Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas.
J Am Soc Cytopathol. 2020 Nov-Dec;9(6):478-484. doi: 10.1016/j.jasc.2020.07.131. Epub 2020 Jul 22.
There are no established criteria in selecting pleural effusion (PE) specimens for flow cytometric analysis (FCA). FCA on effusion specimens may be ordered by a clinician or a cytopathologist. In an effort to improve lab test utilization, this retrospective study aims to identify characteristics of PE specimens on which the addition of FCA has high diagnostic yield.
We identified consecutive cases of PE cytology specimens on which FCA was performed over a 5-year period (2014-2019). Patient demographic data and history, FCA diagnosis, cytologic diagnosis, cellular quantity and composition, and peripheral blood cell counts were collected. Chi-square, Mann-Whitney U, and t tests were used when appropriate with a significance level of P < 0.05.
We identified 164 FCA cases corresponding to 142 patients (age: 19-90 years; male:female 2:1). The majority of cases had no abnormality by cytologic examination, whereas others were obviously malignant due to non-hematologic malignancy. Most (119 of 164, 73%) had negative immunophenotypic studies by FCA. Forty-five of 164 (27%) FCA cases were positive for a monoclonal myeloid or lymphoid population. Clinicopathologic features associated with positive FCA results included a history of hematologic malignancy, peripheral blood lymphocytes of ≥20%, the presence of a monomorphic lymphoid population, large atypical cells, and mitoses.
This study identifies features that are associated with positive FCA in PE cytology specimens. Using these features by cytopathologists to order FCA on PE specimens as a reflex test would significantly reduce unnecessary testing and improve FCA utilization.
目前尚无选择胸腔积液（PE）标本进行流式细胞分析（FCA）的既定标准。FCA 可由临床医生或细胞病理学家开单检测。为了提高实验室检测的利用率，本回顾性研究旨在确定可提高 FCA 诊断收益的胸腔积液标本特征。
我们确定了在 5 年内（2014-2019 年）进行 FCA 的连续胸腔积液细胞学标本。收集了患者的人口统计学数据和病史、FCA 诊断、细胞学诊断、细胞数量和组成以及外周血细胞计数。适当使用卡方检验、Mann-Whitney U 检验和 t 检验，显著性水平 P < 0.05。
我们确定了 164 例 FCA 病例，对应 142 名患者（年龄：19-90 岁；男：女 2:1）。大多数病例的细胞学检查无异常，而其他病例由于非血液系统恶性肿瘤而明显恶性。大多数（164 例中有 119 例，73%）FCA 免疫表型研究结果为阴性。164 例 FCA 中有 45 例（27%）为单克隆髓系或淋巴系群体阳性。与 FCA 阳性结果相关的临床病理特征包括血液系统恶性肿瘤病史、外周血淋巴细胞计数≥20%、存在单形性淋巴样群体、大异型细胞和有丝分裂。
本研究确定了与胸腔积液细胞学标本中 FCA 阳性相关的特征。细胞病理学家使用这些特征，将 FCA 作为胸腔积液标本的反射试验进行检测，将显著减少不必要的检测并提高 FCA 的利用率。
