Predictive value of blood and bone marrow flow cytometry in B-cell lymphoma classification

Comparative analysis of flow cytometry and tissue biopsy in 252 patients

William G. Morice, Paul J. Kurtin, Janice M. Hodnefield, Tait D. Shanafelt, James Hoyer, Ellen McPhail, Curtis A. Hanson

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To study the effectiveness of peripheral blood (PB) and bone marrow flow cytometric immunophenotyping (FCIP) in predicting the histologic B-cell lymphoma type. PATIENTS AND METHODS: We studied the FCIP results and tissue histopathology from 252 patients with B-cell lymphoma seen at Mayo Clinic's site in Rochester, MN, between January 1, 1997, and January 1, 2004, who had positive results on PB, bone marrow, or body fluid FCIP and a corresponding diagnostic tissue biopsy specimen. RESULTS: Most of the B-cell lymphomas studied were low grade, with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma being most common. Flow cytometric immunophenotyping histogram analysis was more informative than tabulated percentage antigen positivity; surface immunoglobulin and CD20 staining intensity, CD5 and CD23 positivity, CD10 positivity, and the coexpression of CD11c/CD22 and CD103 were the most pertinent markers. Using these FCIP parameters and strict immunophenotypic definitions for CLL, mantle cell lymphoma (MCL), and hairy cell leukemia, we obtained greater than 95% specificity for each diagnosis. However, we encountered the following exceptions to standard paradigms of B-cell lymphoma-associated FCIP: (1) CD5 expression by disorders distinct from CLL and MCL, (2) lack of uniform CD5 positivity in some CLL and MCL cases, (3) absence of CD10 in approximately 50% of follicular lymphomas, and (4) expression of CD103 by occasional marginal zone lymphomas. CONCLUSION: Stringent interpretation of PB and bone marrow FCIP results enables identification of certain B-cell lymphoma types. However, the observed exceptions to accepted immunophenotypic paradigms highlight the occasional phenotypic overlap among diseases and emphasize that a systematic approach to FCIP interpretations is key to providing clinically useful diagnostic information.

Original languageEnglish (US)
Pages (from-to)776-785
Number of pages10
JournalMayo Clinic Proceedings
Volume83
Issue number7
DOIs
StatePublished - 2008

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Immunophenotyping
B-Cell Lymphoma
Flow Cytometry
Bone Marrow
B-Cell Chronic Lymphocytic Leukemia
Biopsy
Mantle-Cell Lymphoma
Hairy Cell Leukemia
B-Cell Antigen Receptors
Follicular Lymphoma
Body Fluids
Lymphoma
Staining and Labeling
Antigens

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Predictive value of blood and bone marrow flow cytometry in B-cell lymphoma classification : Comparative analysis of flow cytometry and tissue biopsy in 252 patients. / Morice, William G.; Kurtin, Paul J.; Hodnefield, Janice M.; Shanafelt, Tait D.; Hoyer, James; McPhail, Ellen; Hanson, Curtis A.

In: Mayo Clinic Proceedings, Vol. 83, No. 7, 2008, p. 776-785.

Research output: Contribution to journalArticle

Morice, William G. ; Kurtin, Paul J. ; Hodnefield, Janice M. ; Shanafelt, Tait D. ; Hoyer, James ; McPhail, Ellen ; Hanson, Curtis A. / Predictive value of blood and bone marrow flow cytometry in B-cell lymphoma classification : Comparative analysis of flow cytometry and tissue biopsy in 252 patients. In: Mayo Clinic Proceedings. 2008 ; Vol. 83, No. 7. pp. 776-785.
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abstract = "OBJECTIVE: To study the effectiveness of peripheral blood (PB) and bone marrow flow cytometric immunophenotyping (FCIP) in predicting the histologic B-cell lymphoma type. PATIENTS AND METHODS: We studied the FCIP results and tissue histopathology from 252 patients with B-cell lymphoma seen at Mayo Clinic's site in Rochester, MN, between January 1, 1997, and January 1, 2004, who had positive results on PB, bone marrow, or body fluid FCIP and a corresponding diagnostic tissue biopsy specimen. RESULTS: Most of the B-cell lymphomas studied were low grade, with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma being most common. Flow cytometric immunophenotyping histogram analysis was more informative than tabulated percentage antigen positivity; surface immunoglobulin and CD20 staining intensity, CD5 and CD23 positivity, CD10 positivity, and the coexpression of CD11c/CD22 and CD103 were the most pertinent markers. Using these FCIP parameters and strict immunophenotypic definitions for CLL, mantle cell lymphoma (MCL), and hairy cell leukemia, we obtained greater than 95{\%} specificity for each diagnosis. However, we encountered the following exceptions to standard paradigms of B-cell lymphoma-associated FCIP: (1) CD5 expression by disorders distinct from CLL and MCL, (2) lack of uniform CD5 positivity in some CLL and MCL cases, (3) absence of CD10 in approximately 50{\%} of follicular lymphomas, and (4) expression of CD103 by occasional marginal zone lymphomas. CONCLUSION: Stringent interpretation of PB and bone marrow FCIP results enables identification of certain B-cell lymphoma types. However, the observed exceptions to accepted immunophenotypic paradigms highlight the occasional phenotypic overlap among diseases and emphasize that a systematic approach to FCIP interpretations is key to providing clinically useful diagnostic information.",
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AU - Hanson, Curtis A.

