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Singh A, Patil J, Ghogale SG, Deshpande N, Girase K, Shetye N, Rajpal S, Chatterjee G, Patkar N, Jain D, Epari S, Shet T, Gujral S, Subramanian PG, Tembhare PR. Utility of leukocyte-associated immunoglobulin-like receptor-1 (CD305) in flow cytometric detection of minimal bone marrow involvement by B-cell non-Hodgkin lymphoma. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2024; 106:359-369. [PMID: 39031805 DOI: 10.1002/cyto.b.22193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
Abstract
Multicolor flow cytometry (MFC) is crucial in detecting occult or minimal bone marrow (BM) involvement by non-Hodgkin lymphomas (NHL), which may not be detected using trephine biopsy or imaging studies. Detection of low-level BM involvement can be challenging without definite immunophenotypic aberrancies. We studied the utility of CD305 in MFC detection of minimal BM involvement by B-NHL, especially in the absence of aberrancies by commonly used markers. The study included 1084 consecutive BM samples submitted for the staging of B-NHLs (excluding CLL) over two years. Samples were studied for morphological, immunophenotypic, and histopathological assessment. MFC studies were performed using 10-13 color MFC, including CD305-antibody (clone, DX26). Minimal BM involvement was defined with a cutoff of ≤10% lymphoma cells in viable cells on MFC assessment. Of 1084, 148 samples revealed overt morphological involvement by B-NHL and were excluded from analysis. BM samples of 172/936 patients were morphologically negative but revealed involvement using MFC independently. Corresponding trephine biopsy involvement was detected in only 79/172 (45.9%) patients. On MFC, 23/172 samples showed BM involvement with >10% lymphoma cells, and 149/172 (86.6%) samples revealed minimal involvement. In 54/149 (36.24%) samples, lymphoma cells were detected only with aberrant loss of CD305 expression. In 78 of the remaining 95 samples (82.1%), it provided an immunophenotypic aberrancy addition to other markers and supported the results. CD305 is a highly useful marker in the flow cytometric assessment of minimal BM involvement by B-NHL. MFC is a superior modality to trephine biopsy in detecting low-level BM involvement.
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Affiliation(s)
- Anu Singh
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Jagruti Patil
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Sitaram G Ghogale
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Nilesh Deshpande
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Karishma Girase
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Navami Shetye
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Sweta Rajpal
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Gaurav Chatterjee
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Disha Jain
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, Maharashtra, India
| | - Papagudi G Subramanian
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Prashant R Tembhare
- Hematopathology Department, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
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Ramalingam TR, Muthu A, Lakshmanan A, Narla S, Subramanyan A, Simon S, Govindaraj J, Vaidhyanathan L, Easow J, Raja T. Role of high acquisition flow cytometry in the detection of marrow involvement in patients with extramedullary B cell non-Hodgkins lymphoma: a comparison with marrow aspirate cytology, trephine biopsy, and PET. Leuk Lymphoma 2022; 63:2589-2596. [DOI: 10.1080/10428194.2022.2092858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Anurekha Muthu
- Department of Hematology, Apollo Cancer Centre, Chennai, India
| | | | - Swetha Narla
- Department of Histopathology, Apollo Cancer Centre, Chennai, India
| | | | - Shelley Simon
- Department of Nuclear Medicine, Apollo Cancer Centre, Chennai, India
| | | | | | - Jose Easow
- Department of Medical Oncology, Blood and Marrow Transplantation, Apollo Cancer Centre, Chennai, India
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Tembhare PR, Chatterjee G, Chaturvedi A, Dasgupta N, Khanka T, Verma S, Ghogale SG, Deshpande N, Girase K, Sengar M, Bagal B, Jain H, Shetty D, Rajpal S, Patkar N, Agrawal T, Epari S, Shet T, Subramanian PG, Gujral S. Critical Role of Flow Cytometric Immunophenotyping in the Diagnosis, Subtyping, and Staging of T-Cell/NK-Cell Non-Hodgkin's Lymphoma in Real-World Practice: A Study of 232 Cases From a Tertiary Cancer Center in India. Front Oncol 2022; 12:779230. [PMID: 35299754 PMCID: PMC8923658 DOI: 10.3389/fonc.2022.779230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/26/2022] [Indexed: 01/18/2023] Open
Abstract
Background T-cell/NK-cell non-Hodgkin’s lymphoma (T/NK-NHL) is an uncommon heterogeneous group of diseases. The current classification of T/NK-NHL is mainly based on histopathology and immunohistochemistry. In practice, however, the lack of unique histopathological patterns, overlapping cytomorphology, immunophenotypic complexity, inadequate panels, and diverse clinical presentations pose a great challenge. Flow cytometric immunophenotyping (FCI) is a gold standard for the diagnosis, subtyping, and monitoring of many hematological neoplasms. However, studies emphasizing the role of FCI in the diagnosis and staging of T/NK-NHL in real-world practice are scarce. Methods We included T-cell non-Hodgkin’s lymphoma (T-NHL) patients evaluated for the diagnosis and/or staging of T/NK-NHL using FCI between 2014 and 2020. We studied the utility of FCI in the diagnosis and subtyping of T/NK-NHL and correlated the FCI findings with the results of histopathology/immunohistochemistry. For correlation purposes, patients were categorized under definitive diagnosis and subtyping, inadequate subtyping, inadequate diagnosis, and misdiagnosis based on the findings of each technique. Results A total of 232 patients were diagnosed with T/NK-NHL. FCI findings provided definitive diagnoses in 198 patients and subtyping in 187/198 (95.45%) patients. The correlation between FCI and histopathological/immunohistochemistry results (n = 150) demonstrated an agreement on the diagnosis and subtyping in 69/150 (46%) patients. Of the remaining cases, the diagnosis and subtyping were inadequate in 64/150 (42.7%), and 14/150 (9.33%) were misdiagnosed on histopathology/immunohistochemistry results. FCI provided definitive diagnosis and subtyping in 51/64 (79.7%) patients. Among these, 13 patients diagnosed with peripheral T-cell lymphoma not-otherwise-specified were reclassified (angioimmunoblastic T-cell lymphoma (AITL)-11 and prolymphocytic leukemia-2) on FCI. It corrected the diagnosis in 14 patients that were misdiagnosed (6 B-cell NHL (B-NHL), 3 Hodgkin’s lymphoma, 1 acute leukemia, and 1 subcutaneous panniculitis-like T-cell lymphoma) and misclassified (3 T-NHL) on histopathological results. AITL was the commonest T-NHL misclassified on histopathological results. FCI also confirmed the definite involvement in 7/83 (8.4%) and 27/83 (32.5%) bone marrow (BM) samples reported as suspicious and uninvolved, respectively, on histopathological evaluation. Conclusion AITL was the most frequently diagnosed T/NK-NHL in this study. FCI provided a distinct advantage in detecting BM involvement by T/NK-NHL, especially in patients with low-level involvement. Overall, our study concluded that FCI plays a critical role in the diagnosis, subtyping, and staging of T/NK-NHL in real-world practice.
