A simple clinical scoring system to improve the sensitivity and standardization of the diagnosis of mycosis fungoides type cutaneous T-cell lymphoma: logistic regression of clinical and laboratory data

Abstract

The logistic regression models and scoring systems integrate clinical and laboratory assessments, allow rapid probability estimation, and provide a threshold for the diagnosis of MF in an objective, standardized manner.

Usefulness of flow cytometry in the diagnosis of mycosis fungoides

“…16 Therefore, this study is the most comprehensive analysis of MF by flow cytometry from skin biopsy specimens and demonstrates the usefulness of flow cytometry for the diagnosis of MF. In all, 11 of the 14 analyzed specimens from patients with lesions suggestive for MF demonstrated a T-cell abnormality by flow cytometry (patients [1][2][3][4][5][6][7][8][9][10][11]. TCR gene rearrangement studies revealed clonally rearranged bands in 10 of the 11 patients in which a phenotypic abnormality was detected, supporting our flow cytometric interpretation.…”

“…9 We have also reported a similar system. 10 These schemes help in establishing a less subjective diagnosis of MF, but still rely on supplementary analytic techniques with significant limitations.…”

Defining early mycosis fungoides

“…80 That the more sensitive molecular studies may be able to unmask this subset of ''benign'' dermatoses is supported by studies showing clonal populations, 81,82 aberrant immunophenotypes, 57 and/or MF-like T-cell cytokine production profiles 83 in the peripheral blood of some patients diagnosed as ''parapsoriasis en plaques.'' More recently developed techniques, such as single-cell PCR combined with laser-assisted microdissection, that exceed the current sensitivity of PCR-based methods (;1% clonal detection threshold) 76,77 need further evaluation regarding their specificity.…”

Practical Aspects Regarding the Histopathological Diagnosis of Early Mycosis Fungoides

“…Often, the diagnosis can be made with sufficient certainty only after clinical-pathological correlations and multiple biopsy assessments in the course of the disease. Algorithms for establishing an objective diagnosis of mycosis fungoides in the early phase have been proposed in several papers [6,[8][9][10][11]], but they have not been included in the WHO classification so far [12]. This fact makes it clear that the early diagnosis of this disease is still an area of debate, not easy to integrate into simple algorithms.…”

“…As a consequence, cytological atypia was assigned a pivotal role in different diagnostic algorithms for early MF attempted so far [6,[8][9][10][11]. …”