Diagnosis of lymphoma by fine-needle aspiration cytology using the revised European-American classification of lymphoid neoplasms

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Abstract
Recent changes in the classification of non-Hodgkin lymphoma (NHL) emphasize the diagnostic importance of cytomorphology, immunophenotyping, and molecular findings in addition to histology. These changes have allowed for a greater role of fine-needle aspiration cytology (FNA) in the diagnosis of NHL. A review of the English language literature regarding the use of FNA in the cytodiagnosis of lymphoma was performed. The revised European–American classification of lymphoid neoplasms (REAL) was reviewed in the context of its adaptability to the cytologic diagnosis of lymphoid neoplasms. FNA is being used more frequently in the diagnosis, staging, and follow-up of lymphoma whenever supportive studies are readily available. Cytomorphologic, immunophenotypic, and molecular criteria as well as pitfalls in the diagnosis of lymphoma by FNA have been delineated. Information was compiled into tables to facilitate correlation of criteria with the proposed REAL system. Many cases of NHL can be diagnosed and subclassified by FNA when there is adequate immunophenotypic information. [See editorial on pages 322–4, this issue.] Cancer (Cancer Cytopathol) 1999;87:325–45. © 1999 American Cancer Society.