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Affiliation(s)
- Prashant R Tembhare
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Anumeha Chaturvedi
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Niharika Dasgupta
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Twinkle Khanka
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Shefali Verma
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sitaram G Ghogale
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Karishma Girase
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sweta Rajpal
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nikhil Patkar
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Tushar Agrawal
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India.,Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
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Wang W, Li Y, Rivera Rivera X, Zhao L, Mei D, Hu W, Jiang B. Application of CD54 in diagnosing bone marrow involvement by using flow cytometry in patients with diffuse large B-cell lymphoma. BMC Cancer 2021; 21:1011. [PMID: 34503477 PMCID: PMC8431857 DOI: 10.1186/s12885-021-08753-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background Flow cytometry plays a key role in detecting bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL). To improve its detection sensitivity, we need to explore novel markers. In this study, we detected the expression CD54 on lymphoma cells in BM specimens from DLBCL patients and clarified its diagnostic significance in BM involvement by DLBCL. Methods We collected BM specimens from 76 patients with DLBCL (germinal center B-cell (GCB) = 25, non-GCB = 51) and 10 control patients without lymphoma. We detected and compared the expression of CD54 on lymphoma cells and normal mature B cells by using 10-color panels. Results Normal plasma cells expressed a higher level of CD54 as compared with hematogones (p < 0.05) and normal mature B cells (p < 0.05). Among 76 patients, 23 of them (GCB = 12, non-GCB = 11) had BM involvement. Lymphoma B cells from 12 cases (GBC = 4, non-GCB = 8) expressed a higher level of CD54 compared to normal mature B cells (p < 0.05). Additionally, lymphoma cells of the non-GCB subtype frequently expressed a higher level of CD54 in comparison to the GCB subtype (p < 0.05). And the high expression of CD54 was not related to plasmacytoid differentiation. Conclusion Aberrant expression of CD54 on lymphoma cells is frequently seen in patients’ BM specimens involved by DLBCL, especially in the non-GCB subtype. CD54 could be used as a new marker to gate on lymphoma cells and improve the detection sensitivity of BM involvement in patients with DLBCL. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08753-0.
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Affiliation(s)
- Wei Wang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Yan Li
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Xavier Rivera Rivera
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Linjun Zhao
- Department of Lymphoma, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Di Mei
- Department of Lymphoma, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Wenqing Hu
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Bin Jiang
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China.
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Cytofluorimetric and immunohistochemical comparison for detecting bone marrow infiltration in non-Hodgkin lymphomas: a study of 354 patients. Leuk Res 2020; 88:106267. [DOI: 10.1016/j.leukres.2019.106267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/01/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
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Merzianu M, Groman A, Hutson A, Cotta C, Brynes RK, Orazi A, Reddy V, Teruya-Feldstein J, Amre R, Balasubramanian M, Brandao G, Cherian S, Courville E, Czuchlewski D, Fan G, Grier D, Hoehn D, Inamdar KV, Juskevicius R, Kaur P, Lazarchick J, Lewis MR, Miles RR, Myers JB, Nasr MR, Qureishi HN, Olteanu H, Robu VG, Salaru G, Vajpayee N, Vos J, Zhang L, Zhang S, Aye L, Brega E, Coad JE, Grantham J, Ivelja S, McKenna R, Sultan K, Wilding G, Hutchison R, Peterson L, Cheney RT. Trends in Bone Marrow Sampling and Core Biopsy Specimen Adequacy in the United States and Canada: A Multicenter Study. Am J Clin Pathol 2018; 150:393-405. [PMID: 30052721 PMCID: PMC6166687 DOI: 10.1093/ajcp/aqy066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess bone marrow (BM) sampling in academic medical centers. METHODS Data from 6,374 BM samples obtained in 32 centers in 2001 and 2011, including core length (CL), were analyzed. RESULTS BM included a biopsy (BMB; 93%) specimen, aspirate (BMA; 92%) specimen, or both (83%). The median (SD) CL was 12 (8.5) mm, and evaluable marrow was 9 (7.6) mm. Tissue contraction due to processing was 15%. BMB specimens were longer in adults younger than 60 years, men, and bilateral, staging, and baseline samples. Only 4% of BMB and 2% of BMB/BMA samples were deemed inadequate for diagnosis. BM for plasma cell dyscrasias, nonphysician operators, and ancillary studies usage increased, while bilateral sampling decreased over the decade. BM-related quality assurance programs are infrequent. CONCLUSIONS CL is shorter than recommended and varies with patient age and sex, clinical circumstances, and center experience. While pathologists render diagnoses on most cases irrespective of CL, BMB yield improvement is desirable.
