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Immunohistochemistry can be used to subtype acute myeloid leukemia in routinely processed bone marrow biopsy
E J Manaloor1, R S Neiman, D K Heilman
1Indiana University School of Medicine, Indianapolis, USA.
Insights
Immunohistochemistry can reliably subclassify acute myeloid leukemia (AML) when flow cytometry is unavailable. This method shows comparable sensitivity and specificity to flow cytometry for AML immunophenotyping.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Flow cytometry (FC) is the standard for acute myeloid leukemia (AML) immunophenotyping.
- Alternative methods are needed when FC is not accessible.
- Immunohistologic staining of bone marrow biopsy specimens offers potential for immunophenotypic analysis.
Purpose of the Study:
- To evaluate the utility of immunohistologic staining for AML subclassification.
- To compare the diagnostic value of immunohistochemistry (IHC) with FC.
- To confirm the reliability of IHC in AML diagnosis.
Main Methods:
- Eighty newly diagnosed AML cases were studied, classified by French-American-British (FAB) criteria and confirmed by FC.
- Paraffin-embedded bone marrow specimens were stained using antibodies against CD34, myeloperoxidase (MPO), hemoglobin, factor VIII-related antigen, and CD68.
- Immunohistochemical results were compared with FC immunophenotyping data.
Main Results:
- Immunohistochemistry using paraffin-reactive antibodies (CD34, MPO, CD68, antihemoglobin, factor VIII-related antigen) enabled AML subclassification.
- Significant concordance was observed between IHC and FC for shared markers.
- Both methods demonstrated comparable sensitivity and specificity (P > .53).
Conclusions:
- Immunohistochemistry is a valuable tool for subclassifying AML, especially when FC is unavailable.
- The findings support the use of IHC as a reliable alternative to FC for AML immunophenotyping.
- IHC offers comparable diagnostic accuracy to FC in AML.
Abstract:
Flow cytometry (FC) is the preferred method of immunophenotyping acute myeloid leukemia (AML). However, there are situations in which FC is unavailable and in which immunohistologic staining of bone marrow biopsy specimens can be used to provide immunophenotypic information. To evaluate immunohistologic staining and to confirm its value, we selected 80 newly diagnosed cases of AML that were classified according to French-American-British (FAB) criteria and confirmed by flow cytometric analysis for this study. Paraffin-embedded bone marrow specimens were stained using a panel of antibodies that included CD34 (QBEND10), antimyeloperoxidase (anti-MPO), antihemoglobin, factor VIII-related antigen, and 3 epitopes of CD68 (HAM56, KP1, and PG-M1). Our findings suggest that with the use of the paraffin-reactive antibodies CD34 (QBEND10), MPO, CD68 (PG-M1), antihemoglobin, and factor VIII-related antigen, immunohistochemistry can be used to subclassify AML. Comparison of immunohistochemical results with FC immunophenotyping suggests that there is significant concordance in the results for markers that can be used with both techniques, indicating that the sensitivity and specificity of both methods is comparable (P > .53 in all cases).
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