title: Predictive value of blood and bone marrow flow cytometry in B-cell lymphoma classification: comparative analysis of flow cytometry and tissue biopsy in 252 patients.
abstract: OBJECTIVE
  To study the effectiveness of peripheral blood (PB) and bone marrow flow cytometric immunophenotyping (FCIP) in predicting the histologic B-cell lymphoma type.
  
  
  METHODS
  We studied the FCIP results and tissue histopathology from 252 patients with B-cell lymphoma seen at Mayo Clinic's site in Rochester, MN, between January 1, 1997, and January 1, 2004, who had positive results on PB, bone marrow, or body fluid FCIP and a corresponding diagnostic tissue biopsy specimen.
  
  
  RESULTS
  Most of the B-cell lymphomas studied were low grade, with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma being most common. Flow cytometric immunophenotyping histogram analysis was more informative than tabulated percentage antigen positivity; surface immunoglobulin and CD20 staining intensity, CD5 and CD23 positivity, CD10 positivity, and the coexpression of CD11c/CD22 and CD103 were the most pertinent markers. Using these FCIP parameters and strict immunophenotypic definitions for CLL, mantle cell lymphoma (MCL), and hairy cell leukemia, we obtained greater than 95% specificity for each diagnosis. However, we encountered the following exceptions to standard paradigms of B-cell lymphoma-associated FCIP: (1) CD5 expression by disorders distinct from CLL and MCL, (2) lack of uniform CD5 positivity in some CLL and MCL cases, (3) absence of CD10 in approximately 50% of follicular lymphomas, and (4) expression of CD103 by occasional marginal zone lymphomas.
  
  
  CONCLUSIONS
  Stringent interpretation of PB and bone marrow FCIP results enables identification of certain B-cell lymphoma types. However, the observed exceptions to accepted immunophenotypic paradigms highlight the occasional phenotypic overlap among diseases and emphasize that a systematic approach to FCIP interpretations is key to providing clinically useful diagnostic information.
authors.affiliation: Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA. morice.william@mayo.edu
authors.forename: William G
authors.initials: WG
authors.lastname: Morice
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kurtin
authors.forename: Janice M
authors.initials: JM
authors.lastname: Hodnefield
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.forename: James D
authors.initials: JD
authors.lastname: Hoyer
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Remstein
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Hanson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000032:analysis*; D001706:Biopsy / Q000379:methods*; D001772:Blood Cell Count / Q000379:methods; D001853:Bone Marrow / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D016130:Immunophenotyping / Q000379:methods; D008214:Lymphocytes / Q000276:immunology* / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000145:classification* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015703:Antigens, CD