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Updated: Jul 4, 2026
Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma
Published on: January 9, 2019
Role of immunohistochemistry in staging diffuse large B-cell lymphoma (DLBCL)
Dipti Talaulikar1, Jane Esther Dahlstrom, Bruce Shadbolt
1Department of Haematology, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia. dipti.talaulikar@act.gov.au
Insights
Immunohistochemistry (IHC) improves bone marrow staging in diffuse large B-cell lymphoma (DLBCL) by detecting more lymphoma cases. Routine IHC also offers better survival prediction than standard histology alone for DLBCL patients.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Immunohistochemistry (IHC) is typically reserved for ambiguous bone marrow staging in non-Hodgkin's lymphoma (NHL).
- The utility of routine IHC in diffuse large B-cell lymphoma (DLBCL) bone marrow staging is not well-established.
Purpose of the Study:
- To assess if routine IHC improves lymphomatous involvement detection in DLBCL bone marrow compared to histology alone.
- To evaluate IHC's impact on survival prediction versus standard histological stains (H&E, Giemsa, reticulin).
Main Methods:
- Analysis of 156 DLBCL bone marrow trephines using routine histology and IHC.
- IHC panel included B-cell (CD20, CD79a), T-cell (CD45RO, CD3), and light chain markers.
Main Results:
- IHC identified lymphomatous involvement in an additional 11% of cases compared to histology alone.
- Both histology and IHC predicted survival, but IHC demonstrated superior predictive value in multivariate analysis.
Conclusions:
- Routine IHC in bone marrow staging can enhance the detection of occult lymphoma in DLBCL.
- IHC serves as a more robust predictor of survival than conventional histological examination in DLBCL.
Abstract:
The use of immunohistochemistry (IHC) in staging bone marrow in non-Hodgkin's lymphoma (NHL) is largely limited to ambiguous cases, particularly those with lymphoid aggregates. Its role in routine clinical practice remains unestablished. This study aimed to determine whether the routine use of IHC in diffuse large B-cell lymphoma (DLBCL) would improve the detection of lymphomatous involvement in the bone marrow. It also sought to determine the impact of IHC on predicting survival compared with routine histological diagnosis using hematoxylin and eosin (H&E), Giemsa, and reticulin staining. The bone marrow trephines of 156 histologically proven DLBCL cases were assessed on routine histology, and IHC using two T-cell markers (CD45RO and CD3), two B-cell markers (CD20 and CD79a), and kappa and lambda light chains. IHC detected lymphomatous involvement on an additional 11% cases compared with histology alone. Although both routine histology and IHC were good predictors of survival, IHC was better at predicting survival on stepwise multivariate Cox regression analysis. IHC performed routinely on bone marrow trephines has the ability to improve detection of occult lymphoma in experienced hands. Furthermore, it is a better predictor of survival compared with routine histological examination alone.