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Affiliation(s)
- Mihai Merzianu
- Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Adrienne Groman
- Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Alan Hutson
- Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Claudiu Cotta
- Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Attilio Orazi
- Pathology, Weill Cornell Medical College, New York, NY
| | | | | | - Ramila Amre
- Pathology, McGill University Health Centre , Royal Victoria Hospital, Montreal, Canada
| | | | - Guilherme Brandao
- Pathology, McGill University Jewish General Hospital, Montreal, Canada
| | | | | | | | - Guang Fan
- Pathology, Oregon Health and Science University, Portland
| | - David Grier
- Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Daniela Hoehn
- Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | | | - Ridas Juskevicius
- Pathology, East Carolina University Brody School of Medicine, Greenville, NC
| | - Prabhjot Kaur
- Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John Lazarchick
- Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston
| | - Michael R Lewis
- Pathology and Laboratory Medicine, University of Vermont, Burlington
| | | | - Jerome B Myers
- Pathology, Penrose Saint Francis Health Services, Colorado Springs, CO
| | | | - Hina N Qureishi
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha
| | | | | | - Gratian Salaru
- Clinical Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Neerja Vajpayee
- Pathology, State University of New York Upstate Medical University, Syracuse
| | - Jeffrey Vos
- Pathology, West Virginia University, Morgantown
| | - Ling Zhang
- Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Shanxiang Zhang
- Pathology and Laboratory Medicine, Indiana University, Indianapolis
| | - Le Aye
- Pathology, Keck School of Medicine of USC, Los Angeles
| | - Elisa Brega
- Pathology, McGill University Jewish General Hospital, Montreal, Canada
| | | | | | - Sinisa Ivelja
- Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Robert McKenna
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | | | - Gregory Wilding
- Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Robert Hutchison
- Pathology, State University of New York Upstate Medical University, Syracuse
| | | | - Richard T Cheney
- Pathology and Anatomical Sciences, University at Buffalo–The State University of New York
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Kim B, Lee ST, Kim HJ, Kim SH. Bone marrow flow cytometry in staging of patients with B-cell non-Hodgkin lymphoma. Ann Lab Med 2015; 35:187-93. [PMID: 25729719 PMCID: PMC4330167 DOI: 10.3343/alm.2015.35.2.187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/31/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
Background Bone marrow biopsies are routinely performed for staging patients with B-cell non-Hodgkin lymphoma (NHL). In addition to histomorphological studies, ancillary tools may be needed for accurate diagnosis. We investigated the clinical utility of multiparameter flow cytometric examination of bone marrow aspirates. Methods A total of 248 bone marrow specimens from 232 patients diagnosed with B-cell NHL were examined. Monoclonal antibodies directed against CD19, CD20, CD10 (or CD5), and κ and λ immunoglobulins were used. Multi-stage sequential gating was performed to select specific cells of interest, and the results were compared with bone marrow histology. Results The concordance rate between histomorphology and flow cytometry was 91.5% (n=227). Eight cases (3.2%) were detected by flow cytometry alone and were missed by histomorphology analysis, and 6 of these 8 cases showed minimal bone marrow involvement (0.09-2.2%). The diagnosis in these cases included large cell lymphoma (n=3), mantle cell lymphoma (n=3), and mucosa-associated lymphoid tissue (MALT) lymphoma (n=2). Thirteen cases were histopathologically positive and immunophenotypically negative, and the diagnoses in these cases included diffuse large cell lymphoma (n=7), T-cell/histiocyte-rich large B-cell lymphoma (n=2), anaplastic lymphoma kinase (ALK)-positive large B-cell lymphoma (n=1), follicular lymphoma (n=1), MALT lymphoma (n=1), and unclassifiable lymphoma (n=1). Conclusions Multi-color flow cytometry can be a useful method for assessing bone marrow in staging NHL and also plays a complementary role, especially in detecting small numbers of lymphoma cells.
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Affiliation(s)
- Borahm Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Berget E, Helgeland L, Liseth K, Løkeland T, Molven A, Vintermyr OK. Prognostic value of bone marrow involvement by clonal immunoglobulin gene rearrangements in follicular lymphoma. J Clin Pathol 2014; 67:1072-7. [PMID: 25233852 PMCID: PMC4251203 DOI: 10.1136/jclinpath-2014-202382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Aims We aimed to evaluate the prognostic value of routine use of PCR amplification of immunoglobulin gene rearrangements in bone marrow (BM) staging in patients with follicular lymphoma (FL). Methods Clonal rearrangements were assessed by immunoglobulin heavy and light-chain gene rearrangement analysis in BM aspirates from 96 patients diagnosed with FL and related to morphological detection of BM involvement in biopsies. In 71 patients, results were also compared with concurrent flow cytometry analysis. Results BM involvement was detected by PCR in 34.4% (33/96) of patients. The presence of clonal rearrangements by PCR was associated with advanced clinical stage (I–III vs IV; p<0.001), high FL International Prognostic Index (FLIPI) score (0–1, 2 vs ≥3; p=0.003), and detection of BM involvement by morphology and flow cytometry analysis (p<0.001 for both). PCR-positive patients had a significantly poorer survival than PCR-negative patients (p=0.001, log-rank test). Thirteen patients positive by PCR but without morphologically detectable BM involvement, had significantly poorer survival than patients with negative morphology and negative PCR result (p=0.002). The poor survival associated with BM involvement by PCR was independent of the FLIPI score (p=0.007, Cox regression). BM involvement by morphology or flow cytometry did not show a significant impact on survival. Conclusions Our results showed that routine use of PCR-based clonality analysis significantly improved the prognostic impact of BM staging in patients with FL. BM involvement by PCR was also an independent adverse prognostic factor.
