Determination of CD43 and CD200 surface expression improves accuracy of B-cell lymphoma immunophenotyping
Joerg Hoffmann1, Marissa Rother1, Ulrich Kaiser2
1Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany.
Insights
The extended Matutes score (MS-e), incorporating CD200 and CD43, significantly improves chronic lymphocytic leukemia (CLL) diagnosis sensitivity compared to the standard MS. This enhanced method aids in differentiating CLL from other B-cell lymphomas, especially in ambiguous cases.
Area of Science:
- Hematology
- Immunophenotyping
- Oncology
Background:
- The Matutes score (MS) is used to distinguish chronic lymphocytic leukemia (CLL) from other B-cell non-Hodgkin lymphomas (B-NHLs).
- Ambiguous immunophenotypes present a diagnostic challenge in differentiating these conditions.
- The diagnostic utility of CD200 and CD43 expression in conjunction with standard MS antigens was evaluated.
Purpose of the Study:
- To assess the diagnostic benefit of incorporating CD200 and CD43 expression into the standard Matutes score.
- To improve the differentiation of chronic lymphocytic leukemia (CLL) from other B-cell non-Hodgkin lymphomas (B-NHLs), particularly in cases with ambiguous immunophenotypes.
Main Methods:
- A cohort of 276 lymphoma patient samples was analyzed.
- Samples were classified using the standard Matutes score (MS) and an extended version (MS-e) that includes CD200 and CD43 expression levels.
- Cases with intermediate MS scores were reclassified using the MS-e for improved diagnostic accuracy.
Main Results:
- The MS-e correctly identified 92.9% of CLL cases and 85.7% of non-CLL cases within the initially ambiguous intermediate MS group.
- The sensitivity for CLL diagnosis was significantly increased with MS-e (98.8%) compared to the classical MS (82.7%) (p = 0.0009).
- The specificity remained comparable between MS-e (98.3%) and classical MS (94.7%). Sole measurement of CD43 and CD200 demonstrated superior test accuracy (F1 score 96.2) over the classical MS (93.6).
Conclusions:
- CD200 and CD43 expression levels are highly informative in diagnostic immunophenotyping.
- The MS-e facilitates better separation of CLL from other B-NHLs, especially in diagnostically challenging ambiguous cases.
- Incorporating CD200 and CD43 enhances the diagnostic accuracy for CLL detection.
Background:
The Matutes score (MS) was proposed to differentiate chronic lymphocytic leukemia (CLL) from other B-cell non-Hodgkin lymphomas (B-NHLs). However, ambiguous immunophenotypes are common and remain a diagnostic challenge. Therefore, we evaluated the diagnostic benefit of measuring CD200 and CD43 expression together with the standard MS antigens.
Methods:
138 lymphoma patient samples and a validation cohort of 138 additive samples were classified according to the standard MS and further assigned with one or two additional points, for high CD200 and/or CD43 expression levels. The "classical" MS and the "Matutes score-extended" (MS-e) were categorized as high (4-5/6-7), intermediate (2-3/4-5), and low (0-1/0-3). Samples were reclassified into the MS-e with focus on ambiguous cases with an intermediate "classical" MS.
Results:
A total of 35 of 138 (25.4%) patient samples were assigned to the intermediate MS group and confirmed by histopathological reports as CLL (14/40.0%) and B-NHLs other than CLL (21/60%). MS-e analysis identified 13 of 14 (92.9%) of CLL cases (MS-e 4-5) and 18/21 (85.7%) non-CLL cases (MS-e ≤ 3) correctly. Overall, the sensitivity of the CLL diagnosis was significantly increased by application of MS-e compared to the "classical" MS (98.8% vs. 82.7%; p = 0.0009), while specificity of both methods was almost equal (94.7% vs. 98.3%; p = 0.4795). Of note, sole measurement of CD43 and CD200 on B-cells sufficiently differentiated CLL from non-CLL with a test accuracy superior to the "classical" MS (F1 score 96.2 vs. 93.6).
Conclusion:
CD200 and CD43 have a high informative value in diagnostic immunophenotyping and facilitate the separation of CLL from other B-NHLs particularly in ambiguous cases.
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