Zardawi I M, Jain S, Bennett G
Department of Anatomical Pathology, Canberra Hospital, Garran, Australian Capital Territory, Australia.
Diagn Cytopathol. 1998 Oct;19(4):274-8. doi: 10.1002/(sici)1097-0339(199810)19:4<274::aid-dc9>3.0.co;2-a.
To analyze the value and limitations of flow cytometry (FCM) in the investigation of patients with lymphadenopathy, a retrospective study of 196 patients, referred for fine-needle aspiration (FNA) cytology, was carried out in Canberra, Australian Capital Territory, Australia, between 1992-1997. Complete cytological, flow-cytometric, and outcome (clinical and histological) data were available on all the cases. The FNA appearances were read in conjunction with FCM findings. The following cytological categories were recognized: benign, 78 cases (39.8%); indeterminate, 9 cases (4.6%); and malignant, 109 cases (55.6%). None of the 78 cytologically benign cases had malignant outcome. All 109 cytologically malignant cases had malignant histology, and 8/9 of the cytologically indeterminate FNAs had malignant histology. The cytologically malignant category contained 106 B-cell lymphomas and three T-cell lymphomas. All 65 B-cell lymphomas with K light chain predominance had K/L ratio greater than 3/1, and all 34 B-cell lymphomas with L light chain predominance had an L/K ratio greater than 2/1. Clonality was therefore established for K/L and L/K at 3/1 and 2/1, respectively. When K/L and L/K ratios were below these figures (7 cases), other parameters, including the proportion of CD20 and the dual expression of CD19/CD10 and CD20/CD5, were used to determine the nature of the aspirate. In the B-cell lymphomas without demonstrable light chain restriction, CD20 positivity in excess of 85%, CD19/CD10 positivity of more than 18%, or CD20/CD5 positivity greater than 35% were independently diagnostic of B-cell lymphoma. In the T-cell lymphomas, greater than 90% of the cells were T cells, and aberrant T-cell antigen expression with loss of at least one pan-T-cell antigen was detected. In conclusion, the sensitivity of diagnosis of malignancy, false-negative rate, and predictive value of malignant diagnosis with combined FNA cytology and FCM were 99%, 0%, and 100%, respectively.
为分析流式细胞术（FCM）在淋巴结病患者检查中的价值和局限性，1992年至1997年在澳大利亚首都直辖区堪培拉对196例接受细针穿刺（FNA）细胞学检查的患者进行了一项回顾性研究。所有病例均有完整的细胞学、流式细胞术及结果（临床和组织学）数据。FNA表现结合FCM结果进行解读。确认了以下细胞学分类：良性，78例（39.8%）；不确定，9例（4.6%）；恶性，109例（55.6%）。78例细胞学良性病例均无恶性结果。109例细胞学恶性病例组织学均为恶性，9例细胞学不确定的FNA中有8例组织学为恶性。细胞学恶性分类中包含106例B细胞淋巴瘤和3例T细胞淋巴瘤。所有65例κ轻链占优势的B细胞淋巴瘤κ/λ比值均大于3/1，所有34例λ轻链占优势的B细胞淋巴瘤λ/κ比值均大于2/1。因此分别将κ/λ和λ/κ比值为3/1和2/1作为判断克隆性的标准。当κ/λ和λ/κ比值低于这些数值时（7例），则使用包括CD20比例以及CD19/CD10和CD20/CD5双重表达等其他参数来确定穿刺物的性质。在无明显轻链限制的B细胞淋巴瘤中，CD20阳性率超过85%、CD19/CD10阳性率超过18%或CD20/CD5阳性率大于35%均可独立诊断B细胞淋巴瘤。在T细胞淋巴瘤中，超过90%的细胞为T细胞，且检测到至少一种泛T细胞抗原缺失的异常T细胞抗原表达。总之，联合FNA细胞学和FCM诊断恶性肿瘤的敏感性、假阴性率及恶性诊断的预测值分别为99%、0%和100%。
