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Cited by 10Viral-associated cancers and disordersLymphadenopathy Diagnosis and AnalysisLymphoma Diagnosis and Treatment

Significance of lymph node fine needle aspiration for the diagnosis of HIV-associated lymphoma in a low-resource setting

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Vogt, Samantha L., Maloma, Lucia, Xian, Rena R., Ambinder, Richard F., Philip, Vinitha, Patel, Moosa, Martinson, Neil A., Omar, Tanvier·2022·AIDS
DOI 10.1097/qad.0000000000003261PMC PMC9329253
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Abstract

Objective: Fine needle aspiration (FNA) is an early step in the work-up of lymphadenopathy in people with HIV (PWH). We set out to characterize the FNA cytology in PWH and report on the time to lymphoma diagnosis through the FNA clinics in the public healthcare system in Johannesburg, South Africa. Design: Retrospective review of laboratory database. Methods: A retrospective chart review of patients undergoing FNA through the department of cytopathology at the National Health Laboratory Service (NHLS) was undertaken. Results of FNAs performed between March and May 2018 were reviewed. Medical record chart abstraction included general demographics, HIV status, site and results of FNA, prior history of malignancy and other laboratory data. Results: Five hundred and thirty-nine lymph node FNAs were performed on PWH. Pathological findings included tuberculosis 47% (252), inadequate sampling 14% (75), reactive adenopathy 13% (71), benign disease 12% (63), suspicious for lymphoproliferative neoplasm 8% (45), other malignancy 4% (21) and inflammation 2% (n = 12). Only 53% (24) of lymphomas were confirmed by biopsy. Those not confirmed had a high mortality (57%) and loss to follow-up rate (29%) over the following year. The median diagnostic interval exceeded 8 weeks from time of FNA to lymphoma diagnosis. Conclusion: FNA is an important screening modality in this high HIV and tuberculosis (TB) burden region. Patients with cytology suggestive for lymphoma, but without biopsy confirmation, have a high mortality rate suggesting undiagnosed lymphoma. A better understanding of the barriers to appropriate diagnostic triage for lymphoma is needed.

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  • FNAB serves as a valuable screening modality in high HIV and TB burdened regions for diagnosing infections, particularly TB, reactive lymphadenopathy, and HIV-associated lymphoma.

    “FNAB also serves as a valuable screening modality in this high HIV and TB burdened region in diagnosing infections, particularly TB, reactive lymphadenopathy, and HIV-associated lymphoma.”

    From Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries (2024) · cites this paper as [27]

    The Introduction says FNA diagnoses TB and reactive adenopathy and is an important first step in the lymphoma work-up. The Discussion says that, for lymphoma, FNA alone is inadequate to inform treatment decisions; the Introduction adds that lymphoma diagnoses on FNA require biopsy confirmation. It supports lymphoma screening, but not a definitive lymphoma diagnosis by FNAB. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a South African study, a significant proportion of PLWH with cytology suggestive of lymphoma did not proceed to diagnostic biopsy, resulting in a high mortality rate.

    “However, in their study a significant proportion of PLWH with cytology suggestive of lymphoma did not proceed to diagnostic biopsy, resulting in a high mortality rate.”

    From Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries (2024) · cites this paper as [27]

    The Results report that 21 of 45 PLWH with cytology concerning for lymphoma did not proceed to biopsy; 12 of those 21 died within a year. The Discussion describes mortality in this group as 57%–86%, accounting for loss to follow-up. The paper does not establish that failure to undergo biopsy caused the deaths, as “resulting in” implies. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In a South African study, FNAB is a critical initial step in assessing lymphadenopathy in people living with HIV.

    “A study done in the National Health Laboratory Service in South Africa on the utility of FNAB for the diagnosis of lymphadenopathy in people living with HIV (PLWH) reported that FNAB is a critical initial step in assessing lymphadenopathy in PLWH.”

    From Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries (2024) · cites this paper as [27]

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Research works printed but not linked: 1

  1. [27]Vogt S, Ashmore P, Patel M, Martinson N, Ambinder F. Delay in South African AIDS lymphoma diagnosis. Presented at the 16th International Conference on Malignancies in HIV/AIDS, Washington, DC, USA, 2017

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Authors
Vogt, S. L., Maloma, L., Xian, R. R., Ambinder, R. F., Philip, V., Patel, M., Martinson, N. A., & Omar, T.
Affiliations
  • Johns Hopkins University (US)
  • University of the Witwatersrand (ZA)
  • National Health Laboratory Service (ZA)
Corresponding author
Vogt, Samantha L.
ORCID
Venue
AIDS
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-04-23
Volume
36
Issue
10
Pages
1393-1398
ISSN
  • 0269-9370 (ISSN-L)
  • 1473-5571
DOI
10.1097/qad.0000000000003261
PMC
PMC9329253
OpenAlex
W4224833270
Semantic Scholar
7e293c98d943c26fd39b77fa20c7c9e6eea090d7
Cited by
10
References
29
Citations by year
2026: 2 · 2025: 4 · 2024: 2 · 2022: 2
FWCI
0.84
Type
journal article
Language
en
Open access
Licence
Locations
  • AIDS (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5u01ca121947-06)
  • National Cancer Institute (R01CA250069, U01-CA121947, R21CA232891, UM1CA121947, T32CA009071, P30CA006973)
  • National Institute of Allergy and Infectious Diseases (P30AI094189)
  • Fogarty International Center (R25TW009340)
Topics
  • Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
  • Health Sciences › Medicine › Surgery › Lymphadenopathy Diagnosis and Analysis
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
Keywords
HIV-associated lymphoma, lymph node fine needle aspiration, cytology, HIV, tuberculosis, delayed diagnosis, lymphoma mortality, loss to follow-up, resource-limited settings, diagnostic triage, lymphadenopathy
MeSH terms
Humans, Lymph Nodes, Lymphoma, Neoplasms, Retrospective Studies, South Africa, Tuberculosis, HIV Infections, Biopsy, Fine-Needle

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