TITLE: Fine-Needle Aspirate for the Evaluation of Suspected Lymphoma: Clinical
Effectiveness and Guidelines
DATE: 31 March 2015
RESEARCH QUESTION
1. What is the clinical effectiveness of fine-needle aspirate (FNA) in the evaluation of suspected lymphoma?
2. What are the evidence-based guidelines for the use of FNA in the evaluation of suspected lymphoma?
KEY FINDINGS
One systematic review and two evidence-based guidelines were identified regarding FNA in the evaluation of suspected lymphoma.
METHODS
A limited literature search was conducted on key resources including PubMed, The Cochrane
Library (2015, Issue 3), University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused
Internet search. Methodological filters were applied to limit retrieval to health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, and guidelines.
Where possible, retrieval was limited to the human population. The search was also limited to
English language documents published between January 1, 2010 and March 23, 2015. Internet links were provided, where available.
The summary of findings was prepared from the abstracts of the relevant information. Please note that data contained in abstracts may not always be an accurate reflection of the data contained within the full article.
Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in
Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect.
CADTH is not liable for any loss or damages resulting from use of the information in the report.
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SELECTION CRITERIA
One reviewer screened citations and selected studies based on the inclusion criteria presented in Table 1.
Table 1: Selection Criteria
Population
Intervention
Comparator
Outcomes
Study Designs
Patients with suspected lymphoma
FNA
No FNA;
Other diagnostic procedures or tests (e.g., excisional biopsy, image-guided cone biopsy
Clinical effectiveness (benefits and harms);
Guidelines
Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, evidence-based guidelines
FNA = fine-needle aspirate
RESULTS
Rapid Response reports are organized so that the higher quality evidence is presented first.
Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials and evidence-based guidelines.
One systematic review and two evidence-based guidelines were identified regarding the use of
FNA in the evaluation of suspected lymphoma. No relevant health technology assessments or randomized controlled trials were identified.
Additional references of potential interest are provided in the appendix.
OVERALL SUMMARY OF FINDINGS
One systematic review
1
and two evidence-based guidelines
2,3
were identified regarding the use of FNA in the evaluation of suspected lymphoma.
A systematic review
1
that evaluated the diagnostic rate of lymphoma using FNA cytology in combination with other techniques concluded that this method, as well as FNA alone, was inadequate for successful diagnosis and should be followed by excisional lymph node biopsy.
An Alberta Health Services guideline
2 about lymphoma does not recommend fine needle aspirate biopsies for initial diagnosis of lymphoma. Guidelines published by the British
Committee for Standards in Haematology and the Royal College of Pathologists
3
in the United
Kingdom do not recommend FNA as the sole source of tissue samples for the diagnosis of lymphoma.
Fine-Needle Aspirate for the Evaluation of Suspected Lymphoma 2

REFERENCES SUMMARIZED
Health Technology Assessments
No literature identified.
Systematic Reviews and Meta-analyses
1. Frederiksen JK, Sharma M, Casulo C, Burack R. Systematic review of the effectiveness of fine-needle aspiration and/or core needle biopsy for subclassifying lymphoma, Arch Pathol
Lab Med [Internet]. 2015 [cited 2015 Mar 30];139:245 –251. Available from: http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2013-0674-RA
Randomized Controlled Trials
No literature identified.
Guidelines and Recommendations
2. Alberta Provincial Hematology Tumour Team. Lymphoma [Internet]. Edmonton (AB):
Alberta health Services; 2014 [cited 2015 Mar 30]. (Clinical practice guideline LYHE-002,
Version 8). Available from: http://www.albertahealthservices.ca/hp/if-hp-cancer-guidelyhe002-lymphoma.pdf
See: Diagnosis and Pathologic Classification, page 4
3. Parker A, Bain B, Devereux S, Gatter K, Jack A, Matutes E et al. Best practice in
Lymphoma diagnosis and reporting [Internet]. London (UK): British Committee for
Standards in Haematology and the Royal College of Pathologists; 2010 [cited 2015 Mar
30]. Available from: http://www.bcshguidelines.com/documents/Lymphoma_diagnosis_bcsh_042010.pdf
See: Recommendations, page 8
PREPARED BY:
Canadian Agency for Drugs and Technologies in Health
Tel: 1-866-898-8439 www.cadth.ca
Fine-Needle Aspirate for the Evaluation of Suspected Lymphoma 3

APPENDIX – FURTHER INFORMATION:
Guidelines and Recommendations – Unclear Methodology
4. ESMO Guidelines Working Group. Newly diagnosed and relapsed follicular lymphoma:
ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of
Oncology [Internet]. 2010 [cited 2015 Mar 30]; 21 (Supplement 5): v181 –v183. Available from: http://annonc.oxfordjournals.org/content/21/suppl_5/v181.full.pdf+html
See: Diagnosis, page v181
Review Articles
5. Health Quality Ontario. The accuracy of fine-needle aspiration cytology in the diagnosis of lymphoma [Internet]. Toronto (ON): Health Quality Ontario; 2014 Oct [cited 2015 Mar 30].
Available from: http://www.hqontario.ca/Portals/0/documents/eds/report-cwc-lymphoma-1410-en.pdf
6. Stein SA, Wartofsky L. Primary thyroid lymphoma: a clinical review. J Clin Endocrinol
Metab.
2013 Aug;98(8):3131-8.
PubMed: PM23714679
Fine-Needle Aspirate for the Evaluation of Suspected Lymphoma 4