title: Flow cytometry increases the sensitivity of detection of leukemia and lymphoma cells in bronchoalveolar lavage specimens.
abstract: BACKGROUND
  Recent studies have definitively determined that flow cytometry (FC) is significantly more sensitive than cytomorphology (CM) in detection of hematolymphoid neoplasms (HLNs). However, its utility in paucicellular bronchoalveolar lavage (BAL) specimens has not been established.
  
  
  METHODS
  FC was performed on BAL specimens submitted from 44 patients with a prior diagnosis of HLN. Panels chosen were based upon cellularity of specimen and patient history. FC results were compared with concurrent CM evaluations.
  
  
  RESULTS
  All 44 BALs were deemed satisfactory for FC and yielded informative results that assisted in diagnosis. Diagnoses included 22/44 B-cell neoplasms, 16/44 T-cell neoplasms, four/44 myeloid neoplasms, and two/44 plasma cell neoplasms. Overall concordance was demonstrated between FC and CM in 77% (34/44) of cases. In nine/44 cases (20%), one technique (FC or CM) clearly detected malignant cells when the other did not. FC was more sensitive than CM in detecting a HLN in eight/nine discordant cases. In only one case (one/44, 2%) were malignant HLN cells suspected by CM, but not identified by FC (one/44, 2%).
  
  
  CONCLUSIONS
  We demonstrate, in the largest series published to date, that FC can be performed on BAL specimens. FC is indicated in evaluation of BAL for HLN and improves sensitivity of detection of HLN over CM alone. An integrated FC and CM approach is superior to either technique alone in diagnostic evaluation of BAL.
authors: Hematopathology Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors: Joo Y
authors: JY
authors: Song
authors: Armando C
authors: AC
authors: Filie
authors: David
authors: D
authors: Venzon
authors: Maryalice
authors: M
authors: Stetler-Stevenson
authors: Constance M
authors: CM
authors: Yuan
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D005434:Flow Cytometry; D006801:Humans; D007938:Leukemia / Q000175:diagnosis / Q000473:pathology*; D008223:Lymphoma / Q000175:diagnosis / Q000473:pathology*; D012680:Sensitivity and Specificity