Qualitative versus quantitative immunophenotyping.
Qualitative versus quantitative immunophenotyping.
复制标题
定性与定量免疫表型分析。
DOI：
10.1111/j.1749-6632.1993.tb38773.x
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发表时间：
1993
影响因子：
5.2
通讯作者：
Smith,BR
中科院分区：
文献类型：
--
作者：
Smith,BR
许多流式细胞术诊断更类似于读取骨髓抽吸，而不是测定血清钠水平。对于前者，临床病理学家或血液学家综合大量定性和定量信息（核/细胞质相对成熟度、髓/红比值等），得出解释——诊断。精确测定骨髓与红细胞的比例并不是关键的工作；理解这个比率的重要性是。然而，对于血清钠的测定，实验室的工作是获得尽可能精确的值，因为在这种情况下，准确的定量是至关重要的临床变量，血清钠在正常生理状态下保持在一个非常狭窄的范围内。对于流式细胞术，白血病和淋巴细胞增生性疾病的免疫分型与骨髓抽吸的解释类似；CD4计数代表了再现性需求的范例。随着越来越多的临床经验越来越清楚，流式细胞术定性诊断是非常有益的；相比之下，依赖于淋巴细胞亚群精确定量的流式细胞技术是否会发挥更大的作用仍然是一个悬而未决的问题。正如本卷其他地方概述的那样，免疫分型在白血病和淋巴瘤诊断中的司法应用是很好的。免疫表现型在CD4计数之外的应用的另一个例子是对恶性疾病诊断不确定的体液的评估。在一项检查体液中B细胞克隆过剩作用的研究中，细胞学诊断的假阳性率为6.1%（3/49例），假阴性率为12.2%（6/49例）；流式细胞术诊断的可比率均为4.1%。最重要的是，当两种诊断方式一致时（28例），本研究中没有假阳性或假阴性，这表明流式细胞术诊断技术，特别是与其他方式和敏锐的病理判断相结合时，提供了非常重要的可解释信息。为了将这项研究扩展到包括对不仅仅涉及表面免疫球蛋白表达B细胞的疾病的评估，并开始建立相关的参考范围，我们回顾了1991年1月至1992年3月在耶鲁大学流式细胞术液体分析的经验。分析了34种液体：17种是脑脊液（CSF）， 17种来自胸膜、腹膜或心包。一个
Much flow cytometric diagnosis is more analogous to reading a bone marrow aspirate than determining a serum sodium level. For the former, the clinical pathologist or hematologist synthesizes a large amount of qualitative and quantitative information (relative nuclear/cytoplasmic maturity, myeloid/erythroid ratio, and so forth) and arrives at an interpretation-a diagnosis. Determination of a precise myeloidl erythroid ratio is not the crucial exercise; understanding the significance of this ratio is. For the determination of serum sodium, however, it is the job of the laboratory to obtain as precise a value as possible because, in this case, it is the accurate quantitation that is the crucially followed clinical variable and the serum sodium is maintained in a very narrow range in normal physiology. For flow cytometry, immunophenotyping of leukemias and lymphoproliferative disorders represents the analogue of the interpretation of the bone marrow aspirate; CD4 counts represent the paradigm of the need for reproducibility. It is becoming increasingly clear with more and more clinical experience that flow cytometric qualitative diagnosis can be extremely beneficial; by contrast, whether there is an expanding role for flow cytometric techniques that depend on accurate quantitation of lymphocyte subsets remains an open question.As outlined elsewhere in this volume, judicial use of immunophenotyping in leukemia and lymphoma diagnosis is well established. Another example of such utility of immunophenotyping that goes beyond CD4 counts is the evaluation of diagnostically uncertain body fluids for malignant disease. In a study examining the role of B cell clonal excess in fluids,'the false positive rate for cytologic diagnosis was 6.1%(3/49 cases) and the false negative rate was 12.2%(6/49); for flow cytometric diagnosis, the comparable rates were both 4.1%. Most significantly, when both diagnostic modalities were in agreement (28 cases), there were no false positives or false negatives in this study, suggesting that flow cytometric diagnostic techniques, especially when combined with other modalities and astute pathologic judgment, provide very important interpretable information. In order to extend this study to include the evaluation of disorders not involving solely surface immunoglobulin-expressing B cells and to begin to establish relevant reference ranges, we reviewed our experience in flow cytometric fluid analysis at Yale from January 1991 to March 1992. Thirty-four fluids were analyzed: 17 were cerebrospinal fluid (CSF) and 17 were pleural, peritoneal, or pericardial in origin. A