探讨非霍奇金淋巴瘤骨髓实验诊断体系的临床应用价值

Clinical application value of bone marrow experimental diagnosis system on non-hodgkin's lymphoma

目的探讨联合多种检测技术的骨髓实验诊断体系诊断非霍奇金淋巴瘤骨髓浸润的价值。方法以骨髓涂片检查、切片检查、流式细胞术、荧光原位杂交技术和染色体核型分析技术为基础,建立骨髓实验诊断体系。体系内容包括实验流程和诊断结果评价体系。实验流程的检验顺序为:(1)骨髓涂片、骨髓切片;(2)FCM分析和染色体培养分析;(3)FISH探针检测。诊断结果评价体系以骨髓涂片(BMA)和病理切片(BMB)作为定性诊断指标,特异性的FCM或免疫组织化学(IHC)的免疫表型和FISH探针的基因表型作为分型依据。CAA结果作为诊断及预后判断指标。各项检测技术的实验操作按常规进行。结果总例数为115例,BMA和BMB完成检查各115例,FCM完成74例,FISH 85例,CAA 23例。各单项检出阳性率分别为BMA 72.17%,BMB 89.96%,FCM 90.54%,FISH 54.12%。实验诊断体系综合分析检出率为100%。单项比较,BMB和FCM的阳性检出率明显高于BMA和FISH,差异显著。将75例淋巴结病理确诊为NHL患者的诊断结论在定性、免疫分型和病理分型3个层面上,做骨髓实验诊断结果与淋巴结病理诊断结果的对比分析,其吻合率分别为98.67%,91.94%,72.00%,说明骨髓诊断NHL在较精准的病理分型水平上还有差距。结论骨髓实验诊断的各单项技术对NHL-BMI的诊断有其临床价值,也有不足和局限。骨髓涂片和骨髓切片检查是基本方法,可以做出定性诊断。进一步做FCM或IHC可以明确免疫分型,配合FISH及CAA可以得到精细的病理分型诊断。多技术联合应用的实验诊断体系是诊断NHL的有效方法,可以提高NHL-BMI的诊断正确性和阳性率。

ObjectiveTo research the value of bone marrow experimental diagnosis system which combination of detecting techniques for bone marrow infiltration of non-hodgkin＇s lymphoma.Methods Bone marrow smear and biopsy, flow cytometry, fluorescencein situhybridization technique and karyotype analysis technology was the foundation to establish the bone marrow experimental diagnosis system. System includes experimental process and result evaluation system. The process of test in proper order include： （1） The bone marrow smear, bone marrow section; （2） FCM analysis and chromosome culture analysis; （3） FISH probe detection. Diagnosis evaluation system had many groups including bone marrow smear （BMA） and pathological section （BMB） as qualitative diagnosis index, specific FCM or immunohistochemistry （IHC） for immune phenotype, and FISH probe gene phenotype as a typing basis, CAA results as a diagnostic and prognostic indicators. The detecting technology of experiments was performed on routine.Results The total number of cases was 115 cases. The patients were checked respectively with BMA（115 cases）, BMB（115 cases）, FCM（74 cases）, FISH（85 cases） and CAA（23 cases）.NHL-BMI detection rate was 72.17% by BMA, 89.96 % by BMB, 90.54% by FCM, 54.12 % by FISH respectively and 100% by bone marrow experimental diagnosis system. BMB and FCM positive detection rate was obviously higher than that of the BMA and FISH by Single comparison and statistics was significant difference. 75patients were diagnosed with NHL by lymph node pathology. The conclusion of diagnosis was compared on the three level of qualitation, immune typing and pathological typing by both of bone marrow experimental diagnosis and lymph node pathological diagnosis results. The ratio of coincidence was 98.67%, 91.94%, 72.00%.The comparative analysis indicates above 2 methods also has the disparity on the accurate pathological typing level. ConclusionEach single technology testing bone marrow for diagnosis of NHL-BMI has its clinical value and also has deficiencies and limitations. Bone marrow smear and bone marrow biopsy is the basic method and can make qualitative diagnosis. Further FCM or IHC can make the immune typing, with addition of FISH and CAA can get fine pathology typing diagnosis. The BM experimental diagnosis system including many technology methods can improve the diagnostic accuracy and the positive rate of NHL-BMI.