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N2 - OBJECTIVE: To study the effectiveness of peripheral blood (PB) and bone marrow flow cytometric immunophenotyping (FCIP) in predicting the histologic B-cell lymphoma type. PATIENTS AND METHODS: We studied the FCIP results and tissue histopathology from 252 patients with B-cell lymphoma seen at Mayo Clinic's site in Rochester, MN, between January 1, 1997, and January 1, 2004, who had positive results on PB, bone marrow, or body fluid FCIP and a corresponding diagnostic tissue biopsy specimen. RESULTS: Most of the B-cell lymphomas studied were low grade, with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma being most common. Flow cytometric immunophenotyping histogram analysis was more informative than tabulated percentage antigen positivity; surface immunoglobulin and CD20 staining intensity, CD5 and CD23 positivity, CD10 positivity, and the coexpression of CD11c/CD22 and CD103 were the most pertinent markers. Using these FCIP parameters and strict immunophenotypic definitions for CLL, mantle cell lymphoma (MCL), and hairy cell leukemia, we obtained greater than 95% specificity for each diagnosis. However, we encountered the following exceptions to standard paradigms of B-cell lymphoma-associated FCIP: (1) CD5 expression by disorders distinct from CLL and MCL, (2) lack of uniform CD5 positivity in some CLL and MCL cases, (3) absence of CD10 in approximately 50% of follicular lymphomas, and (4) expression of CD103 by occasional marginal zone lymphomas. CONCLUSION: Stringent interpretation of PB and bone marrow FCIP results enables identification of certain B-cell lymphoma types. However, the observed exceptions to accepted immunophenotypic paradigms highlight the occasional phenotypic overlap among diseases and emphasize that a systematic approach to FCIP interpretations is key to providing clinically useful diagnostic information.

AB - OBJECTIVE: To study the effectiveness of peripheral blood (PB) and bone marrow flow cytometric immunophenotyping (FCIP) in predicting the histologic B-cell lymphoma type. PATIENTS AND METHODS: We studied the FCIP results and tissue histopathology from 252 patients with B-cell lymphoma seen at Mayo Clinic's site in Rochester, MN, between January 1, 1997, and January 1, 2004, who had positive results on PB, bone marrow, or body fluid FCIP and a corresponding diagnostic tissue biopsy specimen. RESULTS: Most of the B-cell lymphomas studied were low grade, with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma being most common. Flow cytometric immunophenotyping histogram analysis was more informative than tabulated percentage antigen positivity; surface immunoglobulin and CD20 staining intensity, CD5 and CD23 positivity, CD10 positivity, and the coexpression of CD11c/CD22 and CD103 were the most pertinent markers. Using these FCIP parameters and strict immunophenotypic definitions for CLL, mantle cell lymphoma (MCL), and hairy cell leukemia, we obtained greater than 95% specificity for each diagnosis. However, we encountered the following exceptions to standard paradigms of B-cell lymphoma-associated FCIP: (1) CD5 expression by disorders distinct from CLL and MCL, (2) lack of uniform CD5 positivity in some CLL and MCL cases, (3) absence of CD10 in approximately 50% of follicular lymphomas, and (4) expression of CD103 by occasional marginal zone lymphomas. CONCLUSION: Stringent interpretation of PB and bone marrow FCIP results enables identification of certain B-cell lymphoma types. However, the observed exceptions to accepted immunophenotypic paradigms highlight the occasional phenotypic overlap among diseases and emphasize that a systematic approach to FCIP interpretations is key to providing clinically useful diagnostic information.

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