FLow Cytometric Detection of Malignant Cells in Body Fluids

仅凭形态学很难证明血液系统恶性肿瘤累及脑脊液(CSF)。“不典型”或“可疑”的诊断经常用于细胞数量少或形态不明确的病例。在一项单独的形态学与流式细胞术的形态学比较研究中，我们证明了在一系列已知的淋巴瘤或白血病患者中，流式细胞仪免疫荧光分型有助于确定肿瘤的诊断，以及使用形态标准初步诊断“不典型的”或“可疑的”脑脊液。流式细胞术单位评估了流式细胞术分析在高级别B细胞淋巴瘤患者分期和治疗中的作用。我们通过流式细胞术和细胞学对新诊断为侵袭性B细胞淋巴瘤且有中枢神经系统(CNS)受累风险的患者的脑脊液(CSF)进行了评估。流式细胞术发现肿瘤克隆仅占脑脊液淋巴细胞总数的0.2%。流式细胞仪检测到细胞学、化学和细胞计数失败的受累。流式细胞仪检测疾病是一个负面的预后因素，现在促使NCI方案的患者进行治疗干预。作为这项研究的结果，我们建议有中枢神经系统受累风险的侵袭性B细胞淋巴瘤患者接受用流式细胞仪进行的脑脊液分期评估。许多流式细胞仪实验室报告说，在分析脑脊液标本时成功率很低。流式细胞术单位、CCR、NCI、NIH开发了用于脑脊液的流式细胞仪分析的特殊方案，导致了高成功率。流式细胞术单位参加了一次国际共识会议，以确定对脑脊液进行流式细胞术分析的最佳方法。流式细胞术单元帮助范德比尔特大学医学中心实施了我们的系统，目前正在协助匹兹堡大学医学中心。

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 University of Pittsburgh Medical Center.