Impact of Eight-Color Flow Cytometry on the Diagnosis of Cerebrospinal Fluid (CSF) Involvement by Leukemia or Lymphoma.
Jennifer D Duven, Carol J Holman, Timothy Singleton, Adina M Cioc, Dan M McKeon, Stefan E Pambuccian. University of Minnesota, Minneapolis
Background: Cytologic examination (CYT) of the CSF has long been the standard diagnostic procedure for detection of leukemia and lymphoma (L&L) in the CSF. However, recent reports have shown an increase in the detection rate of CSF involvement by L&L ranging from 20% to 600% by the concomitant use of flow cytometry (FC).
The aim of this study was to determine the impact of 8-color FC, a method ideally suited for hypocellular samples such as CSF, on the diagnosis of CSF involvement by L&L.
Design: All cases that had CYT and FC performed on samples obtained from the same lumbar puncture from 1/1/08 to 8/1/10 were identified. CYT and FC diagnoses were independent, the CYT diagnosis usually preceding the FC interpretation. 8-color FC was performed on a BD FACS Canto II flow cytometer. The typical antibody panel consisted of CD5, CD10, CD19, CD20, CD45, κ, λ and either CD14, CD38, CD56 or CD58 depending on the L&L suspected, with a secondary T-cell or myeloid panel performed as needed. Age and sex of the patient, L&L type, CYT and FC interpretations were entered into a spreadsheet for analysis.
Results: We identified a total of 282 cases from 143 patients. 78M/65F, aged 4-84 (mean 51) with diagnoses of acute lymphocytic leukemia (n=23), acute myelocytic leukemia (n=28), acute bilineage leukemia (n=1) chronic lymphocytic leukemia (n=4) chronic myelocytic leukemia (n=3) hairy cell leukemia (n=1), lymphoma (n=57), and other diagnoses (n=26). Of the 19 CYT+ cases, 8 were lymphomas and 11 leukemias (AML, ALL, CLL, CML); the FC+ cases were 9 lymphomas and 23 leukemias (AML, ALL, CML).
|FC Negative||FC Atypical||FC Suspicious||FC Positive|