Lymphoid and myeloid neoplasms involving cerebrospinal fluid: comparison of morphologic examination and immunophenotyping by flow cytometry
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Published on: November 28, 2015
Andres A Roma1, Alejandro Garcia, Alejandra Avagnina
1Center for Medical Education and Clinical Investigations, Buenos Aires, Argentina. andresroma@hotmail.com
Insights
Combining cytologic examination and flow cytometry immunophenotyping significantly improves lymphoma/leukemia detection in cerebrospinal fluid (CSF) samples. This enhanced diagnostic approach increases detection rates by 75% compared to morphology alone.
Area of Science:
- Neurology
- Oncology
- Immunology
Background:
- Cerebrospinal fluid (CSF) analysis is crucial for diagnosing central nervous system (CNS) diseases.
- Malignant lymphoma and leukemia can infiltrate the CNS, requiring accurate and timely diagnosis.
- Cytologic examination alone may have limitations in detecting neoplastic cells in CSF.
Purpose of the Study:
- To evaluate the combined diagnostic utility of cytologic examination and immunophenotyping by flow cytometry for detecting lymphoma/leukemia in CSF.
- To determine the incremental diagnostic yield of flow cytometry when used in conjunction with traditional cytologic methods.
Main Methods:
- Analysis of 53 CSF samples from 43 patients using both morphologic examination and immunophenotyping by flow cytometry.
- Patients included those with a prior diagnosis of malignant lymphoma/leukemia and others with various CNS diseases.
- Comparison of detection rates between morphologic examination alone and the combined approach.
Main Results:
- Lymphoma/leukemia was detected in 21 out of 53 CSF samples.
- The combined method (cytology + flow cytometry) detected lymphoma/leukemia in 21 cases, whereas cytology alone identified it in 12 cases.
- Flow cytometry alone identified lymphoma/leukemia in 9 cases, and was crucial for confirming suspected cases.
- The combined approach demonstrated a 75% enhancement in detection rate over morphologic examination alone.
Conclusions:
- The combination of cytologic examination and flow cytometry immunophenotyping significantly enhances the detection of lymphoma/leukemia in CSF samples.
- This integrated diagnostic strategy improves diagnostic accuracy and offers a higher detection rate compared to cytology alone.
- Flow cytometry is a valuable tool for confirming diagnoses, particularly in cases with suspicious morphology or low cell counts.
Abstract:
We studied 53 samples of cerebrospinal fluid (CSF) by cytologic examination and immunophenotyping by flow cytometry. The samples were taken from 43 patients; 25 had a previous diagnosis of malignant lymphoma/leukemia and the remaining 18 a variety of other diseases involving the central nervous system (CNS). Lymphoma/leukemia was detected in 21 samples: 12 by morphologic examination and immunophenotyping and nine by immunophenotyping alone. There were two cases with a suspicious morphologic examination and negative immunophenotyping in which the final diagnosis were cryptococcal and viral meningitis. In the group of 18 patients, one was diagnosed as a primary malignant lymphoma of the CNS and was positive with cytology and immunophenotyping. The other 17 were negative with both methods and follow-up showed no evidence of lymphoma/leukemia. This study shows that morphologic examination combined with flow cytometry enhances the detection rate by 75% over morphologic examination alone in CSF samples.
