Gupta R, Rahman K, Singh M K, Kumari S, Yadav G, Nityanand S
Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Int J Hematol Oncol Stem Cell Res. 2018 Jan 1;12(1):29-34.
Diagnosis of myelodysplastic syndromes (MDS) is challenging in the presence of morphological mimickers. Flow cytometric immunophenotyping (FCI) has been added to the diagnostic armamentarium, but its use in clinical practice is variable. Bone marrow aspirate samples from 54 patients with a clinical and/or morphological suspicion of MDS were subjected to FCI using a single-tube, 6-colour panel comprising of monoclonal antibodies against CD13, CD11b, CD16, CD34, CD45 and CD56. Analysis was centered on the abnormal maturation pattern of granulocytes, blast percentage (≥3%) and ratio of side scatter peak channel value (SSC-PCV) of granulocytes and lymphocytes. Each of these parameters was assigned a score of 1. Overall sensitivity and specificity of this panel was ascertained to differentiate cytopenia/s of MDS from non-MDS cases. Forty MDS and 14 non-MDS cases were diagnosed based on morphology and cytogenetic results. Twenty control samples were also processed simultaneously for FCI to assign the cutoff for various flow cytometric parameters. A score ≥2 was defined as positive for MDS. Hypogranularity was present in 62.5% cases of MDS. The median SSC-PCV of granulocytes and lymphocytes was 6.16 in the MDS group, 7.9 in the non-MDS group and 8.90 in the control group (p <0.05). This cut-off value of 6.16 had a specificity of 92.5% based on the ROC curve analysis. Abnormal granulocyte maturation patterns for CD13/16, CD13/11b and CD11b/16 dot plots were observed in 95.3, 69.8 and 74.4% cases, respectively. The overall sensitivity and specificity of the panel was found to be 87.5% and 64.2%, respectively. FCI is now an important tool for diagnostic workup in patients presenting with persistent cytopenia with or without morphological evidence of dyspoiesis. Inclusion of objective parameters like SSC-PCV would also reduce inter-lab variability in MDS diagnosis.
在存在形态学相似疾病的情况下，骨髓增生异常综合征（MDS）的诊断具有挑战性。流式细胞术免疫表型分析（FCI）已被纳入诊断手段，但在临床实践中的应用情况各不相同。对54例临床和/或形态学上怀疑患有MDS的患者的骨髓穿刺样本进行FCI检测，采用单管6色检测方案，该方案包含针对CD13、CD11b、CD16、CD34、CD45和CD56的单克隆抗体。分析集中在粒细胞的异常成熟模式、原始细胞百分比（≥3%）以及粒细胞与淋巴细胞的侧向散射峰通道值（SSC-PCV）比值。这些参数中的每一个都被赋予1分。确定该检测方案区分MDS血细胞减少症与非MDS病例的总体敏感性和特异性。根据形态学和细胞遗传学结果诊断出40例MDS病例和14例非MDS病例。同时对20份对照样本进行FCI检测，以确定各种流式细胞术参数的临界值。将评分≥2定义为MDS阳性。62.5%的MDS病例存在颗粒减少。MDS组粒细胞与淋巴细胞的SSC-PCV中位数为6.16，非MDS组为7.9，对照组为8.90（p<0.05）。根据ROC曲线分析，6.16的这个临界值特异性为92.5%。在95.3%、69.8%和74.4%的病例中分别观察到CD13/16、CD13/11b和CD11b/16点图的粒细胞成熟模式异常。该检测方案的总体敏感性和特异性分别为87.5%和64.2%。对于出现持续性血细胞减少且有或无造血异常形态学证据的患者，FCI现在是诊断检查的重要工具。纳入SSC-PCV等客观参数也将减少MDS诊断中的实验室间差异。
