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Published on: February 8, 2016
Immunophenotyping of cytologic specimens by flow cytometry
A T Moriarty1, L Wiersema, W Snyder
1Department of Pathology and Laboratory Medicine, Methodist Hospital of Indiana, Indianapolis 46206.
Insights
Flow cytometry immunophenotyping is valuable for fine needle aspirates (FNA) but limited for cerebrospinal fluid analysis. Body cavity fluid analysis is feasible but less diagnostic for monoclonal proliferation.
Area of Science:
- Hematology
- Cytopathology
- Immunology
Background:
- Immunophenotyping by flow cytometry is crucial for diagnosing hematopoietic neoplasms.
- Cytologic specimens are often overlooked for flow cytometry due to perceived low cellularity, despite being ideal cell suspensions.
Purpose of the Study:
- To evaluate the utility of immunophenotyping cytologic specimens using flow cytometry.
- To assess diagnostic yield across different specimen types: cerebrospinal fluid, body cavity fluids, and fine needle aspirates.
Main Methods:
- Retrospective review of cytologic specimens analyzed by flow cytometry between 1988 and 1991.
- Analysis included cerebrospinal fluid (31 cases), body cavity fluids (32 cases), and fine needle aspirates (118 cases).
- Number of cell surface markers used ranged from 1 to 22 depending on the specimen type.
Main Results:
- Cerebrospinal fluid analysis had inadequate cells in 15/31 cases, with only 5 showing monoclonal proliferation.
- Body cavity fluids (peritoneal, pleural, pericardial, bronchoalveolar lavage) were analyzable in all cases, but only 7/32 showed monoclonal proliferation.
- Fine needle aspirates (FNA) yielded adequate cells in 116/118 cases, with 61 demonstrating monoclonal proliferation.
Conclusions:
- Flow cytometry immunophenotyping is of limited value for cerebrospinal fluid analysis, requiring prior study knowledge.
- Analysis of body cavity fluids is technically feasible but less frequently diagnostic for monoclonal proliferation.
- Flow cytometry immunophenotyping is a valuable adjunctive technique for fine needle aspirates, providing adequate cellular material for analysis.
Abstract:
Immunophenotyping by flow cytometry is well established as an ancillary technique in the diagnosis of hematopoietic neoplasms. However, flow cytometry is rarely performed on cytologic specimens because most cytologist are more comfortable with direct microscopy and believe that there is inadequate cellularity for analysis. Paradoxically, cytologic material is usually cell suspensions making it ideal for flow cytometry. In order to evaluate the usefulness of immunophenotyping cytologic specimens by flow cytometry, we retrospectively reviewed all cytologic specimens submitted to our flow cytometry unit from 1988 to 1991. Thirty-one cerebrospinal fluid specimens were analyzed. There were inadequate cells for analysis in 15 cases. Five showed a monoclonal proliferation; 11 were nondiagnostic. A range (r) of one to six cell surface markers were performed. Thirty-two body cavity fluids were analyzed: 7 peritoneal, 19 pleural, 2 pericardial, and 4 bronchoalveolar lavage. There were cells to analyze in all cases. Seven had a monoclonal proliferation; 25 were nondiagnostic (r = 4-21 markers performed). One hundred eighteen fine needle aspirates (FNA) were reviewed; 58 FNA were radiologically guided, 60 were superficial lesions. There were inadequate cells for analysis in two cases. Sixty-one demonstrated a monoclonal proliferation; 55 were nondiagnostic (r = 1-22 markers performed). We conclude that immunophenotyping by flow cytometry is of limited value for cerebrospinal fluid analysis and that knowledge of previous immunophenotyping studies is essential for correct analysis; analysis of body cavity fluids is easily performed but less often demonstrates a monoclonal proliferation. Immunophenotyping by flow cytometry is a valuable adjunctive technique for FNA and yields adequate cells for analysis.
