Flow Cytometric Detection of Malignant Cells in Body Fluids

脑脊液（CSF）受累的造血恶性肿瘤可能很难证明单独的形态学。“非典型”或“可疑”的诊断常用于细胞数量少或形态模糊的病例。在一项比较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表型分型在建立一系列已知淋巴瘤或白血病患者的肿瘤诊断以及使用形态学标准对“非典型”或“可疑”脑脊液的初步诊断方面是有用的。流式细胞术小组评估了流式细胞术分析在高级别B细胞淋巴瘤患者的分期和治疗中的作用。我们通过流式细胞术和细胞学评估了新诊断为侵袭性b细胞淋巴瘤并有中枢神经系统（CNS）受损伤风险的患者的脑脊液（CSF）。流式细胞术鉴定的肿瘤克隆仅占脑脊液淋巴细胞总数的0.02%。流式细胞术检测到细胞学、化学和细胞计数失败的受累部位。流式细胞术检测疾病是一个负面的预后因素，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细胞淋巴瘤累及中枢神经系统风险的患者通过流式细胞术进行脑脊液分期评估。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制定了脑脊液流式细胞术分析的特殊方案，导致了很高的成功率。流式细胞术组参加了一次国际共识会议，以确定脑脊液流式细胞术分析的最佳方法。流式细胞仪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疗中心。

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 0.02% 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.