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Molecular clonality assessment shows high performance to predict malignant B-cell non-Hodgkin's lymphoma using cytological smears
  1. Paul Roepman1,
  2. Cecile-Marie Boots1,
  3. Karen C Scheidel1,
  4. Tobias Sprong1,
  5. Peter de Bruin1,
  6. Okke de Weerdt2,
  7. Patricia J T A Groenen3,
  8. J Alain Kummer1
  1. 1Pathologie DNA, Nieuwegein, The Netherlands
  2. 2Department of Hematology, St. Antonius Hospital, Nieuwegein, The Netherlands
  3. 3Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Dr Paul Roepman, Pathologie DNA, Koekoekslaan 1, Nieuwegein 3435 CM, The Netherlands; p.roepman{at}


Aims Molecular PCR-based clonality analysis is helpful for identification of monoclonal B-cell or T-cell populations and to distinguish malignant lymphoma from reactive lymphoid hyperplasia. Typically, clonality assessment on fine-needle aspiration cytology (FNAC) requires freshly obtained aspirates, but the collection and processing of these samples are often challenging in daily practice. In this study, we assessed the routine diagnostic value of the EuroClonality/BIOMED-2 assay for B-cell clonality on air-dried archived Giemsa-stained smears.

Methods This study comprised a retrospective analysis of a consecutive diagnostic cohort of 192 FNAC samples from 184 patients with at least 2-year follow-up. The results from the clonality assay were integrated with cytomorphological assessment and evaluated for their accuracy in detecting malignant disease. EuroClonality expert re-evaluation was performed for all cases with ambiguous results and for cases in which the diagnosis did not match the follow-up data.

Results The clonality assay showed a high accuracy of 93% for detection of malignancy, with a sensitivity of 93% and a specificity of 92%. All 64 cases with monoclonal Ig heavy chain (IGH)/Ig kappa chain (IGK) rearrangements were confirmed malignant by histology or clinical follow-up. Expert re-evaluation changed the definite diagnosis for five cases (3%), mainly because of low signals or no proper duplicate results. We discuss and elucidate all cases for which the clonality results did not match the disease follow-up.

Conclusions This study showed that EuroClonality/BIOMED-2 assay can successfully be performed on cytological Giemsa-stained smears and inclusion in daily practice can assist in better identification of malignant lymphoma.

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  • Handling editor Runjan Chetty

  • Contributors PR, C-MB and JAK have designed the study, collected the data, performed the analyses and have written the manuscript. KCS and TS have performed the molecular assay. PdB and OdW have provided clinical samples and discussion, PJTAG was responsible for re-evaluation of the data and has written the manuscript. All authors have read and approved the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.