Subirá Dolores, Barriopedro Fabiola, Fernández Jesús, Martínez Ruth, Chara Luis, Castelao Jorge, García Eugenia
Flow Cytometry Unit, Department of Hematology, Hospital Universitario de Guadalajara, c/Donante de sangre s.n, Guadalajara, 19002, Spain.
Department of Pneumology, Hospital Universitario de Guadalajara, c/Donante de sangre s.n, Guadalajara, 19002, Spain.
Clin Exp Metastasis. 2023 Dec;40(6):505-515. doi: 10.1007/s10585-023-10236-4. Epub 2023 Oct 9.
Diagnosing malignant pleural effusions (MPE) is challenging when patients lack a history of cancer and cytopathology does not detect malignant cells in pleural effusions (PE). We investigated whether a systematic analysis of PE by flow cytometry immunophenotyping (FCI) had any impact on the diagnostic yield of MPE. Over 7 years, 570 samples from patients with clinical suspicion of MPE were submitted for the FCI study. To screen for epithelial malignancies, a 3-color FCI high sensitivity assay was used. The FCI results, qualified as "malignant" (FCI+) or "non-malignant" (FCI-), were compared to integrated definitive diagnosis established by clinicians based on all available information. MPE was finally diagnosed in 182 samples and FCI detected 141/182 (77.5%). Morphology further confirmed FCI findings by cytopathology detection of malignant cells in PE (n = 91) or histopathology (n = 29). Imaging tests and clinical history supported the diagnosis in the remaining samples. The median percentage of malignant cells was 6.5% for lymphoma and 0.23% for MPE secondary to epithelial cell malignancies. FCI identified a significantly lower percentage of EpCAM cells in cytopathology-negative MPE than in cytopathology-positive cases (0.02% vs. 1%; p < 0.0001). Interestingly, 29/52 MPE (55.8%) where FCI alerted of the presence of malignant cells were new diagnosis of cancer. Overall, FCI correctly diagnosed 456/522 samples (87.4%) suitable for comparison with cytopathology. These findings show that high sensitivity FCI significantly increases the diagnostic yield of MPE. Early detection of FCI + cases accelerates the diagnostic pathway of unsuspected MPE, thus supporting its implementation in clinical diagnostic work-up as a diagnostic tool.
当患者没有癌症病史且细胞病理学检查未在胸腔积液（PE）中检测到恶性细胞时，诊断恶性胸腔积液（MPE）具有挑战性。我们研究了通过流式细胞术免疫表型分析（FCI）对PE进行系统分析是否会对MPE的诊断率产生影响。在7年多的时间里，对570例临床怀疑为MPE的患者样本进行了FCI研究。为了筛查上皮性恶性肿瘤，使用了三色FCI高灵敏度检测法。将FCI结果分为“恶性”（FCI+）或“非恶性”（FCI-），并与临床医生根据所有可用信息建立的综合明确诊断进行比较。最终在182个样本中诊断出MPE，FCI检测到其中的141/182例（77.5%）。形态学通过PE中恶性细胞的细胞病理学检测（n = 91）或组织病理学检测（n = 29）进一步证实了FCI的结果。影像学检查和临床病史支持其余样本的诊断。淋巴瘤的恶性细胞中位数百分比为6.5%，上皮细胞恶性肿瘤继发的MPE为0.23%。FCI在细胞病理学阴性的MPE中鉴定出的EpCAM细胞百分比明显低于细胞病理学阳性病例（0.02%对1%；p < 0.0001）。有趣的是，FCI提示存在恶性细胞的52例MPE中有29例（55.8%）是新诊断的癌症。总体而言，FCI正确诊断了456/522个适合与细胞病理学比较的样本（87.4%）。这些发现表明，高灵敏度FCI显著提高了MPE的诊断率。早期检测FCI+病例可加速未怀疑MPE的诊断途径，从而支持将其作为一种诊断工具应用于临床诊断检查。
