title: Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma.
abstract: The diagnostic procedure of chronic pulmonary opacities may envisage the search for non-Hodgkin lymphoma (NHL). Previous retrospective studies have shown that clonality analysis of bronchoalveolar B lymphocytes could reflect the clonality of pulmonary lymphocytes. Our objective was to define the diagnostic usefulness of bronchoalveolar lavage (BAL) B-lymphocyte clonality analysis in the setting of a clinical suspicion of both primary and secondary pulmonary lymphoma. A prospective BAL fluid B-cell clonality analysis was performed by polymerase chain reaction (PCR) in 106 consecutive patients presenting with a clinical suspicion of pulmonary NHL. Diagnosis was pulmonary B-cell lymphoma for 22 patients (13 primary and 9 secondary). When compared, pulmonary biopsy and BAL fluid have clonal identity. The detection of a strong B-cell clonal population in BAL fluid was associated with the diagnosis of pulmonary NHL (P <.0001), with a 97% specificity and a 95% negative predictive value. Thus, the absence of a dominant B-cell clone detection in BAL fluid could help to dismiss invasive investigations of pulmonary lesions. The detection of a dominant B-cell clone would lead to the performance of a pulmonary biopsy to get histologic diagnosis in primary pulmonary lymphoma and, by contrast, would avoid the need for biopsy in the setting of a secondary pulmonary lymphoma.
authors.affiliation: Service de Pneumologie, Hôpital Foch, Suresnes, France.
authors.forename: Simona
authors.initials: S
authors.lastname: Zompi
authors.forename: Louis-Jean
authors.initials: LJ
authors.lastname: Couderc
authors.forename: Jacques
authors.initials: J
authors.lastname: Cadranel
authors.forename: Martine
authors.initials: M
authors.lastname: Antoine
authors.forename: Bernard
authors.initials: B
authors.lastname: Epardeau
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Fleury-Feith
authors.forename: Natalia
authors.initials: N
authors.lastname: Popa
authors.forename: François
authors.initials: F
authors.lastname: Santoli
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Farcet
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Delfau-Larue
mesh_terms: D001402:B-Lymphocytes / Q000276:immunology* / Q000473:pathology; D001483:Base Sequence; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology; D002999:Clone Cells / Q000276:immunology / Q000473:pathology; D022801:Complementarity Determining Regions / Q000235:genetics*; D004273:DNA, Neoplasm / Q000235:genetics; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000473:pathology; D016133:Polymerase Chain Reaction / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011650:Pulmonary Alveoli / Q000276:immunology* / Q000473:pathology*; D012680:Sensitivity and Specificity
chemical_list: D022801:Complementarity Determining Regions; D004273:DNA, Neoplasm