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Affiliation(s)
- Ellen Berget
- The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Lars Helgeland
- The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Knut Liseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Turid Løkeland
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Anders Molven
- The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Olav Karsten Vintermyr
- The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Pathology, Haukeland University Hospital, Bergen, Norway
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Karnes HE, Frater JL. A quality improvement assessment of multiple, concurrent flow cytometry analyses at a tertiary care center. Int J Lab Hematol 2014; 37:90-7. [PMID: 24811935 DOI: 10.1111/ijlh.12244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/26/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The utility of flow cytometry (FC) in diagnosis and staging of hematologic malignancy is controversial. Often, multiple specimens from the same patient are processed concurrently for FC analyses, alongside tissue for histomorphologic diagnosis. METHODS To assess the diagnostic utility of multiple, concurrent FC analyses, a 10-year retrospective review of cases with ≥2 concurrent specimens (from the same patient) submitted for FC was conducted. Light microscopic (LM) diagnoses were compared to FC findings, and the contribution of FC results to final diagnoses was examined. RESULTS Of 4058 specimens (predominantly lymph nodes, bone marrows, and oropharyngeal tissues) submitted for FC analyses, 129 (3.2%) represented cases with multiple (average: 2.19) concurrent FC analyses. All were accompanied by tissues and/or aspirates for LM examination. In 115 (89.1%) cases, multiple FC analyses were performed prior to morphologic examination. In 87.0% of those cases, ≥1 FC result(s) aligned with LM findings. In 15 (13.0%) cases where FC results differed from morphologic diagnoses, 86.7% (13/15) failed to detect an abnormal cell population by FC in the presence of a hematologic malignancy by LM. In one case (0.9%), FC detected a lymphoma, without morphologic evidence by LM. CONCLUSIONS Overall, multipart FC failed to demonstrate a significant contribution in initial diagnoses of hematologic malignancies compared with analysis of a single specimen.
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Affiliation(s)
- H E Karnes
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Nelson BP, Abdul-Nabi A, Goolsby C, Winter J, Peterson L. Characterization of tissue findings in bone marrow biopsy specimens with small monoclonal B-cell populations. Am J Clin Pathol 2014; 141:687-96. [PMID: 24713740 DOI: 10.1309/ajcpd5tobdju4gko] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Bone marrows (BMs) with incidentally identified, small monotypic B-cell populations (MBPs) were evaluated. METHODS BM aspirates with MBPs representing 5% or less of total events by flow cytometry, less than 5.0 × 10(9)/L B cells in blood, and no history of lymphoma or MBP with a different phenotype from prior lymphoma were selected. Clinical, immunophenotypic, and histologic findings were evaluated. RESULTS Forty-one of 3,052 BMs had MBPs at 5% or less of total events (median, 1%); 17 were females and 24 were males aged 30 to 87 years (median, 73 years). The MBPs were CD5- in 24, CD5+ resembling chronic lymphocytic leukemia (CLL) in 13, and CD5+ unlike CLL in four. Eighteen of 40 had lymphoid aggregates (LAs) with mostly T cells or a mixture of B and T cells, but three cases had B-cell-rich LAs. CONCLUSIONS Unlike monoclonal B lymphocytosis in blood, MBPs in BMs were more commonly CD5-. Forty-five percent of BMs had LAs; none were interpreted as lymphoma, although three were suspicious for B-cell lymphoma.
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Affiliation(s)
| | | | - Charles Goolsby
- Department of Pathology, Feinberg Medical School, Chicago, IL
| | - Jane Winter
- Department of Medicine, Division of Hematology Oncology, Northwestern University, Feinberg Medical School, Chicago, IL
| | - LoAnn Peterson
- Department of Pathology, Feinberg Medical School, Chicago, IL
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11
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Wolach O, Fraser A, Luchiansky M, Shapiro C, Radnay J, Shpilberg O, Lishner M, Lahav M. Can flow cytometry of bone marrow aspirate predict outcome of patients with diffuse large B cell lymphoma? A retrospective single centre study. Hematol Oncol 2014; 33:42-7. [DOI: 10.1002/hon.2127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Ofir Wolach
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital; Rabin Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Abigail Fraser
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol and School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Michael Luchiansky
- Department of Medicine; Rabin Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Chava Shapiro
- Department of Medicine; Meir Medical Center; Kfar Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Judith Radnay
- Department of Medicine; Meir Medical Center; Kfar Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ofer Shpilberg
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Lishner
- Department of Medicine; Meir Medical Center; Kfar Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Meir Lahav
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital; Rabin Medical Center; Petah Tikva Israel
- Department of Medicine; Rabin Medical Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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12
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Joetzke AE, Eberle N, Nolte I, Mischke R, Simon D. Flow cytometric evaluation of peripheral blood and bone marrow and fine-needle aspirate samples from multiple sites in dogs with multicentric lymphoma. Am J Vet Res 2012; 73:884-93. [PMID: 22620704 DOI: 10.2460/ajvr.73.6.884] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether the extent of disease in dogs with lymphoma can be assessed via flow cytometry and to evaluate the suitability of fine-needle aspirates from the liver and spleen of dogs for flow cytometric examination. ANIMALS 44 dogs with multicentric B-cell (n = 35) or T-cell lymphoma (9) and 5 healthy control dogs. Procedures-Peripheral blood and bone marrow samples and fine-needle aspirates of lymph node, liver, and spleen were examined via flow cytometry. Logarithmically transformed T-cell-to-B-cell percentage ratio (log[T:B]) values were calculated. Thresholds defined by use of log(T:B) values of samples from control dogs were used to determine extranodal lymphoma involvement in lymphoma-affected dogs; results were compared with cytologic findings. RESULTS 12 of 245 (5%) samples (9 liver, 1 spleen, and 2 bone marrow) had insufficient cellularity for flow cytometric evaluation. Mean log(T:B) values of samples from dogs with B-cell lymphoma were significantly lower than those of samples from the same site in dogs with T-cell lymphoma and in control dogs. In dogs with T-cell lymphoma, the log(T:B) of lymph node, bone marrow, and spleen samples was significantly higher than in control dogs. Of 165 samples assessed for extranodal lymphoma involvement, 116 (70%) tested positive via flow cytometric analysis; results agreed with cytologic findings in 133 of 161 (83%) samples evaluated via both methods. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that flow cytometry may aid in detection of extranodal lymphoma involvement in dogs, but further research is needed. Most fine-needle aspirates of liver and spleen were suitable for flow cytometric evaluation.
