Diagnosis of lymphoma by fine-needle aspiration cytology using the revised European-American classification of lymphoid neoplasms

[The following is the letter sent by the corresponding authors to William J. Frable, Principal Editor] We have with interest read the article by Drs. Young and Al-Saleem in Cancer Cytopathology regarding use of the revised European–American classification of lymphoid neoplasms.1 As you are well aware, their conclusions are in excellent agreement with our concept regarding the use of fine-needle aspiration cytology (FNAC) and immunocytochemistry in the diagnosis of lymphomas. However, we strongly object to the authors' claim of reviewing the English literature. There are no references to the pioneer studies by Lewitt et al.,2 Oertel and Oertel,3 and Tani et al.4 The lack of these references is completely unacceptable. We also were unable to find references to any of our 21 published articles and 3 textbook chapters published within this field during the last 10–12 years (see enclosed suggested reading list). However, there are several articles from North American authors, which may give the false impression that the art of FNAC in the diagnosis of lymphoma originated and was promoted in the U.S. It is our opinion that such a prestigious journal as Cancer Cytopathology should respond in one way or another to this type of inappropriate referencing. We are fully aware of the difficulties in selecting appropriate references when publishing an article. However, it must be in the interest of the cytologic community that credit is given to the major contributors to the field. This also will lead to an improved citation index for all journals in the field. We have noticed that other cytology journals have similar problems in many of their articles with poorly representative reference lists. The reason we have reacted to this particular case is that we believe the article by Young and Al-Saleem is such a flagrant example of inadequate reference citation. We look forward to your comments, preferably in the form of an Editorial in Cancer Cytopathology. [The following is a letter sent by the corresponding authors to Drs. Young and Al-Saleem] We would like to congratulate you on your recent article in Cancer Cytopathology, which is a very important contribution toward promoting the use of fine-needle aspiration cytology (FNAC) in conjunction with immunocytochemistry to diagnose lymphomas. We fully agree that the revised European–American classification of lymphoid neoplasms (REAL classification) allows for the conclusive cytologic diagnosis of nearly all entities of lymphoma in a way that was not conceivable with the Working Formula. As you most likely are well aware, the Kiel classification also was based on mainly cytologic features, but some diagnoses also included histologic features. This may be one reason why FNAC has been more widely accepted in Europe compared with the U.S. Hopefully there will, in the future, be a more open attitude toward the role of FNAC in the diagnosis of lymphomas. At the Karolinska Hospital, the majority of patients with lymphomas are not only diagnosed based on FNAC material but also are treated based on this diagnosis. Histologic confirmation is not mandatory but in some patients lymph nodes are excised for research purposes. In the “Methods” section in the Abstract, you state that you performed a review of the literature regarding the use of FNAC in the cytodiagnosis of lymphoma. However, to our surprise, we were unable to find some of the pioneering work in this area cited in your reference list. Thus, we believe it would have been appropriate to refer to the studies by Levitt et al.,2 Oertel et al.,3 and Tani et al.,4 which all, many years ago, described the usefulness of immunocytochemistry as an aid to cytology in the diagnosis of lymphoma. Moreover, we ourselves have published 21 articles and 3 textbook chapters (see suggested reading list), yet none can be found in your reference list. For us, this is not only surprising but also extremely disappointing. We believe that your article could have been an even more valuable contribution with as complete a reference list as was indicated in your Abstract. Lambert Skoog M.D., Ph.D.*, Edneia Tani M.D., Ph.D.*, * Division of Clinical Cytology, Department of Pathology, and Cytology, Karolinska Institute, and Hospital, Stockholm, Sweden