Analysis of T-Cell Receptor Gene Rearrangement in Lymph Nodes of Patients With Mycosis Fungoides

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

“…However, 13% of LN 2 nodes, 83% of LN 3 nodes, and 100% of patients with LN 4 nodes had clonal rearrangements in one of the studies. 62 These studies indicate that Southern blot analysis is useful as an adjunct study for lymph nodes that show higher histologic grades of involvement, especially given that the prognosis of such patients with evidence of a clone was worse than patients without a clone. 62 However, the Southern blot technique has largely been replaced by the technically easier polymerase chain reaction (PCR)-based methods, with much more sensitive detection thresholds.…”

“…62 These studies indicate that Southern blot analysis is useful as an adjunct study for lymph nodes that show higher histologic grades of involvement, especially given that the prognosis of such patients with evidence of a clone was worse than patients without a clone. 62 However, the Southern blot technique has largely been replaced by the technically easier polymerase chain reaction (PCR)-based methods, with much more sensitive detection thresholds. 66 Although not significant in a multivariate analysis, Fraser-Andrews et al 67 have reported detection of T-ell clones by PCR in 6 of 19 N 0-2 lymph nodes and Assaf et al 68 in 7 of 14 dermatopathic lymph nodes in patients with MF, and in none of the lymph nodes obtained from patients with benign conditions.…”

“…However, the prognostic importance of lesser degrees of involvement as defined by light microscopy alone is less clear. 24,59,61,62 Some investigators advocate that the LN 3 rating should be considered equivalent to LN 4 for staging purposes. 13 Although in the context of MF and SS, the survival of patients with an NCI/VA LN 3 node rating is worse than patients with LN 0-2 , 24,62 it must be remembered that findings comparable with LN 3 have been found in nodes from patients with benign disorders 56,60,63 and that the survival of patients with LN 4 is worse than for those with LN 3 .…”

“…24 In 3 studies that have reported on the use of Southern blot technique, which has a 5% detection threshold to show clonal T cells in lymph nodes, 62,64,65 none of the lymph nodes classified histologically as uninvolved (NCI/VA LN 0-1 or Dutch grade 1) had evidence of a clone. However, 13% of LN 2 nodes, 83% of LN 3 nodes, and 100% of patients with LN 4 nodes had clonal rearrangements in one of the studies.…”

Cytologic evaluation of lymphadenopathy associated with mycosis fungoides and Sezary syndrome

“…However, clonal T-cell populations have been identified in lymph nodes of MF patients thought to be histologically uninvolved by lymphoma. [27][28][29] Preliminary data suggest that these patients have decreased overall survival compared with those patients who have negative TCR PCR studies. 27,28 The clinical significance of T-cell clones identified in histologically uninvolved lymph nodes remains to be determined and requires further study.…”