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Affiliation(s)
- Alexa E Joetzke
- Small Animal Hospital, University of Veterinary Medicine Hannover, 30559 Hannover, Germany.
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13
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Palmeira C, Sousa ME, Godinho I, Pires AM, Mendes C, Martins G. Flow cytometry CD45-negative B-NHL: a case report of a diffuse large B-cell lymphoma without extranodal involvement. CYTOMETRY PART B-CLINICAL CYTOMETRY 2012; 82:369-71. [PMID: 22961721 DOI: 10.1002/cyto.b.21038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND The loss of CD45, the leukocyte-common antigen, has been described in rare cases of large B-cell lymphoma (LBCL) subtypes with extranodal involvement by immunohistochemical methods. Here we report a case of a patient with LBCL, with no extranodal lesions, which is CD45 negative by flow cytometry (FC) immunophenotyping. METHODS Immunophenotyping and DNA content analysis was performed by multiparametric FC on lymph node and bone marrow aspirate obtained from a 65 year old male patient. RESULTS Malignant B-lymphocytes were CD5-, CD10+/++, CD11c-, CD19+, CD20+/++, CD23-, CD34-, CD38-/+, CD45-, CD79b++/+++, BCL2 overexpressed, FMC7++, IgM++/+++, TdT- with Lambda light chain restriction. This pathological cellular population showed near-diploid DNA content, with a high proliferate rate. CONCLUSIONS To our knowledge, we describe the first case of a CD19+ B-cell non-Hodgkin lymphoma without expression of CD45 detected by FC, and the first case without extranodal involvement presentation. This case is reported not only because it is a rare one but also to raise awareness of FC users of its correct diagnosis.
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Affiliation(s)
- Carlos Palmeira
- Flow Cytometry Laboratory, Department of Hematology, IPO-Porto, Porto, Portugal.
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14
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Merli M, Arcaini L, Boveri E, Rattotti S, Picone C, Passamonti F, Tenore A, Sozzani L, Lucioni M, Varettoni M, Rizzi S, Morello L, Ferretti V, Pascutto C, Paulli M, Lazzarino M. Assessment of bone marrow involvement in non-Hodgkin’s lymphomas: comparison between histology and flow cytometry. Eur J Haematol 2010; 85:405-15. [DOI: 10.1111/j.1600-0609.2010.01503.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Flowcytometric immunophenotyping in the diagnosis of pediatric lymphoma: how reliable is it and how can we optimize its use? J Pediatr Hematol Oncol 2010; 32:298-303. [PMID: 20224437 DOI: 10.1097/mph.0b013e3181ca86f5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to evaluate the role of flowcytometric immunophenotyping (FCI) as an adjunct to histologic examination in pediatric lymphoma. We conducted a retrospective review of 39 fresh tissue samples and 2 pleural fluids submitted to the histopathology department with a clinical suspicion of lymphoma during a 4-year period, where FCI was performed. The FCI results were correlated with the final histologic diagnosis. The study comprised 38 lymphoid lesions and 3 nonlymphoid tumors. The concordance of FCI for all lesions was 71% and that for non-Hodgkin lymphoma was 75%. When Hodgkin lymphoma was excluded, the correlation was 93.1%. In 3 cases of nonhematologic tumors, FCI was useful in excluding a lymphoma. In one of them, FCI supported the diagnosis of neuroblastoma when CD81, CD9, GD2, and CD56 were added to the FCI panel. FCI produced rapid same-day results with a high sensitivity for benign lymphoid lesions and non-Hodgkin lymphoma. It was not helpful for Hodgkin lymphoma. Although the main application of FCI was to assess lymphoid lesions, it was also useful in the identification of nonlymphoid tumors, especially neuroblastoma. As the prevalence of lymphomas in children differ from that in adults, we believe that the algorithm proposed by us to triage specimens using imprint cytology can optimize the use of FCI in routine pediatric pathology practice.
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16
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Talaulikar D, Shadbolt B, Dahlstrom JE, McDonald A. Routine use of ancillary investigations in staging diffuse large B-cell lymphoma improves the International Prognostic Index (IPI). J Hematol Oncol 2009; 2:49. [PMID: 19930611 PMCID: PMC2786909 DOI: 10.1186/1756-8722-2-49] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 11/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Prognostic Index (IPI) is used to determine prognosis in diffuse large B-cell lymphoma (DLBCL). One of the determinants of IPI is the stage of disease with bone marrow involvement being classified as stage IV. For the IPI, involvement on bone marrow is traditionally defined on the basis of histology with ancillary investigations used only in difficult cases to aid histological diagnosis. This study aimed to determine the effect of the routine use of flow cytometry, immunohistochemistry and molecular studies in bone marrow staging upon the IPI. RESULTS Bone marrow trephines of 156 histologically proven DLBCL cases at initial diagnosis were assessed on routine histology, and immunohistochemistry using two T-cell markers (CD45RO and CD3), two B-cell markers (CD20 and CD79a) and kappa and lambda light chains. Raw flow cytometry data on all samples were reanalysed and reinterpreted blindly. DNA extracted from archived paraffin-embedded trephine biopsy samples was used for immunoglobulin heavy chain and light chain gene rearrangement analysis. Using immunophenotyping (flow cytometry and immunohistochemistry), 30 (19.2%) cases were upstaged to stage IV. A further 8 (5.1%) cases were upstaged using molecular studies. A change in IPI was noted in 18 cases (11.5%) on immunophenotyping alone, and 22 (14.1%) cases on immunophenotyping and molecular testing. Comparison of two revised IPI models, 1) using immunophenotyping alone, and 2) using immunophenotyping with molecular studies, was performed with baseline IPI using a Cox regression model. It showed that the revised IPI model using immunophenotyping provides the best differentiation between the IPI categories. CONCLUSION Improved bone marrow staging using flow cytometry and immunohistochemistry improves the predictive value of the IPI in patients with DLBCL and should be performed routinely in all cases.
