Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Health System Research, Parkland Health and Hospital System, Dallas, TX, USA.
Ann Hematol. 2018 Sep;97(9):1707-1716. doi: 10.1007/s00277-018-3336-3. Epub 2018 Apr 21.
In patients with hematologic malignancies, multiparameter flow cytometry (FCM) offers greater sensitivity than cytology in detecting malignant cells in the initial cerebrospinal fluid (CSF) specimen. However, the role of FCM in assessment of subsequent specimens is unclear. We developed an algorithm to reduce the number of low-yield FCM tests without significant impact on clinically meaningful results. Patients with hematologic malignancies were studied in a derivation cohort, and the following algorithm was developed: (1) cytology and FCM on all initial samples, (2) cytology on all subsequent samples, and (3) FCM on subsequent samples only if previous FCM was positive. A separate population served as the validation cohort. The derivation cohort included 197 patients representing 1157 cytology and 543 FCM samples. Common malignancies were B-Cell ALL (25.3%), diffuse large B cell lymphoma (29.4%), and Burkitt lymphoma (7.7%). In the derivation cohort, the algorithm yielded a sensitivity of 90.0% (95% CI, 81.2-95.6%) and a specificity of 100% (95% CI, 98.9-100.0%). The validation cohort included 132 patients with 563 cytology and 602 FCM samples. In the validation cohort, the testing algorithm yielded a sensitivity of 87.5% (95% CI, 75.9-94.8%) and a specificity of 100% (95% CI, 99.1-100.0%). Of the 15 samples that were missed by the algorithm, FCM findings did not impact patients' management because of known CNS disease (seven patients) or they were responding to treatment (eight patients). CSF testing in hematologic malignancies using the proposed algorithm presents an evidence-based approach to reduce the number of unnecessary FCM tests of CSF without compromising patient care.
在血液系统恶性肿瘤患者中，与细胞学相比，多参数流式细胞术（FCM）在检测初始脑脊液（CSF）标本中的恶性细胞方面具有更高的敏感性。然而，FCM 在评估后续标本中的作用尚不清楚。我们开发了一种算法，可在不显著影响有临床意义结果的情况下减少低产量 FCM 检测的数量。在推导队列中研究了患有血液系统恶性肿瘤的患者，并制定了以下算法：（1）对所有初始样本进行细胞学和 FCM 检测，（2）对所有后续样本进行细胞学检测，（3）仅在前次 FCM 检测为阳性时对后续样本进行 FCM 检测。另一个队列用作验证队列。推导队列包括 197 例患者，代表 1157 例细胞学和 543 例 FCM 样本。常见恶性肿瘤为 B 细胞急性淋巴细胞白血病（25.3%）、弥漫性大 B 细胞淋巴瘤（29.4%）和伯基特淋巴瘤（7.7%）。在推导队列中，该算法的敏感性为 90.0%（95%CI，81.2-95.6%），特异性为 100%（95%CI，98.9-100.0%）。验证队列包括 132 例患者，有 563 例细胞学和 602 例 FCM 样本。在验证队列中，该检测算法的敏感性为 87.5%（95%CI，75.9-94.8%），特异性为 100%（95%CI，99.1-100.0%）。在该算法遗漏的 15 个样本中，由于已知的中枢神经系统疾病（7 例患者）或对治疗有反应（8 例患者），FCM 结果并未影响患者的治疗。该算法为血液系统恶性肿瘤的 CSF 检测提供了一种循证方法，可以减少不必要的 CSF FCM 检测数量，同时又不影响患者的护理。
