Assessment of the Use of Available Resources for Diagnosing Diffuse Large B-Cell Lymphoma in an HIV-Prevalent Setting

IF 2.3 4区医学 Q3 HEMATOLOGY

International Journal of Laboratory Hematology Pub Date : 2025-03-06 DOI:10.1111/ijlh.14453

Gaone Abigail Moalosi, Jenifer Vaughan, Elise Schapkaitz

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引用次数: 0

Abstract

Background

Limited availability of diagnostic tests in low-resource settings hampers the diagnosis and classification of diffuse large B-cell lymphoma (DLBCL). A study was performed to assess the use of resources for classifying DLBCL in South Africa (SA) using ‘essential’ and ‘desirable’ investigations as per published guidelines.

Methods

A record review was performed of 74 patients newly diagnosed with DLBCL by tissue biopsy at the National Health Laboratory Service (NHLS) in Johannesburg between 1 January 2019 and 31 December 2022. The immunohistochemistry (IHC) and/or molecular work-up performed for the primary diagnosis of DLBCL and the associated costs were recorded.

Results

The primary diagnosis of DLBCL was based on 34 (45.9%) nodal and 40 (54.1%) extra-nodal biopsy sections. Overall, 60 (81.1%) were from participants living with human immunodeficiency virus (HIV) infection. ‘Essential’ IHC for CD3, CD10, CD20, Ki-67, BCL-2, BCL-6, MUM-1 and ‘desirable’ fluorescence in situ hybridisation (FISH) for MYC gene rearrangement were most requested for diagnosis. ‘Essential’ IHC for c-MYC was not performed because of non-availability of the testing. The ‘essential’ IHC was diagnostic in 97.3%. ‘Desirable’ FISH for MYC rearrangement was done in 56 (79.7%) cases, with additional FISH for BCL2 and BCL6 rearrangement performed in cases positive for MYC rearrangement. The average cost of diagnosis at the NHLS was half that of the recommended diagnostic testing.

Conclusion

The advocated ‘essential’ investigations, in addition to ‘desirable’ tests where necessary, enabled the accurate and cost-effective diagnosis of DLBCL in SA and are recommended for other parts of the world with limited resources.

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评估在hiv流行的环境中诊断弥漫性大b细胞淋巴瘤的可用资源的使用。

背景：在低资源环境中，有限的诊断试验的可用性阻碍了弥漫性大b细胞淋巴瘤（DLBCL）的诊断和分类。根据已公布的指南，采用“必要”和“理想”调查，对南非DLBCL分类的资源使用情况进行了一项研究。方法：对2019年1月1日至2022年12月31日期间在约翰内斯堡国家卫生实验室服务（NHLS）通过组织活检新诊断为DLBCL的74例患者进行记录回顾。记录了用于原发性DLBCL诊断的免疫组织化学（IHC）和/或分子检查以及相关费用。结果：DLBCL的初步诊断是基于34个（45.9%）淋巴结和40个（54.1%）淋巴结外活检切片。总的来说，60例（81.1%）来自感染人类免疫缺陷病毒（HIV）的参与者。CD3、CD10、CD20、Ki-67、BCL-2、BCL-6、MUM-1的“必要”免疫组化检测和MYC基因重排的“理想”荧光原位杂交（FISH）是诊断中最需要的。由于无法获得检测，未进行c-MYC的“基本”免疫组化。“必要的”IHC诊断率为97.3%。56例（79.7%）患者对MYC重排进行了“理想的”FISH检查，对MYC重排阳性的患者进行了BCL2和BCL6重排的额外FISH检查。国民保健服务的平均诊断费用是推荐的诊断测试费用的一半。结论：所提倡的“必要”调查，以及必要时的“理想”检查，能够准确且具有成本效益地诊断SA中的DLBCL，并推荐用于世界上资源有限的其他地区。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Laboratory Hematology 医学-血液学

CiteScore

4.50

自引率

6.70%

发文量

211

审稿时长

6-12 weeks

期刊介绍： The International Journal of Laboratory Hematology provides a forum for the communication of new developments, research topics and the practice of laboratory haematology. The journal publishes invited reviews, full length original articles, and correspondence. The International Journal of Laboratory Hematology is the official journal of the International Society for Laboratory Hematology, which addresses the following sub-disciplines: cellular analysis, flow cytometry, haemostasis and thrombosis, molecular diagnostics, haematology informatics, haemoglobinopathies, point of care testing, standards and guidelines. The journal was launched in 2006 as the successor to Clinical and Laboratory Hematology, which was first published in 1979. An active and positive editorial policy ensures that work of a high scientific standard is reported, in order to bridge the gap between practical and academic aspects of laboratory haematology.