High sensitivity flow cytometry immunophenotyping increases the diagnostic yield of malignant pleural effusions.

IF 4.2 3区 医学 Q2 ONCOLOGY
Clinical & Experimental Metastasis Pub Date : 2023-12-01 Epub Date: 2023-10-09 DOI:10.1007/s10585-023-10236-4
Dolores Subirá, Fabiola Barriopedro, Jesús Fernández, Ruth Martínez, Luis Chara, Jorge Castelao, Eugenia García
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Abstract

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.

Abstract Image

高灵敏度的流式细胞术免疫表型可提高恶性胸腔积液的诊断率。
当患者缺乏癌症病史且细胞病理学未检测到胸腔积液(PE)中的恶性细胞时,诊断恶性胸腔积液(MPE)是一项挑战。我们研究了通过流式细胞术免疫表型(FCI)对PE的系统分析是否对MPE的诊断率有任何影响。在7年多的时间里,来自临床怀疑MPE患者的570份样本被提交给FCI研究。为了筛选上皮恶性肿瘤,使用了三色FCI高灵敏度测定法。FCI结果被定性为“恶性”(FCI+)或“非恶性”(FCI-),与临床医生根据所有可用信息确定的综合明确诊断进行比较。在182个样本中最终诊断为MPE,检测到141/182(77.5%)的FCI。形态学通过对PE中恶性细胞的细胞病理学检测进一步证实了FCI的发现(n = 91)或组织病理学(n = 29)。影像学检查和临床病史支持其余样本的诊断。恶性细胞的中位百分比淋巴瘤为6.5%,继发于上皮细胞恶性肿瘤的MPE为0.23%。FCI发现EpCAM的百分比明显较低+ 细胞病理学阴性MPE中的细胞比细胞病理学阳性病例中的细胞多(0.02%vs.1%;p
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来源期刊
CiteScore
7.80
自引率
5.00%
发文量
55
审稿时长
12 months
期刊介绍: The Journal''s scope encompasses all aspects of metastasis research, whether laboratory-based, experimental or clinical and therapeutic. It covers such areas as molecular biology, pharmacology, tumor biology, and clinical cancer treatment (with all its subdivisions of surgery, chemotherapy and radio-therapy as well as pathology and epidemiology) insofar as these disciplines are concerned with the Journal''s core subject of metastasis formation, prevention and treatment.
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