Lymphoma, leukemia, and pleiocytosis in cerebrospinal fluid: Is accurate cytopathologic diagnosis possible based on morphology alone?
Lymphoma, leukemia, and pleiocytosis in cerebrospinal fluid: Is accurate cytopathologic diagnosis possible based on morphology alone?
复制标题
淋巴瘤、白血病和脑脊液中的细胞增多症：仅根据形态学可以进行准确的细胞病理学诊断吗？
DOI：
10.1002/dc.21110
复制
发表时间：
2009
影响因子：
1.3
通讯作者：
Syed Z. Ali
中科院分区：
文献类型：
--
作者：
Julie M. Wu;M. Georgy;F. Burroughs;E. Weir;D. Rosenthal;Syed Z. Ali
脑脊液（CSF）的良性与恶性血液学过程的区分是困难的，因为明显的形态重叠和经常缺乏标本。我们的研究比较了细胞形态学分析和FC分析在脑脊液血液学恶性肿瘤中的诊断能力。我们确定了32例脑脊液提交细胞病理学分析，并附有相应的FC数据、组织学或临床随访。载玻片是盲法的，研究参与者（一名血液病理学家、两名细胞病理学家和一名细胞技术专家）在没有额外信息的情况下回顾了每个病例的关键载玻片。这些诊断与原始诊断在临床信息和辅助研究的背景下进行比较。疾病范围包括急性髓系白血病、套细胞淋巴瘤、慢性淋巴细胞淋巴瘤、伯基特淋巴瘤、大细胞淋巴瘤、T细胞淋巴瘤和非霍奇金淋巴瘤。62.5%的病例有平行诊断。有趣的是，良性病例的正确诊断率为73%，恶性病例的正确诊断率为52%。在恶性肿瘤病例中，急性恶性肿瘤基于形态学的正确诊断率（67%）高于慢性恶性肿瘤（47%）。敏感性为73%，特异性为52%，阳性预测值为60%，阴性预测值为66%。对恶性肿瘤诊断最有用的特征是细胞单调和核轮廓不规则。在脑脊液中，仅凭形态学诊断恶性肿瘤是困难的。辅助研究如FC分析大大提高了准确区分良性和恶性血液学过程的能力。成岩作用。Cytopathol》2009。©2009 Wiley‐Liss, Inc。
The differentiation of benign versus malignant hematologic processes on cerebrospinal fluid (CSF) is difficult given the significant morphologic overlap and frequently scant specimen. Our study compared the diagnostic power of cytomorphologic analyses and FC analyses in the context of CSF hematologic malignancies. We identified 32 cases of CSF submitted for cytopathologic analysis with corresponding FC data, histologic, or clinical follow‐up. The slides were blinded and the study participants (one hematopathologist, two cytopathologists, and one cytotechnologist) reviewed the key slides of each case without additional information. These diagnoses were compared with the original diagnoses made in the context of clinical information and ancillary studies. The spectrum of disease ranged from acute myeloid leukemia, mantle cell lymphoma, chronic lymphocytic lymphoma, Burkitt lymphoma, large cell lymphoma, T cell lymphoma, and non‐Hodgkin lymphoma. Parallel diagnoses were made in 62.5% of the cases. Interestingly, the correct diagnoses were rendered in 73% of benign cases, compared with 52% of malignant cases. Of the malignant cases, there was a higher proportion of correct diagnosis based on morphology in the acute malignancies (67%) versus the chronic malignancies (47%). The sensitivity, specificity, positive predictive value, and negative predictive value were 73, 52, 60, and 66% respectively. Features most useful for diagnosis of malignancy included cellular monotony and nuclear contour irregularity. The diagnosis of malignancy based on morphology alone is difficult in CSF. Ancillary studies such as FC analyses greatly enhance the ability to accurately distinguish between benign and malignant hematologic processes. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.