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[Chronic lymphatic leukemia. Immunophenotyping as an aid to correct diagnosis]
B Ly1, J Hammerstrøm, J Bergheim
1Hematologisk avdeling, Medisinsk klinikk Aker sykehus Oslo.
Insights
Immune phenotyping is crucial for accurately diagnosing chronic lymphocytic leukemia (CLL), especially in cases with atypical features or low lymphocyte counts, ensuring correct patient management and treatment strategies.
Area of Science:
- Hematology
- Oncology
- Immunology
Context:
- Chronic lymphocytic leukemia (CLL) diagnosis relies on clinical and morphological criteria.
- Accurate diagnosis is essential for appropriate patient management and treatment.
- Population-based studies are vital for understanding disease prevalence and diagnostic accuracy.
Purpose:
- To evaluate the accuracy of initial CLL diagnoses based on clinical and morphological assessments.
- To determine the utility of immune phenotyping in refining diagnoses within a population-based CLL cohort.
- To identify potential misdiagnoses and the impact of immune phenotyping on diagnostic outcomes.
Summary:
- Immune phenotyping was performed on 222 patients with a clinical diagnosis of CLL.
- The study identified 11 (5%) patients with alternative diagnoses, including prolymphocytic leukemia and lymphomas.
- Atypical clinical or morphological features were noted in 8 of the 11 misdiagnosed patients.
Impact:
- Immune phenotyping is valuable for confirming CLL diagnoses and identifying alternative hematologic malignancies.
- The technique is particularly essential for patients with modest lymphocytosis.
- Accurate diagnosis through immune phenotyping improves patient stratification and therapeutic decisions.
Abstract:
The purpose of the study was to examine the validity of the primary diagnosis in chronic lymphocytic leukemia based on clinical and morphological criteria, and to examine the role of immune phenotyping for correct diagnosis in an unselected population-based group of patients. Over a 2-year period leukemic cells from 222 of 235 patients in Norway with a recent clinical diagnosis of chronic lymphocytic leukemia (CLL) were immune phenotyped in order to find cases erroneously diagnosed as CLL. Median age was 72.5 years, and the ratio of men to women was 1.47. At the time of diagnosis, 77% of the patients were in Binet stage A and 23% in stage B or C. Immune phenotyping, in some patients followed by lymph node or bone marrow biopsy, showed a different diagnosis in 11 (5%) of 222 patients: prolymphocytic leukemia, four patients (three B-cell and one T-cell); morbus Waldenstrøm, one patient; T-cell CLL, one patient; hairy cell leukemia, one patient; mycosis fungoides, one patient; mantle cell lymphoma, one patient; monocytoid B-cell lymphoma, one patient and immunoblastic lymphoma one patient. In eight of these 11 patients, the clinical features or morphology, or both, were atypical for CLL, but this was not recognized at the time of diagnosis. Thus, immune phenotyping is valuable for correct diagnosis in a small subgroup of patients with chronic B- or T-cell leukemia, and it is essential in patients with modest lymphocytosis (lymphocytes < 10. 10(9)/1).