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Affiliation(s)
- Dipti Talaulikar
- Department of Haematology, The Canberra Hospital, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
- Australian National University Medical School, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
| | - Bruce Shadbolt
- Australian National University Medical School, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
- Department of Epidemiology, The Canberra Hospital, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
| | - Jane E Dahlstrom
- Australian National University Medical School, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
- Department of Anatomical Pathology, The Canberra Hospital, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
| | - Anne McDonald
- National Capital Private Hospital, Yamba Drive, Garran, Canberra, ACT, 2605, Australia
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17
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Talaulikar D, Dahlstrom JE. Staging bone marrow in diffuse large B-cell lymphoma: the role of ancillary investigations. Pathology 2009; 41:214-22. [PMID: 19291532 DOI: 10.1080/00313020902756295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin's lymphoma (NHL) that requires treatment at initial diagnosis. Treatment decisions may be guided by staging investigations, which include assessment of bone marrow (BM). Traditionally this assessment has included light microscopic examination of the bone marrow aspirate and trephine biopsy. Ancillary testing--including immunophenotyping using flow cytometry on BM aspirates, immunohistochemistry (IHC) on BM trephines and molecular studies using immunoglobulin heavy (IgH) or light (IgL) chain gene rearrangements--are performed as required to aid histological diagnosis. This review examines the evidence for the routine use of ancillary tests in the initial staging of DLBCL, including the limitations, potential pitfalls and possible clinical implications of their use in this setting.
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Affiliation(s)
- Dipti Talaulikar
- Department of Haematology, The Canberra Hospital, Canberra, Australia.
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18
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Schmidt B, Kremer M, Götze K, John K, Peschel C, Höfler H, Fend F. Bone marrow involvement in follicular lymphoma: Comparison of histology and flow cytometry as staging procedures. Leuk Lymphoma 2009; 47:1857-62. [PMID: 17064998 DOI: 10.1080/10428190600709127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Bone marrow (BM) examination is a routine staging procedure in follicular lymphoma (FL). Commonly, both BM histology as well as flow cytometry (FCM) of BM aspirates are performed. In order to compare the diagnostic value of these two techniques, we retrospectively evaluated trephine BM biopsies and listmode data of patients with a confirmed diagnosis of FL, obtained in parallel during a 5-year period. One hundred and thirty nine specimens from 91 patients with FL were eligible for analysis. After joint review, nine cases (6.5%) were reclassified, either in histology (six cases) or FCM (three cases). Seventy nine specimens (57%) showed no infiltration with both methods. Sixty specimens (43%) were scored positive for BM involvement by any of the two techniques. Concordant positive results were obtained in 41 cases (68% of positive BM). False negative results were obtained by FCM in 14 cases (23% of positive BM) and by histology in five cases (8%). Discrepant results between BM histology and FCM are frequent in patients with FL, most likely due to the predominantly paratrabecular infiltration and fibrosis typical for FL. Due to the lower false negative rate, trephine BM biopsy remains crucial for the detection of BM involvement in FL.
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Affiliation(s)
- Burkhard Schmidt
- Department of Hematology and Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
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19
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Davis BH, Holden JT, Bene MC, Borowitz MJ, Braylan RC, Cornfield D, Gorczyca W, Lee R, Maiese R, Orfao A, Wells D, Wood BL, Stetler-Stevenson M. 2006 Bethesda International Consensus recommendations on the flow cytometric immunophenotypic analysis of hematolymphoid neoplasia: medical indications. CYTOMETRY PART B-CLINICAL CYTOMETRY 2008; 72 Suppl 1:S5-13. [PMID: 17803188 DOI: 10.1002/cyto.b.20365] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The clinical indications for diagnostic flow cytometry studies are an evolving consensus, as the knowledge of antigenic definition of hematolymphoid malignancies and the prognostic significance of antigen expression evolves. Additionally the standard of care is not routinely communicated to practicing clinicians and diagnostic services, especially as may relate to new technologies. Accordingly there is often uncertainty on the part of clinicians, payers of medical services, diagnostic physicians and scientists as to the appropriate use of diagnostic flow cytometry. In an attempt to communicate contemporary diagnostic utility of immunophenotypic flow cytometry in the diagnosis and follow-up of patients with hematolymphoid malignancies, the Clinical Cytometry Society organized a two day meeting of international experts in this area to reach a consensus as to this diagnostic tool. This report summarizes the appropriate use of diagnostic flow cytometry as determined by unanimous approval of these experienced practitioners.
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Affiliation(s)
- B H Davis
- Trillium Diagnostics, Brewer, Maine, USA.
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20
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Talaulikar D, Dahlstrom JE, Shadbolt B, McNiven M, Broomfield A, Pidcock M. Occult bone marrow involvement in patients with diffuse large B-cell lymphoma: results of a pilot study. Pathology 2007; 39:580-5. [DOI: 10.1080/00313020701684417] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Iancu D, Hao S, Lin P, Anderson SK, Jorgensen JL, McLaughlin P, Medeiros LJ. Follicular Lymphoma in Staging Bone Marrow Specimens: Correlation of Histologic Findings With the Results of Flow Cytometry Immunophenotypic Analysis. Arch Pathol Lab Med 2007; 131:282-7. [PMID: 17284114 DOI: 10.5858/2007-131-282-flisbm] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Bone marrow (BM) examination is part of the staging workup of lymphoma patients. Few studies have compared BM histologic findings with results of flow cytometric immunophenotyping analysis in follicular lymphoma (FL) patients.
Objective.—To correlate histologic findings with immunophenotypic data in staging BM biopsy and aspiration specimens of FL patients.
Design.—Bone marrow biopsy specimens of untreated FL patients were reviewed. Histologic findings were correlated with 3-color flow cytometric immunophenotyping results on corresponding BM aspirates.
