| Along with the rapid development of the modern science and the enhancement of the overlapping between different subjects, kinds of advanced effective assistant diagnostic instrument emerged one after another incessantly, and the FCM is a typical representative. After the development of more than 40 years, FCM has already held the indispensable status in the diagnosis of hematopoietic malignancies. According to the REAL/WHO diagnostic criteria for lymphoma, immunophenotyping has already become an essential part of the diagnosis, especially non-Hodgkin lymphoma (NHL). Many hospitals in developed countries are currently using the routine morphology plus immunohistochemistry (IHC) and/or FCM to carry on this mission. In view of the fact that FCM can give additive or even conclusive results with multi-parameters much more rapidly, accurately and sensitively than routine morphology plus IHC, the diagnosis of lymphoma using FCM is now more and more attractive to the hematological clinicians. Since the diagnosis of lymphoma using FCM is techniquely complicated and well trained personnels are definitely required to perform this diagnosticapproach, only a few insititutions in our country have developed this diagnostic approach which has not been reported by using this approach to perform the diagnosis of childhood lymphoma. In this study, 26 cases of childhood lymphoma were selected to make a retrospective study, in order to evaluate the possibility and reliability of the rapid diagnosis for children with lymphoma using FCM.Materials and MethodsA total of 26 children (24 cases with NHL and 2 with Hodgkin Disease) with malignant lymphoma diagnosed during the period of Apr. 2000 through Jul. 2006 were enrolled into this study. 19 of them were diagnosed with routine pathology plus IHC and the other 7 were diagnosed according to their clinical symptoms and other tests. At least one FCM analysis was performed for each case. A total of 29 analyses were performed for the 26 cases of patients with lymphoma. Specimens of involved lymph nodes obtained either by surgical biopsy or fine needle aspirations, tumor tissues, pleural fluids, ascites as well as cerebrospinal fluids were used for the FCM analsyis. The results of FCM were compared with the routine pathological diagnoses and clinical diagnoses in order to evaluate its possibility and the reliability of using this approach in the diagnosis of childhood lymphoma.ResultsAmong the 26 cases, 24 were NHL with 17 T-NHL and 7 B-NHL. The remaining two were HD which was identified by FCM using bone marrow involved with malignant cells.The same specimens with pathological analysis were used for FCM application in 12 cases in which 10 were T-NHL and 2 were B-NHL. The FCM analysis showed that 7 were T-NHL (One of these was diagnosed as malignant lymphoma only without subclassification by pathological analysis), 2 were B-NHL and 3 were benign, of which 2 were the same diagnoses as the routine pathological analysis and the other 1 was inconclusive due to the inappropriate tissue sampling. The concordance rate between FCM and routine pathology was 92% (11/12) for all the 12 cases with the concordance rates of 87.5%( 7/8 ) for T-NHLs and 100% (2/2) for B-NHL while that between FCM and clinical diagnosis was 75% (9/12) for all the 12 cases with concordance rates of 70% (7/10) for T-NHL and 100% (2/2) for B-NHL. The sensitivity of diagnosis using FCM was 90% and the specificity was 100% with a Youden's index of 0.9 (Youden's index is also called Correct index, which is used to evaluate some diagnostic method.If its value increases, the reliability of the method will be better. Youden's index = sensibility+specificity-1).7 cases analysed by FCM using the different specimens from routine pathology. The same diagnoses were obtained for all the 7 cases with additional immunological information on 1 case, which was diagnosed as small lymphocyte lymphoma (SLL) with routine pathology and was eventually proven to be B-SLL after the CSF analysis using FCM. The diagnoses of lymphoma in the remaining 7 cases were not obtained by the routine pathology due to no appropriate specimens available. The clinical diagnoses of these 7 cases were suggested by using all the information including the clinical manifestations and the results from other tests, which were confirmed by FCM.The concordance rates between FCM and clinical diagnosis were 82.35% (14/17) for the 17 T-NHLs and 100% (7/7) for the 7 B-NHLs.Conclusions(1)Immunophenotyping by FCM can serve as an important diagnostic method in the quick and subjective diagnosis and the subclassification of NHL; (2) FCM can be used as a useful complementary approach for routine pathological diagnosis; (3)FCM is informative for the cases without appropriate specimens for routine pathological diagnosis. |
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