disease, and never in benign lymph nodes. The median percentage of proliferative cells (S + G2/M) was 22.6 per cent in diploid high-grade lymphomas, 15.3 per cent in intermediate-, and 8.1 per cent in low-grade lymphomas, as compared with 4.9 per cent in benign lymph nodes (P less than 0.0001). If the presence of DNA aneuploidy or more than 12 per cent of proliferative cells is used as a criterion for malignancy, the diagnostic accuracy of DNA flow cytometry in detecting lymphoma is 81 per cent. DNA flow cytometry suggested correct diagnosis in 10 of the 19 false positive, false negative, or indeterminate cytological findings encountered during the study. It is concluded that DNA flow cytometry combined with fine needle aspiration biopsy has diagnostic value in lymphomas, but false negative results are common especially in low-grade lymphomas; the method should therefore be used in conjunction with light microscopy.     

Fine-needle aspiration of adult small-round-cell tumors studied with flow cytometry

Immunophenotypic study is critical for the diagnosis of adult small-round-cell tumors (SRCTs). We describe three patients with Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) and one patient with neuroblastoma in which flow cytometry immunophenotyping (FCI) on the fine-needle aspirate (FNA) and bone marrow aspirate (BMA) demonstrated an abnormal population of cells that were CD45(-) and CD16/CD56(+). Four patients with mean age of 30 years, three male and one female, clinically suspicious for a lymphoma or SRCT are described. FNA, BMA, and biopsy specimens were obtained for routine cytologic and histologic evaluation. Fresh tissue was studied by FCI. In all cases, the cytology smears showed small cells with round nuclei, slightly irregular nuclear membranes, fine chromatin, and scant cytoplasm. FCI showed CD16/56(+) and CD45(-) neoplastic cells in all cases. In one case, 76% of these cells were CD99(+). The diagnoses of ES/PNET were confirmed by immunohistochemical, ultrastructural, and cytogenetic studies. ES/PNET in FNA and BMA can be efficiently and rapidly diagnosed by combining cytologic examination with FCI using a panel including CD45, CD16/56, and CD99.     

Diagnosis of posttransplant granulocytic sarcoma by fine‐needle aspiration cytology and flow cytometry

We describe a patient who developed granulocytic sarcomas of the mesentery and breast approximately 4 yrs following an allogenic bone marrow transplantation for acute myeloblastic leukemia. The diagnosis was made by a combination of fine‐needle aspiration cytology and flow cytometry. The differential diagnoses of localized masses in posttransplant patients and how the combination of fine‐needle aspiration cytology and flow cytometry may be used are discussed. Diagn Cytopathol 1999;20:85–89. © 1999 Wiley‐Liss, Inc.     

Plasmablastic lymphoma involving breast: a case diagnosed by fine-needle aspiration and core needle biopsy

Plasmablastic lymphoma (PBL) is a rare lymphoma originating from B-cells with terminal differentiation. Most common anatomic site involved by PBL is the oral cavity. Involvement of other body sites has only rarely been reported. Herein, we report a rare case of EBV-negative PBL involving the breast of an HIV positive 47-year-old woman. The patient presented with decreased vision and photophobia. During physical examination, she was found to have bilateral breast masses and multiple lymphadenopathy. Fine-needle aspiration of one of the breast masses showed large malignant cells with plasmacytoid features. Immunohistochemical studies performed on the core biopsy showed that the tumor cells were positive for common leukocyte antigen CD45 and plasma cell marker CD138, but negative for the pan-B cell markers CD20 and CD79a. Molecular genetic studies showed clonal rearrangement of the immunoglobulin kappa light chain gene. This is the first case of PBL involving the breast reported in English cytological literature.     

Comparative analysis of immunoglobulin polymerase chain reaction and flow cytometry in fine needle aspiration biopsy differential diagnosis of non‐Hodgkin B‐cell lymphoid malignancies

Single primer pair polymerase chain reaction (PCR) assays for the detection of clonal immunoglobulin heavy chain (IgH) gene rearrangements and immunophenotyping by flow cytometry have been proved as useful techniques in the diagnosis of lymphoid disorders in fine needle aspirates. However, a comparative analysis of both ancillary techniques in the same samples has not been previously performed. To compare the sensitivity of flow cytometry and PCR techniques, we made a wide prospective study of 77 fine needle aspiration biopsy (FNAB) samples from lymph nodes and extranodal lymphoid infiltrates. The adjunctive values of a single primer pair PCR amplification of IgH genes and of the immunophenotyping by flow cytometry were evaluated comparing their results with the final clinicopathological diagnosis of each patient supported by histological features and clinical follow up. Among the 24 B‐cell non‐Hodgkin lymphomas, monoclonal IgH bands were detected in 22 cases by PCR, and 21 cases were correctly considered B‐cell lymphoma by flow cytometry. A monoclonal IgH band was also detected in 1 of the 53 reactive lymphoid disorders. When both ancillary techniques were combined with morphological findings, 23 of the 24 B‐cell lymphomas were correctly diagnosed but one reactive lymphoid disorder was also considered a B‐cell lymphoma. We demonstrate a similar level of detection of B‐cell lymphomas by single round PCR and flow cytometry techniques, and a strong adjunctive value when combined with morphological findings to diagnose correctly lymphoproliferative disorders by FNAB. However, we must be cautious with PCR results since false‐positive cases can occur. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine-needle aspiration cytology in the follow-up of Hodgkin lymphoma

