INTRODUCTION. Although the cytologic features of Hodgkin disease (HD) has b
een well described, HD accounts for most of the false-negative fine-needle
aspiration (FNA) biopsies of malignant lymphomas. In this study, the author
s examined the factors contributing to a false-negative diagnosis of HD.
METHODS. Eighty-nine cases from 72 patients (23 females and 49 males) with
HD evaluated by FNA were identified between 1990 and 1999. The patients' ag
es ranged from 5 to 90 years (median, 38 years). Eighty-five FNAs were from
lymph nodes, and 4 were from extranodal sites. Histologic correlation was
available for all patients.
RESULTS. Based on the original cytologic diagnosis, 43 (48.3%) cases had a
positive diagnosis of HD, 20 (22.5%) suspicious or atypical diagnosis, 13 (
14.6%) a benign diagnosis (false-negative cases), and 10 (11.2%) were nondi
agnostic. Three (3.4%) additional cases had a malignant diagnosis other tha
n HD. After review, three false-negative cases were reclassified as HD and
seven as atypical lymphoid proliferation. Three of these 10 cases also show
ed conspicuous collections of histiocytes mimicking poorly formed granuloma
s. In those "atypical" cases, only rare Reed-Sternberg (R-S) cells variants
were identified. No R-S cells or its variants were identified in the remai
ning three false-negative cases; subsequent excisional biopsy showed partia
l involvement of the lymph node by HD in two cases. Among the nondiagnostic
cases, nine cases showed considerable fibrosis in the resected lymph node.
In addition, six cases were performed without on-site assessment.
CONCLUSIONS. The cytologic diagnosis of HD can be challenging when classic
R-S cells are absent. Contributing factors for a false-negative diagnosis i
nclude obscuring reactive inflammatory cells, fibrosis of the involved lymp
h nodes, partial involvement of the lymph node by HD, sampling error, and m
isinterpretation. On-site assessment significantly minimizes the false-nega
tive diagnostic rate. Furthermore, additional material can be obtained for
ancillary studies. Cancer (Cancer Cytopathol) 2001;93:52-59. (C) 2001 Ameri
can Cancer Society.