Results.—Bone marrow biopsy specimens (with or without aspirates) of 114 patients with histologic evidence of FL in BM were reviewed. There were 76 bilateral and 38 unilateral biopsies performed, resulting in 190 specimens: 187 involved by FL and 3 negative (in patients with a positive contralateral specimen). The extent of BM involvement was <5% in 32 (17.1%), ≥5% and ≤25% in 102 (54.6%), >25% and ≤50% in 27 (14.4%), and >50% in 26 (13.9%) specimens. The pattern of involvement was purely paratrabecular in 81 (43.3%), mixed in 80 (42.8%), and purely nonparatrabecular in 26 (13.9%). Immunophenotyping was only performed unilaterally, on BM aspirates of 92 patients, and was positive for a monoclonal B-cell population in 53 (57.6%) patients. Immunophenotyping was more often negative when biopsy specimens showed FL with a purely paratrabecular pattern. For comparison, we assessed 163 FL patients without histologic evidence of FL in BM also analyzed by flow cytometric immunophenotyping. A monoclonal B-cell population was identified in 5 patients (3%).
Conclusions.—Our data suggest that 3-color flow cytometric immunophenotyping adds little information to the evaluation of staging BM specimens of FL patients.
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Affiliation(s)
- Dan Iancu
- Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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22
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Kaleem Z. Flow cytometric analysis of lymphomas: current status and usefulness. Arch Pathol Lab Med 2006; 130:1850-8. [PMID: 17149963 DOI: 10.5858/2006-130-1850-fcaolc] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT Immunophenotyping has become a routine practice in the diagnosis and classification of most cases of non-Hodgkin lymphoma, and flow cytometry is often the method of choice in many laboratories. The role that flow cytometry plays, however, extends beyond just diagnosis and classification. OBJECTIVE To review and evaluate the current roles of flow cytometry in non-Hodgkin lymphoma, to compare it with immunohistochemistry, and to discuss its potential future applications in the molecular diagnostic era. DATA SOURCES The information contained herein is derived from peer-reviewed articles on the subject published in the English-language medical literature during the years 1980 to 2005 that were identified using PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi, 1980-2005) search, various books and other sources on flow cytometry, and the author's personal experience of more than 10 years with flow cytometric analysis of lymphomas and leukemia using Becton-Dickinson (San Jose, Calif) and Beckman-Coulter (Miami, Fla) flow cytometers. STUDY SELECTION Studies were selected based on adequate material and methods, statistically significant results, and adequate clinical follow-up. DATA EXTRACTION The data from various sources were compared when the methods used were the same or similar and appropriate controls were included. Most of the studies employed 2-color, 3-color, or 4-color flow cytometers with antibodies from Becton-Dickinson, Beckman-Coulter, or DakoCytomation (Carpinteria, Calif). Results were evaluated from studies utilizing the same or similar techniques and flow cytometers. Only objective data analyses from relevant and useful publications were included for reporting and discussion. DATA SYNTHESIS Flow cytometry serves a variety of roles in the field of lymphoma/leukemia including rapid diagnosis, proper classification, staging, minimal residual disease detection, central nervous system lymphoma detection, evaluation of prognostic markers, detection of target molecules for therapies, ploidy analysis of lymphoma cell DNA, and evaluation of multidrug-resistance markers. It offers many advantages in comparison to immunohistochemistry for the same roles and provides uses that are either not possible or not preferable by immunohistochemistry such as multiparameter evaluation of single cells and detection of clonality in T cells. CONCLUSIONS By virtue of its ability to evaluate not only surface but also cytoplasmic and nuclear antigens, flow cytometry continues to enjoy widespread use in various capacities in lymphoma evaluation and treatment. Additional roles for flow cytometry are likely to be invented in the future and should provide distinctive uses in the molecular era.
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Affiliation(s)
- Zahid Kaleem
- Pathology & Laboratory Research Medical Center, Kansas City, MO, USA.
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23
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Stacchini A, Demurtas A, Godio L, Martini G, Antinoro V, Palestro G. Flow cytometry in the bone marrow staging of mature B-cell neoplasms. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2003; 54:10-8. [PMID: 12827663 DOI: 10.1002/cyto.b.10023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Even though flow cytometric (FC) analysis of bone marrow aspirates is often performed in hematolymphoid disorders at diagnosis and during disease monitoring, its role has not been defined during the staging of B-non-Hodgkin's lymphoma (B-NHL) and B-cell lymphoproliferative diseases. The goal of this study was to provide an objective evaluation of how FC might help in the detection of bone marrow involvement by the different types of B-cell malignant neoplasms. METHODS Fifty-four staging and 156 restaging bone marrow biopsies and bone marrow aspirates, obtained from 185 consecutive patients, were analyzed retrospectively. The results of the morphologic examination and FC were reviewed independently, and their ability to detect bone marrow involvement was compared. RESULTS FC and morphology agreed in 176 cases (83.8%), i.e., both showed 77 positive cases and 99 negative ones. Discrepant results were obtained in 30 cases (14.2%) in which morphologic examination showed 25 (11.9%) positive cases, whereas FC showed no evidence of disease. FC detected involvement in five cases (2.4%) in the presence of a histologically negative bone marrow biopsy. All morphologically undetermined bone marrow cases (four) were negative by FC. CONCLUSIONS Neither morphologic examination nor FC alone is adequate for the detection of all cases of B-lymphoid neoplasm bone marrow involvement. FC failed to detect bone marrow involvement in those B-NHL cases having focal paratrabecular infiltration, but proved to be more sensitive than histology in detecting small clonal B-cells in B-NHL, which demonstrated fewer than 5% neoplastic infiltrates. The clinical relevance of minimal disease detected by FC alone needs further evaluation because staging of lymphomas currently is based only on morphologic data.
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Affiliation(s)
- A Stacchini
- Flow Cytometry Unit, Molinette Hospital, Turin, Italy.
