CAP lymphoma workup guidelines just released

[WEBB PINKERTON]

I agree with them that FNA by itself is pretty much useless. FLEE CYTOPATHOLOGY NOW!!!!!!

Laboratory Workup of Lymphoma in Adults

Evidence-based guideline and recommendations on preanalytic phase of lymphoma testing with focus on specimen requirements and ancillary testing

www.cap.org

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[tiredguy]

Your post fails to address the nuance of many situations. The FNA of enlarged lymph nodes is a logical first step and sending for flow cytometry is standard of care when a lymphoma is suspected. Most surgeons are not going to excise a lymph node before an FNA is performed, I think because they consider it a waste of their abilities. No modern cytopathologist thinks cytomorphology alone can diagnose most lymphomas. Many HLs and most DLBCLs are pretty obvious on cytologic smears. Some FNAs may contain granulomatous inflammation which may suggestion sarcoid or direct cultures to be sent during ROSE.

Maybe there is a surgical service someplace where surgeons just excise superficial lymph nodes all day. I could imagine this could be a money maker, especially if they have their own hemepath pod lab. Anybody?

 

[maxxor]

Your post fails to address the nuance of many situations. The FNA of enlarged lymph nodes is a logical first step and sending for flow cytometry is standard of care when a lymphoma is suspected. Most surgeons are not going to excise a lymph node before an FNA is performed, I think because they consider it a waste of their abilities. No modern cytopathologist thinks cytomorphology alone can diagnose most lymphomas. Many HLs and most DLBCLs are pretty obvious on cytologic smears. Some FNAs may contain granulomatous inflammation which may suggestion sarcoid or direct cultures to be sent during ROSE.

Maybe there is a surgical service someplace where surgeons just excise superficial lymph nodes all day. I could imagine this could be a money maker, especially if they have their own hemepath pod lab. Anybody?

Rads here:
If these are truly enlarged, we just core the nodes. Is there any need for FNA?

Where I was trained, we only FNA things that were too small to core.

 

[LADoc00]

Who is still FNAing anything?

I think I still see thyroid FNAs, thats about it.

I will also add putting patients through an unnecessary procedure like an FNA of a sensitive anatomic site when you know full well they will need excisional tissue anyway for molecular, flow, IHC and morphology is unethical. But do you want guys. You will need to just deal with my endless mockery.

 

[Thr0mbus]

FNA for lymphoma is bull**** especially in an easily accessible place. I just had a composite lymphoma that almost blew me out of the water but got lucky thanks to **** FNA. Could have been sued!!

FLEE PATHOLOGY NOW!!

 

[deleted314957]

Who is still FNAing anything?

I think I still see thyroid FNAs, thats about it.

I will also add putting patients through an unnecessary procedure like an FNA of a sensitive anatomic site when you know full well they will need excisional tissue anyway for molecular, flow, IHC and morphology is unethical. But do you want guys. You will need to just deal with my endless mockery.

Having been what is essentially a professional patient for about 3 years it is sure refreshing to see a physician keep the patient in mind when it comes to unnecessary BS.

 

[Bavarious]

Your post fails to address the nuance of many situations. The FNA of enlarged lymph nodes is a logical first step and sending for flow cytometry is standard of care when a lymphoma is suspected. Most surgeons are not going to excise a lymph node before an FNA is performed, I think because they consider it a waste of their abilities. No modern cytopathologist thinks cytomorphology alone can diagnose most lymphomas. Many HLs and most DLBCLs are pretty obvious on cytologic smears. Some FNAs may contain granulomatous inflammation which may suggestion sarcoid or direct cultures to be sent during ROSE.

Maybe there is a surgical service someplace where surgeons just excise superficial lymph nodes all day. I could imagine this could be a money maker, especially if they have their own hemepath pod lab. Anybody?

FNA's with flow is so useless. First, you are lucky if there is even enough to flow. Then if it's positive "Oh, flow is positive and there are some atypical cells on a smear. Need to excise for further classification." If flow is negative "Oh, flow is negative and there isn't anything overtly atypical on the smear...but I still can't exclude lymphoma. Need to excise." You can replace excise with biopsy...but even that is often sub-optimal, but it at least gives you a decent shot. An FNA is just pointless.

 

[WEBB PINKERTON]

FNA's with flow is so useless. First, you are lucky if there is even enough to flow. Then if it's positive "Oh, flow is positive and there are some atypical cells on a smear. Need to excise for further classification." If flow is negative "Oh, flow is negative and there isn't anything overtly atypical on the smear...but I still can't exclude lymphoma. Need to excise." You can replace excise with biopsy...but even that is often sub-optimal, but it at least gives you a decent shot. An FNA is just pointless.

You hit that nail right on the head. Such a true post.