Hodgkin lymphoma (HL) is characterized by long survival and risk of relapse and second neoplasm. The aim of this study is to evaluate the possibility of improving the accuracy of fine-needle cytology (FNC) in HL follow-up using Power Doppler ultrasound (US) assistance and immediate microscopic evaluation (ICE). The study was performed in two consecutive groups of 200 FNC in HL patients. In the first group FNC of palpable lymph-nodes or extra lymph-nodal masses were performed without US assistance except for impalpable and/or deep located masses (nonassisted group); In the second group, all the FNC were performed under Power Doppler US assistance with ICE and immediately repeated in inadequate cases (assisted group). Cytological diagnoses were controlled by histology (61) or clinical follow-up (69); sensitivity and specificity were calculated in the two groups and to evaluate the effect of Power Doppler alone, adequate cases were compared with the total number of FNC in each of the two groups.FNC identified 90 negative cases, 3 false negatives, 70 HL relapse, 16 inadequate and 14 suspicious; second neoplasia were diagnosed in 12 cases and all histologically confirmed. Sensitivity and specificity were 64 and 84% in the nonassisted group and 86 and 94% in the assisted group and there were significant differences between the number of adequate cases v.s. the total number of FNC in each of the two groups. Sensitivity and specificity in assisted FNC are higher than in nonassisted ones. The main advantage of assisted FNC in the follow-up of HL is to produce accurate diagnoses avoiding invasive biopsies.     

A morphologic and statistical comparative study of small-cell carcinoma and non-Hodgkin's lymphoma in fine-needle aspiration biopsy material from lymph nodes

Small-cell carcinoma (SmC) and high-grade non-Hodgkin's lymphoma (NHL) are aggressive neoplasms that require prompt diagnosis and treatment. An immediate diagnosis can be obtained using fine-needle aspiration biopsy (FNAB) material from lymph nodes (LNs), which are clinically or radiologically suspicious for tumor involvement. However, in aspirates from LNs, the cytologic distinction of SmC from NHL can be challenging. The purpose of this study was to evaluate the usefulness of various cytologic features that can be used during a rapid on-site evaluation to differentiate these two entities. Twenty-seven metastatic SmC and 50 NHLs cases diagnosed by FNAB of LNs were reviewed. All NHL diagnoses (neck, 29; abdomen, 9; axilla, 6; groin, 5; and parotid, 1) were confirmed with tissue sections, flow cytometry, or immunohistochemistry. These cases were classified as follicular, 21 (42%); diffuse large B cell, 13 (26%); small lymphocytic, 7 (14%); mantle cell, 4 (8%); anaplastic large cell, 2 (4%); and 1 each (2%), Burkitt, lymphoplasmacytic, and peripheral T-cell lymphomas. Immunochemistry confirmed the cytologic diagnoses of all SmC cases (neck, 16; mediastinum, 9; abdomen, 1; and axilla, 1) with either positive chromogranin or synaptophysin. All specimens were reviewed independently by three cytopathologists who were unaware of the original diagnoses. The presence and proportion of single (noncohesive) tumor cells, lymphoglandular bodies, nuclear fragments, paranuclear blue inclusions, nuclear molding, evenly dispersed fine-granular chromatin, crush artifact, and composition of cell clusters (monomorphic vs. polymorphic) were statistically evaluated. The presence of evenly dispersed fine-granular chromatin, paranuclear blue inclusions, and nuclear fragments was each statistically significant in differentiating SmC when compared with NHL (P < 0.01). The remaining features were not significant in distinguishing SmC from NHL in LN aspirates. The identification of distinct cytologic findings such as evenly dispersed fine-granular chromatin, paranuclear blue inclusions, and nuclear fragments can be a valuable aid to accurately diagnose and differentiate metastatic SmC from NHL in FNAB preparations from LNs.     

Role of flow cytometry in the diagnosis of lymphadenopathy in children

To evaluate the combination of fine-needle aspiration (FNA) and flow cytometric immunophenotyping (FCI) in the diagnosis of lymphadenopathy in children, we reviewed a total of 71 FNA specimens from pediatric patients with persistent lymphadenopathy. Two cases were deemed inadequate. In the remaining 69 cases, 54 (78%) were diagnosed as benign lesions, 9 (13%) as Hodgkin's lymphoma, 4 (6%) as non-Hodgkin's lymphoma or leukemic infiltrate, and 2 as metastatic tumors. Of the 69 cases, 25 cases (38%) were diagnosed based on cytomorphology alone, 30 (43%) by combined cytomorphology and FCI, and 19 (28%) by surgical biopsy. In conclusion, FNA is an easy, safe, and reliable procedure in the diagnosis of lymphadenopathy in children. In difficult cases, FCI can be used to exclude non-Hodgkin's lymphomas.