Flow Cytometric Detection of Malignant Cells in Body Fluids

造血系统恶性肿瘤累及脑脊液（CSF）可能难以单独通过形态学记录。“非典型”或“可疑”的诊断通常用于细胞数量少或形态不明确的病例。在一项比较单纯形态学与流式细胞术形态学的研究中，我们证明了流式细胞术免疫分型在一系列已知淋巴瘤或白血病患者中建立肿瘤诊断以及使用形态学标准初步诊断“非典型”或“可疑”CSF中是有用的。流式细胞术单位评价了流式细胞术分析在高级别B细胞淋巴瘤患者的分期和管理中的作用。我们通过流式细胞术和细胞学对新诊断为侵袭性B细胞淋巴瘤并有中枢神经系统（CNS）受累风险的患者的脑脊液（CSF）进行了评估。流式细胞术鉴定了占总CSF淋巴细胞0.2%的肿瘤克隆。流式细胞术检测参与细胞学，化学和细胞计数失败。流式细胞术检测疾病是一个消极的预后因素，现在提示对NCI方案的患者进行治疗干预。作为研究的结果，我们建议有侵袭性B细胞淋巴瘤累及CNS风险的患者接受流式细胞术分期CSF评估。许多流式细胞术实验室报告CSF标本分析的成功率较低。流式细胞术单位，CCR，NCI，NIH开发了用于CSF流式细胞术分析的特殊方案，其成功率很高。流式细胞术单位参加了一次国际共识会议，以确定CSF流式细胞术分析的最佳方法。流式细胞术部门已经帮助范德比尔特大学医学中心实施了我们的系统，目前正在协助其他医学中心。

Involvement of the cerebrospinal fluid (CSF) by hematopoietic malignancies may be difficult to document by morphology alone. The diagnoses of "atypical" or "suspicious" is frequently used in cases with low numbers of cells or ambiguous morphology. In a study comparing morphology alone to morphology with flow cytometry, we demonstrated that flow cytometric immunophneotyping was useful in establishing a diagnosis of neoplasia in a series of patients with known lymphoma or leukemia and an initial diagnosis of "atypical" or "suspicious" CSF using morphologic criteria. The Flow Cytometry Unit evaluated the role of flow cytometric analysis in staging and management of patients with high grade B cell lymphomas. We assessed the cerebrospinal fluid (CSF) by flow cytometry and cytology in patients newly diagnosed with aggressive B-cell lymphomas and at risk for central nervous system (CNS) involvement. Flow cytometry identified neoplastic clones that constituted as little as 0.2% of total CSF lymphocytes. Flow cytometry detected involvement where cytology, chemistry and cell counts failed. Flow cytometric detection of disease was a negative prognostic factor and now prompts therapeutic intervention in patients on NCI protocols. As a result of the study we recommended that patients at risk for CNS involvement by aggressive B cell lymphoma undergo staging CSF evaluation by flow cytometry. Many flow cytometry laboratories report a low success rate in analysis of CSF specimens. The Flow Cytometry Unit, CCR, NCI, NIH developed special protocols for flow cytometric analysis of CSF that has led to a high success rate. The Flow Cytometry Unit participated in an international consensus conference to determine optimal methodology for flow cytometric analysis of CSF. The Flow Cytometry Unit has helped Vanderbilt University Medical Center implement our system and is currently assisting other medical centers.