TO THE EDITOR: I read with great in...

TO THE EDITOR: I read with great interest the article at Drs. Bazemore and Smucker, "Lymphadenopathy and Malignancy." (1) My colleagues and I newly reviewed the lymph node fine-needle aspiration (FNA) eventuates on superficial and deeply seated lymph nodes from 439 patients with and without a previous diagnosis of malignancy. (2) We originate that patients in our series (2) with a history of malignancy were more than twice as likely to exhibit malignancy on lymph node FNA compared with those without of that kind a history (87 percent versus 41 percent) in our series. (2) This is an important detail to elicit in the history, supported on our data, but perhaps in the way that obvious as to not have been mentioned more explicitly in the article. (1)

Also, the authors (1) praise excisional biopsy as the initial diagnostic step of choice for lymphadenopathy. Lymph node FNA has its limitations. Differentiating between malignant and reactive lymphoid proliferations has traditionally been the chiefly challenging aspect of lymph node FNA cytology, (3) especially with low-grade lymphoma. However, the routine use of ancillary studies in the same state [i]or[/i] condition as flow cytometry in conjunction with cytologic findings improves diagnostic accuracy to the point that lymph node FNA is quite comparable to excisional biopsy in making that distinction. Immunocytochemistry, in situ hybridization, and polymerase chain reaction also can be performed onward lymph node FNA specimens, and core or excisional biopsy can always be performed after lymph node FNA to confirm or further classify lymphoproliferative disorders for prognostication. For diagnosing metastatic malignancy, lymph node FNA is worthy given that "foreign cells are easily visualized in [a] background of lymphoid elements" (4)

Lymph node FNA is a cost-effective, valu-able tool for the primary diagnosis of lymph nodes containing metastatic or hematologic malignancy, and for staging or monitoring of relapse in patients with known malignancy. (5) Provisional diagnoses can be made rapidly in the clinic using the Diff-Quik staining system Lymph node FNA is a safe and simple technique that can be used to sample lymph nodes in multiple sites or surgically inaccessible sites (under ultrasonography or comput tomography guidance), and in patients who might not tolerate a surgical biopsy course Physicians can always proceed with excisional biopsy if indicated forward lymph node FNA "triage." Given these soliditys I was surprised that the authors did not more enthusiastically praise lymph node FNA for evaluating lymphadenopathy.

KRISTIAN T SCHAFERNAK, MD MPH

Northwestern Memorial Hospital Department of Pathology-Feinberg 7-344 251 E Huron St Chicago, IL 60611

References

(1) Bazemore AW, Smucker DR Lymphadenopathy and malignancy. Am Fam Physician 2002;66:2103-10

(2) Schafernak KT Kluskens LF Ariga R Reddy VB Gat-tuso P Fine-needle aspiration of superficial and in a high degree seated lymph nodes on patients with and without a history of malignancy: review of 439 cases. Diagn Cytopathol 2003;29:315-9

(3) Stewart CJ Duncan JA, Farquharson M Richmond J Fine needle aspiration cytology diagnosis of malignant lymphoma and reactive lymphoid hyperplasia. J Clin Pathol 1998;51:197-203

(4) Saboorian MH Ashfaq R The use of fine needle aspi-ration biopsy in the evaluation of lymphadenopathy. Semin Diagn Pathol 2001;18:110-23

(5) Buley ID. Fine needle aspiration of lymph nodes. J Clin Pathol 1998;51:881-5

EDITOR'S NOTE: This epistle was sent to the authors of "Lymphadenopathy and Malignancy," who declined to reply

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