title: Flow cytometry and cytomorphology evaluation of hematologic malignancy in cerebrospinal fluids: comparison with retrospective clinical outcome.
abstract: An independent clinical assessment was compared with flow cytometry (FCM) and cytomorphology results obtained on 227 cerebrospinal fluids investigated for hematologic malignancy, in a retrospective longitudinal study with a median observation time of 11 months. A combined method assessment (CMA), defining "positive" a sample if at least one method gave "positive" results, was also tested. Eleven out of 55 screening samples and 53 out of 166 follow-up samples resulted positive at clinical evaluation. FCM and CM were concordant with positive clinical assessment in 68.5% and 51.5% of cases, respectively. According to CMA, 10.5% of samples (resulting false negative by either FCM or cytomorphology) were rescued as true positive. FCM retained significantly higher accuracy than cytomorphology (p=0.0065) and 100% sensitivity when at least 220 leukocytes were acquired. CMA accuracy was higher than FCM accuracy and significantly higher than cytomorphology accuracy in the analysis of all samples (p<0.0001), samples from mature B/T cell neoplasms (p=0.0021), and samples drawn after intrathecal treatment (p=0.0001). When acquiring ≤220 leukocytes, FCM accuracy was poor, and combining cytomorphology added statistically significant diagnostic advantage (p=0.0043). Although FCM is the best diagnostic tool for evaluating CSF, morphology seems helpful especially when clinically positive follow-up samples are nearly acellular.
authors.affiliation: Department of Transfusion Medicine and Division of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy, clara.cesana@ospedaleniguarda.it
authors.forename: Clara
authors.initials: C
authors.lastname: Cesana
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Barbara
authors.initials: B
authors.lastname: Scarpati
authors.forename: Bruno
authors.initials: B
authors.lastname: Brando
authors.forename: Maurizio
authors.initials: M
authors.lastname: Faleri
authors.forename: Giambattista
authors.initials: G
authors.lastname: Bertani
authors.forename: Arianna
authors.initials: A
authors.lastname: Gatti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Volpato
authors.forename: Claudia
authors.initials: C
authors.lastname: Barba
authors.forename: Ursula
authors.initials: U
authors.lastname: Ferri
authors.forename: Linda
authors.initials: L
authors.lastname: Scampini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grillo
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lando
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nosari
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.forename: Roberto
authors.initials: R
authors.lastname: Cairoli
mesh_terms: D002555:Cerebrospinal Fluid / Q000166:cytology*; D003581:Cytodiagnosis / Q000379:methods* / Q000592:standards; D005260:Female; D005434:Flow Cytometry / Q000379:methods* / Q000592:standards; D019337:Hematologic Neoplasms / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome