Immunophenotypic Pictograms Facilitate Recall and Rapid Interpretation of Diagnostic Information Embedded in Multiparameter Immunophenotyping Assays for Leukemia and Lymphoma
Allen Bryan, German Pihan. Beth Israel Deaconess Medical Center, Boston, MA
Background: Multiparameter flow cytometry assays are integral to the diagnosis and classification of leukemia and lymphoma (L&L). Stereotypic immunophenotypes are increasingly recognized as specific attributes of many forms of L&L, helping in their rapid recognition and often predicting genetic mutations acting as major drivers in these disorders. However, typical numerical display of phenotypes strip out data attributes such as stain intensity and co-expression patterns, which often convey important diagnostic and prognostic information.
Design: To facilitate the visualization, recognition and recall of information-dense and specific multiparameter immunophenotypes, we developed and intuitive visualization tool based on implementation of simple algorithms that can be routinely integrated in the average clinical cytometry laboratory. The presence or absence and the intensity of expression of multiple antigens in L&L were displayed in a circular plot. Markers were arranged circumferentially into sectors according to stereotypical cell type: stem cells, B cells, T cells, NK cells, and myeloid cells. Combined with radial co-display of marker intensity, characteristically unique and disease-defining spider-web, star and spoke pictograms were generated.
Results: Pictograms were produced by entering data manually or by an automated routine, using list mode data. Each immunophenotypic attribute – including its log intensity – was assigned to a fixed cell of a spreadsheet. Pictograms - circular plots of prototypic cases - were generated from these data using Excel graphical methods or application specific algorithms. Easy to recall prototypic pictograms of acute leukemia [t(8;21), t(15;17), inv(16), t(4;11), cNPM1] and lymphoma (13q- CLL, +3 CLL, MCL, FL, T-PLL, HCL) were effective in rapidly training flow cytometry practitioners of varying expertise levels to recognize specific forms of L&L.
Conclusions: Immunophenotypic pictograms represent a simple and effective way of conveying the totality of information embedded in multiparametric flow cytometry assays. They can be used to train naïve, as well as advanced, cytometry practitioners in more readily recognizing patterns in flow cytometry data that provide useful diagnostic and prognostic information, enhancing the capabilities of the busy flow cytometry laboratory.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 188, Tuesday Morning