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

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Abstract

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 (p = 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 (p < 0.0001), samples from mature B/T cell neoplasms (p = 0.0021), and samples drawn after intrathecal treatment (p = 0.0001). When acquiring ≤220 leukocytes, FCM accuracy was poor, and combining cytomorphology added statistically significant diagnostic advantage (p = 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.

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Authors and Affiliations

  1. Department of Transfusion Medicine and Division of Hematology, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy

    Clara Cesana, Barbara Scarpati, Giambattista Bertani, Elisabetta Volpato, Claudia Barba, Ursula Ferri, Linda Scampini, Giovanni Grillo, Giuliana Lando, Annamaria Nosari, Enrica Morra & Roberto Cairoli

  2. Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Catherine Klersy

  3. Blood Center and Hematology Laboratory, Legnano Hospital, Legnano, Italy

    Bruno Brando & Arianna Gatti

  4. Division of Surgical Pathology and Cytogenetics, Ospedale Niguarda Ca’ Granda Hospital, Milan, Italy

    Maurizio Faleri

Authors
  1. Clara Cesana
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  2. Catherine Klersy
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  3. Barbara Scarpati
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  4. Bruno Brando
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  5. Maurizio Faleri
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  6. Giambattista Bertani
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  7. Arianna Gatti
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  8. Elisabetta Volpato
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  9. Claudia Barba
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  10. Ursula Ferri
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  11. Linda Scampini
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  12. Giovanni Grillo
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  13. Giuliana Lando
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  14. Annamaria Nosari
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  15. Enrica Morra
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  16. Roberto Cairoli
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Correspondence to Clara Cesana.

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Cesana, C., Klersy, C., Scarpati, B. et al. Flow cytometry and cytomorphology evaluation of hematologic malignancy in cerebrospinal fluids: comparison with retrospective clinical outcome. Ann Hematol 90, 827–835 (2011). https://doi.org/10.1007/s00277-010-1145-4

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  • DOI: https://doi.org/10.1007/s00277-010-1145-4

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