Flow cytometry increases the sensitivity of detection of leukemia and lymphoma cells in bronchoalveolar lavage specimens
Flow cytometry increases the sensitivity of detection of leukemia and lymphoma cells in bronchoalveolar lavage specimens
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DOI：
10.1002/cyto.b.21026
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发表时间：
2012-09-01
影响因子：
3.4
通讯作者：
Bagwell, C. Bruce
中科院分区：
文献类型：
--
作者：
Herbert, Donald J.;Miller, David T.;Bagwell, C. Bruce
背景资料：髓样核分化抗原（MNDA）在髓单核细胞中表达，在成熟粒细胞和单核细胞中表达水平最高。提示在骨髓增生异常综合征（MDS）患者中表达较弱。因此，MNDA的分析可能会提高多参数流式细胞术（MFC）在MDS中的诊断能力。研究方法：我们使用MFC检测了269例疑似或已知MDS、急性髓性白血病（AML）或慢性粒单核细胞白血病（CMML）、原因不明的血细胞减少症或无恶性肿瘤的患者（阴性对照）的MNDA表达。结果与细胞形态学（CM）和细胞遗传学（CG）诊断结果进行了比较。结果如下：MNDA表达减少的粒细胞和单核细胞的凋亡（dimG和dimM）在MDS患者中较高（平均值+/- SD，20% +/-20%，P < 0.001和31% +/-24%，P < 0.001）和AML经CM诊断的MDS患者（27% +/-27%，P = 0.007和45% +/-31%，P = 0.001）与未患MDS的患者（8% +/- 10%和16% +/- 11%）相比，差异分别显著。还发现单核细胞中MNDA的平均荧光强度（MFI）的显著差异，其在MDS（平均值+/- SD，71 +/- 36，P = 0.004）和AML（55 +/- 39，P < 0.001）中分别低于无MDS样品（85 +/- 28）。在MDS患者中，与无细胞遗传学畸变的患者（16% +/- 21%）相比，有细胞遗传学畸变的病例显示出更高的%dimG（24% +/-18%，P = 0.083）趋势。定义了能够区分MDS和非MDS的单核细胞中%dimG（12%）和%dimM（22%）以及MFI的截止值（72）。结论：骨髓细胞中的MNDA表达可以通过MFC可靠地评估，并且当添加到标准MDS MFC组中时可以促进对发育不良的评估。(c)2012年国际临床细胞测量学会背景：最近的研究明确确定流式细胞术（FC）在检测血淋巴样肿瘤（HLN）方面比细胞形态学（CM）更敏感。然而，其效用在少细胞支气管肺泡灌洗（BAL）标本尚未建立。方法：对44例既往诊断为HLN的患者提交的BAL标本进行FC。根据标本的细胞结构和患者病史选择样本组。FC结果与同期CM评价进行了比较。结果：所有44例巴尔斯均被认为对FC满意，并产生了有助于诊断的信息结果。诊断包括22/44例B细胞肿瘤、16/44例T细胞肿瘤、4/44例骨髓肿瘤和2/44例浆细胞肿瘤。在77%（34/44）的病例中证实了FC和CM之间的总体一致性。在9/44例病例（20%）中，一种技术（FC或CM）清楚地检测到恶性细胞，而另一种则没有。在8/9例不一致病例中，FC在检测HLN方面比CM更敏感。仅1例（1/44，2%）为CM怀疑的恶性HLN细胞，但未被FC鉴别（1/44，2%）。结论：我们证明，在迄今为止发表的最大系列中，可以对BAL标本进行FC。FC适用于HLN的BAL评估，并且相对于单独的CM提高了HLN检测的灵敏度。在BAL的诊断评价中，FC和CM的综合方法优于单独的任何一种技术上级。出版社：Wiley Periodicals，Inc.
Background: Myeloid nuclear differentiation antigen (MNDA) is expressed in myelomonocytic cells with highest levels in mature granulocytes and monocytes. It is suggested to be expressed more weakly in patients with myelodysplastic syndromes (MDS). The analysis of MNDA therefore may improve diagnostic capabilities of multiparameter flow cytometry (MFC) in MDS. Methods: We used MFC for detection of MNDA expression in 269 patients with suspected or known MDS, acute myeloid leukemia (AML) or chronic myelomonocytic leukemia (CMML), cytopenia of unknown cause or without malignancy (negative controls). Results were compared with the diagnoses revealed by cytomorphology (CM) and cytogenetics (CG). Results: Percentages of granulocytes and monocytes with diminished MNDA expression (dimG and dimM) were higher in patients with MDS (mean +/- SD, 20% +/- 20%, P < 0.001 and 31% +/- 24%, P < 0.001) and AML (27% +/- 27%, P = 0.007 and 45% +/- 31%, P = 0.001) diagnosed by CM, vs. patients without MDS (8% +/- 10% and 16% +/- 11%), respectively. Significant differences were also found for mean fluorescence intensity (MFI) of MNDA in monocytes which was lower in MDS (mean +/- SD, 71 +/- 36, P = 0.004) and AML (55 +/- 39, P < 0.001) vs. no MDS samples (85 +/- 28), respectively. Within patients with MDS, cases with cytogenetic aberrations showed a trend to higher %dimG (24% +/- 18%, P = 0.083) compared with those without (16% +/- 21%). Cut-off values for %dimG (12%) and %dimM (22%) as well as for MFI in monocytes (72) were defined capable of discriminating between MDS and non-MDS. Conclusion: MNDA expression in bone marrow cells can be assessed reliably by MFC and may facilitate evaluation of dyspoiesis when added to a standard MDS MFC panel. (c) 2012 International Clinical Cytometry SocietyBackground: Recent studies have definitively determined that flow cytometry (FC) is significantly more sensitive than cytomorphology (CM) in detection of hematolymphoid neoplasms (HLNs). However, its utility in paucicellular bronchoalveolar lavage (BAL) specimens has not been established. Methods: FC was performed on BAL specimens submitted from 44 patients with a prior diagnosis of HLN. Panels chosen were based upon cellularity of specimen and patient history. FC results were compared with concurrent CM evaluations. Results: All 44 BALs were deemed satisfactory for FC and yielded informative results that assisted in diagnosis. Diagnoses included 22/44 B-cell neoplasms, 16/44 T-cell neoplasms, four/44 myeloid neoplasms, and two/44 plasma cell neoplasms. Overall concordance was demonstrated between FC and CM in 77% (34/44) of cases. In nine/44 cases (20%), one technique (FC or CM) clearly detected malignant cells when the other did not. FC was more sensitive than CM in detecting a HLN in eight/nine discordant cases. In only one case (one/44, 2%) were malignant HLN cells suspected by CM, but not identified by FC (one/44, 2%). Conclusion: We demonstrate, in the largest series published to date, that FC can be performed on BAL specimens. FC is indicated in evaluation of BAL for HLN and improves sensitivity of detection of HLN over CM alone. An integrated FC and CM approach is superior to either technique alone in diagnostic evaluation of BAL. Published 2012 Wiley Periodicals, Inc.