流式细胞学技术对非霍奇金淋巴瘤骨髓侵犯的诊断价值

Clinical value of flow cytometry in assessing bone marrow involvement of non-Hodgkin＇s lymphoma

目的 探讨流式细胞学技术对非霍奇金淋巴瘤（NHL）骨髓侵犯的诊断价值.方法 连续选取2013年3至8月在北京大学肿瘤医院淋巴肿瘤科诊断的NHL 206例患者同时进行骨髓涂片、骨髓活检以及骨髓流式细胞学检测,对结果进行回顾性分析和比较.结果 本组NHL病例的骨髓侵犯比例为25.7％（53/206）.其中14例T淋巴细胞母细胞性淋巴瘤/急性淋巴细胞白血病（T-LBL/ALL）患者其骨髓涂片、活检及流式细胞学检测阳性率分别为6/14、6/14和9/14;152例成熟B细胞NHL患者中骨髓涂片、活检及流式细胞学检测的阳性率分别为9.2％ （14/152）、19.1％（29/152）和23.7％ （36/152）;40例成熟T/NK细胞淋巴瘤患者中骨髓涂片、活检及流式细胞学检测的阳性率分别是0（0/40）、15.0％ （6/40）和2.5％（1/40）.骨髓流式细胞学检测和骨髓活检的诊断一致性高达88.3％.结论 骨髓流式细胞学检测对于诊断NHL,尤其T-LBL/ALL和B细胞NHL骨髓侵犯的敏感性高,和骨髓活检的诊断一致性好.通过对骨髓涂片、活检及流式细胞学检测结果的综合分析,可提高NHL骨髓侵犯的诊断的敏感性和准确性.

Objective To evaluate the value of flow cytometry （FCM） in the diagnosis of bone marrow involvement in patients with non-Hodgkin＇s lymphoma （NHL）.Methods The cytomorphology,biopsy and FCM tests were performed concurrently on bone marrow samples from 206 patients who were consecutively diagnosed as NHL from March 2013 to August 2013 at Peking University Cancer Hospital.The results were analyzed and compared.Results Totally bone marrow involvement occurred in 25.7% （53/206） patients.The detection positivity of bone marrow involvement by cytomorphology,biopsy and flow cytometry were 6/14,6/14 and 9/14 respectively in 14 T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia （T-LBL/ALL） patients ; 9.2% （14/152）,19.1% （29/152） and 23.7% （36/152）respectively in 152 mature B-cell NHL patients; 0（0/40）,15.0% （6/40） and 2.5% （1/40）in 40 cases of mature T/NK-cell NHL.The overall rate of concordance of biopsy and flow cytometry was 88.3%.Conclusions FCM has a high sensitivity in detecting bone marrow involvement in NHL patients,especially those with T-LBL/ALL and B-cell NHL.And a combination of morphology,biopsy and FCM may improve the sensitivity and accuracy in the detection of bone marrow involvement in NHL patients.