分析骨髓切片中的免疫组化标志物以评估骨髓增生异常综合征和急性髓系白血病。
Analysis of immunohistochemical markers in bone marrow sections to evaluate for myelodysplastic syndromes and acute myeloid leukemias.
作者信息
Dunphy Cherie H, O'Malley Dennis P, Perkins Sherrie L, Chang Chung-Che
机构信息
Divisions of Hematopathology, Departments of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599-7525, USA.
出版信息
Appl Immunohistochem Mol Morphol. 2007 Jun;15(2):154-9. doi: 10.1097/PAI.0b013e318030dec7.
BACKGROUND
Accurate bone marrow (BM) blast counts (BCs) are essential for diagnosis (dx) of myelodysplasia (MDS), MDS/myeloproliferative (MDS/MPD) disease, or acute myeloid leukemia (AML), and may be difficult in hemodiluted bone marrow aspirates (BMAs). Erythroid precursors (EPs) may be indistinguishable from myeloblasts in BM sections (aspirate clots/cores). We compare the usefulness of immunohistochemistry (IHC) [ie, CD34, CD117, myeloperoxidase (MPO), Hemoglobin A1 (HbA1), and terminal deoxynucleotidyl transferase (TdT)] of BM sections (IHC-BM) with BMA, bone marrow touch preparation (BMTP), and flow cytometry (FC) BCs.
DESIGN
The initial BC (48), percentage (%) of Eps (38) (both based on initial 100 to 600-cell counts), and FC expressions of CD34, CD117, Glycophorin A(GLY A), and TdT (44) were tabulated from 50 BMs (MDS, MDS/MPD, or AML). BMAs (48) and BMTPs (25) subsequently received 500-cell counts. IHC-BM was performed (45:formalin, 5:B5-fixed) [CD34 (46), CD117 (45), HbA1 (45), TdT (42), and MPO (45)].
RESULTS
Retrospective BMA BCs revealed a 31% (15/48) discrepant rate between the original/retrospective BMA BCs; 80% revealed an underestimated initial BC. There was a 28% discordance rate between the retrospective BMA and BMTP reviews; 77% showed a higher BMTP BC. IHC showed significantly higher BCs in 19% (9/47), resulting in a different dx (5). However, CD34 and CD117 IHCS revealed lower BCs in 38% and 48%, respectively. The CD34 IHC results were primarily due to CD34-negative blasts by FC. The CD117 IHC results were largely unexplained. EPs were CD34 and CD117-negative.
CONCLUSIONS
(1) Evaluation for MDS/AML requires 500-cell counts of BMAs and/or BMTPs. (2) CD34 and/or CD117 blasts by FC indicate IHC-BM may increase BC accuracy. (3) CD34 is more reliable than CD117 by IHC; however, in combination, they are most reliable and should be performed on BM clots/cores due to variable reactivity.
背景
准确的骨髓原始细胞计数（BCs）对于骨髓增生异常综合征（MDS）、MDS/骨髓增殖性疾病（MDS/MPD）或急性髓系白血病（AML）的诊断至关重要，而在血液稀释的骨髓穿刺液（BMA）中进行计数可能具有挑战性。在骨髓切片（穿刺凝块/核心）中，红系前体细胞（EPs）可能与原始粒细胞难以区分。我们比较了骨髓切片免疫组化（IHC）[即CD34、CD117、髓过氧化物酶（MPO）、血红蛋白A1（HbA1）和末端脱氧核苷酸转移酶（TdT）]与BMA、骨髓印片（BMTP）及流式细胞术（FC）原始细胞计数的实用性。
设计
从50例骨髓（MDS、MDS/MPD或AML）中列出初始原始细胞计数（48例）、EPs百分比（%）（38例）（均基于最初100至600个细胞计数）以及CD34、CD117、血型糖蛋白A（GLY A）和TdT的FC表达（44例）。随后对BMA（48例）和BMTP（25例）进行500个细胞计数。进行了免疫组化 - 骨髓检测（45例：福尔马林固定，5例：B5固定）[CD34（46例）、CD117（45例）、HbA1（45例）、TdT（42例）和MPO（45例）]。
结果
回顾性BMA原始细胞计数显示，原始/BMA回顾性原始细胞计数之间的差异率为31%（15/48）；80%显示初始原始细胞计数被低估。回顾性BMA与BMTP评估之间的不一致率为28%；77%显示BMTP原始细胞计数更高。免疫组化显示19%（9/47）的原始细胞计数显著更高，导致诊断不同（5例）。然而，CD34和CD117免疫组化分别显示38%和48%的原始细胞计数更低。CD34免疫组化结果主要归因于FC检测为CD34阴性的原始细胞。CD117免疫组化结果在很大程度上无法解释。EPs为CD34和CD117阴性。
结论
（1）对MDS/AML的评估需要对BMA和/或BMTP进行500个细胞计数。（2）FC检测的CD34和/或CD117原始细胞表明免疫组化 - 骨髓检测可能提高原始细胞计数的准确性。（3）免疫组化中CD34比CD117更可靠；然而，联合使用时它们最可靠，并且由于反应性可变，应在骨髓凝块/核心上进行检测。
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