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Kawano-Yamamoto C, Muroi K, Izumi T, Saito K, Ozawa K. Two-color flow cytometry with a CD19 gate for the evaluation of bone marrow involvement of B-cell lymphoma. Leuk Lymphoma 2002; 43:2133-7. [PMID: 12533038 DOI: 10.1080/1042819021000033051] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The usefulness of two-color flow cytometry with a CD19 gate (CD19-FCM) for detecting clonal B-cells in the bone marrow was evaluated. Since kappa and lambda ratios analyzed in the bone marrow from healthy adults were within the range of 0.5-3.0, outside of this range was regarded as the existence of clonal B-cells. Mixing experiments in vitro showed that 10% or more of clonal B-cells contaminating normal bone marrow cells could be detected using CD19-FCM. Ninety-nine bone marrow samples from 60 patients with B-cell lymphoma were simultaneously analyzed using CD19-FCM and histologic examination of both bone marrow aspiration and core needle biopsy samples. The agreement of results obtained by both examinations was 82% (81/99). Discrepant results were found in 18 samples of 10 patients. All except one sample were positive for CD19-FCM analysis but negative for histologic examination and the conversion of CD19-FCM-positivity to CD19-FCM-negativity was associated with chemotherapy. These results suggest that CD19-FCM is useful for the evaluation of bone marrow involvement of B-cell lymphoma.
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Affiliation(s)
- Chizuru Kawano-Yamamoto
- Division of Cell Transplantation and Transfusion, Jichi Medical School, Minamikawachi, Tochigi 329-0498, Japan.
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Wang J, Weiss LM, Chang KL, Slovak ML, Gaal K, Forman SJ, Arber DA. Diagnostic utility of bilateral bone marrow examination: significance of morphologic and ancillary technique study in malignancy. Cancer 2002; 94:1522-31. [PMID: 11920510 DOI: 10.1002/cncr.10364] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND To retrospectively evaluate the significance of morphologic examination and ancillary studies performed on bilateral bone marrow biopsy specimens, 1864 bone marrow samples were studied. METHODS Bilateral bone marrow biopsy specimens included 883 specimens that were evaluated for involvement by non-Hodgkin lymphoma (NHL); 381 specimens that were evaluated for involvement by carcinoma (CA); 362 specimens that were evaluated for involvement by Hodgkin disease (HD); 94 specimens that were evaluated for involvement by sarcoma (SA); 56 specimens that were evaluated for involvement by multiple myeloma (MM); 53 specimens that were evaluated for involvement by acute and chronic leukemia, myelodysplasia, and/or myeloproliferative disorders (LEUK); and 35 specimens that were evaluated for other reasons. RESULTS Of all 1864 specimens, 410 samples (22.0%) were positive for disease, including 77% of MM samples, 58% of LEUK samples, 29.6% of NHL samples, 14% of SA samples, 9.9% of HD samples, and 6.8% of CA samples. A discrepancy between the left and right sides was identified in 48 specimens (11.7% of positive samples). The discrepancy rate was 39% for HD samples, 29% for SA samples, 23% for CA samples, and 9.2% for NHL samples. No morphologic discrepancies between bilateral samples were found in MM samples or LEUK samples. Bilateral flow cytometric studies (n = 113 samples) were positive in 11 samples (9.7%; all morphologically positive), with two discrepancies detected between bilateral samples. Bilateral cytogenetic studies (n = 74 samples) were positive in 5 samples (7%), and there were no discrepancies. Bilateral molecular studies (n = 16 samples) were positive in 7 samples (44%), and there were 3 discrepancies. CONCLUSIONS Bilateral morphologic evaluation is useful in the evaluation of patients with NHL, HD, CA, and SA and is not indicated for patients with acute or chronic leukemia, myelodysplasia, MM, and other diseases. Bilateral flow cytometric or cytogenetic studies of bone marrow did not provide additional information in this population to justify bilateral samples. The role of bilateral molecular analysis needs to be defined further, but pooled samples for molecular studies may be adequate.
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Affiliation(s)
- Jun Wang
- Division of Pathology, City of Hope National Medical Center, Duarte, California 91010, USA
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Timmermann B, Kortmann RD, Kühl J, Meisner C, Dieckmann K, Pietsch T, Bamberg M. Role of radiotherapy in the treatment of supratentorial primitive neuroectodermal tumors in childhood: results of the prospective German brain tumor trials HIT 88/89 and 91. J Clin Oncol 2002; 20:842-9. [PMID: 11821469 DOI: 10.1200/jco.2002.20.3.842] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the outcome of children with supratentorial primitive neuroectodermal tumors after surgery, irradiation, and chemotherapy and to identify factors predictive for survival. PATIENTS AND METHODS Sixty-three children in the prospective trials HIT 88/89 and HIT 91 were eligible. Complete resection was performed in 21 patients. Patients were randomized for preirradiation chemotherapy, consisting of two cycles of ifosfamide, etoposide, methotrexate, cisplatin, and cytarabine (n = 40), or chemotherapy after irradiation, consisting of eight cycles with cisplatin, vincristine, and lomustine (n = 23). Irradiation volume was recommended to encompass the neuraxis with 35.2-Gy total dose followed by a boost (20.0 Gy) to the primary tumor site (n = 54). Seven patients were irradiated to the tumor region only with a total dose of 54.0 Gy. RESULTS Overall survival at 3 years was 48.4%. Progression occurred in 38 children, with local recurrences in 27 patients. The only significant prognostic factor was dose and volume of radiotherapy (progression-free survival after 3 years was 49.3% with correct treatment compared with 6.7% for 15 children with major violations of radiotherapy). Ten early progressions occurred during adjuvant therapy (eight before and two during radiotherapy), nine of them treated with preirradiation chemotherapy. There was a positive trend in outcome for nonmetastatic and pineal tumors. CONCLUSION Significant predictive factors were dose and volume of radiotherapy. Volume of irradiation should encompass the whole CNS with additional boost to the tumor region. Local doses of at least 54 Gy and a craniospinal dose of 35 Gy are necessary. Preirradiation chemotherapy seems to increase risk of early progression.
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Affiliation(s)
- Beate Timmermann
- Department of Radiooncology, and Institute of Medical Information Processing, University of Tübingen, Tübingen, Germany.
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