Flow cytometry and cytomorphology evaluation of hematologic malignancy in cerebrospinal fluids: comparison with retrospective clinical outcome

Clara Cesana (1) , Catherine Klersy (2) , Barbara Scarpati (1) , Bruno Brando (3) , Maurizio Faleri (4) , Giambattista Bertani (1) , Arianna Gatti (3) , Elisabetta Volpato (1) , Claudia Barba (1) , Ursula Ferri (1) , Linda Scampini (1) , Giovanni Grillo (1) , Giuliana Lando (1) , Annamaria Nosari (1) , Enrica Morra (1) , Roberto Cairoli (1)

1 Department of Transfusion Medicine and Division of Hematology
2 Service of Biometry and Clinical Epidemiology
3 Blood Center and Hematology Laboratory
4 Division of Surgical Pathology and Cytogenetics

An independent clinical assessment was compared with flow cytometry (FCM) and cytomorphology results obtained on 227 cerebrospinal fluids investigated for hematologic malignancy, in a retrospective longitudinal study with a median observation time of 11 months. A combined method assessment (CMA), defining "positive" a sample if at least one method gave "positive" results, was also tested. Eleven out of 55 screening samples and 53 out of 166 follow-up samples resulted positive at clinical evaluation. FCM and CM were concordant with positive clinical assessment in 68.5% and 51.5% of cases, respectively. According to CMA, 10.5% of samples (resulting false negative by either FCM or cytomorphology) were rescued as true positive. FCM retained significantly higher accuracy than cytomorphology ( = 0.0065) and 100% sensitivity when at least 220 leukocytes were acquired. CMA accuracy was higher than FCM accuracy and significantly higher than cytomorphology accuracy in the analysis of all samples ( < 0.0001), samples from mature B/T cell neoplasms ( = 0.0021), and samples drawn after intrathecal treatment ( = 0.0001). When acquiring ≤220 leukocytes, FCM accuracy was poor, and combining cytomorphology added statistically significant diagnostic advantage ( = 0.0043). Although FCM is the best diagnostic tool for evaluating CSF, morphology seems helpful especially when clinically positive follow-up samples are nearly acellular.

Mots clés: Cerebrospinal fluid; Cytomorphology; Flow cytometry; Hematologic malignancy; Lymphoid neoplasm

Clara Cesana, Catherine Klersy, Barbara Scarpati, Bruno Brando, Maurizio Faleri, et al.. Flow cytometry and cytomorphology evaluation of hematologic malignancy in cerebrospinal fluids: comparison with retrospective clinical outcome. Annals of Hematology, 2011, 90 (7), pp.827-835. ⟨10.1007/s00277-010-1145-4⟩. ⟨hal-00615418⟩