Critical Analysis and Diagnostic Usefulness of Limited Immunophenotyping of B-Cell Non-Hodgkin Lymphomas by Flow Cytometry

Abstract

We report the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various immunophenotypes characteristic of each class of B-cell non-Hodgkin lymphoma (NHL) based on analysis of 352 morphologically well-characterized B-cell NHLs and 175 benign lymph nodes (LNs) using 2-color flow cytometry. All B-cell NHLs that exhibited a characteristic immunophenotype (except diffuse large B-cell lymphoma) had a high NPV. The immunophenotypes of small lymphocytic lymphoma and mantle cell lymphoma showed high specificity, but only small lymphocytic lymphoma also showed a high PPV. One third of follicular lymphomas coexpressed CD23 and CD10. Diffuse large B-cell NHL showed no consistent immunophenotype. About 90% of all benign LNs expressed no substantial amounts of CD5, CD10, or CD23. Most benign LNs also failed to express substantial amounts of immunoglobulin heavy chains. In contrast, about 90% of NHLs showed expression of 1 or 2 heavy chains. The expression pattern of immunoglobulin light chains was not found helpful in favoring one lymphoma type over another. The usefulness of each immunophenotype for each lymphoma group is of particular diagnostic importance in limited specimens, such as fine-needle aspiration biopsies, small core biopsies, body effusions, extranodal sites, and nodal tissues with various artifacts.

Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-hodgkin lymphoma

“…1,2,[13][14][15] The possibility of applying a complete panel of antibodies and diagnostic algorithms is the most appreciated advantage of the technique; 4,6,8 consequently, many reports stress the high sensitivity in detecting non-Hodgkin lymphoma (NHL) through the combined application of FNC and FC. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The most enthusiastic reports hypothesize that, in the near future, histology will not be necessary strictly for the diagnosis of NHL. In fact, in many institutions, FNC coupled with ancillary techniques like FC routinely has replaced histology in the diagnosis of recurrent NHL (rNHL).…”

“…In fact, in many institutions, FNC coupled with ancillary techniques like FC routinely has replaced histology in the diagnosis of recurrent NHL (rNHL). 1,2,4,8,10 However, the possibility of a definite cytologic diagnosis even for primary NHL is related to the possibility of a correct subclassification of the single entities, according to the most recent Revised European-American Classification of Lymphoid Neoplasms (the REAL classification system). 16,17 The possibility of identifying a follicular NHL through CD10/CD19 coexpression without microscopic visualization of follicular structures is a stimulating idea; and, in recent years, there have been some reports using FC or immunocytochemistry to exploit the possibility of subclassifying NHL.…”

“…16,17 The possibility of identifying a follicular NHL through CD10/CD19 coexpression without microscopic visualization of follicular structures is a stimulating idea; and, in recent years, there have been some reports using FC or immunocytochemistry to exploit the possibility of subclassifying NHL. 4,8,10,13,18,[25][26][27] The objective of this article was to report our experience concerning the application of FC and FNC to the diagnosis of lymph nodal and extra lymph nodal lymphoproliferative disorders emphasizing technical aspects and the possibility of subclassifying NHL.…”

Fluorescence in situ hybridization: Method of choice for a definitive diagnosis of mantle cell lymphoma†

“…The dual staining of CD19 or CD20 with CD5 is most helpful in excluding other tumors except for SLL/CLL. In many studies, the distinction between MCL and SLL/CLL depends on the presence or absence of CD23 [14,15]. The FMC-7 is also used to distinguish these two entities [14,15].…”

“…In many studies, the distinction between MCL and SLL/CLL depends on the presence or absence of CD23 [14,15]. The FMC-7 is also used to distinguish these two entities [14,15]. The absence of CD23 has been considered the major distinction between MCL and CLL/SLL.…”