骨髓细胞形态学和流式细胞术在非霍奇金淋巴瘤患者骨髓侵犯诊断中的价值比较

Comparison of Bone Marrow Cell Morphology and Flow Cytometry in Diagnosis of Bone Marrow Invasion in Patients with Non-Hodgkin’s Lymphoma

目的比较骨髓细胞形态学和流式细胞术在非霍奇金淋巴瘤(NHL)骨髓侵犯诊断中的价值。方法选取2015年6月至2018年11月兰州大学第一医院收治的初诊疑似NHL骨髓侵犯患者150例,分析患者骨髓标本的细胞形态学、流式细胞术及两种方法联合检测的结果和诊断效能。结果骨髓细胞形态学和流式细胞术联合检测NHL骨髓侵犯的阳性率为30.67%(46/150),高于单独骨髓细胞形态学[22.67%(34/150)]、流式细胞术[27.33%(41/150)]检查。骨髓细胞形态学诊断NHL骨髓侵犯的灵敏度、特异度、约登指数、正确率、阳性预测值、阴性预测值和阳性似然比均低于流式细胞术,阴性似然比高于流式细胞术;联合检测的灵敏度、约登指数和阴性预测值均高于两种方法单独检测,特异度、阳性预测值、阳性似然比和阴性似然均低于两种方法单独检测。结论虽然细胞形态学的检出率较低,诊断价值有一定的局限性,但淋巴瘤细胞形态具有一定的特征,仔细观察淋巴瘤细胞的形态特征可做出提示性的诊断。骨髓细胞形态学和流式细胞术的联合检测优于单独检测,联合检测可提高NHL骨髓侵犯的诊断价值。

Objective To compare the value of bone marrow cell morphology and flow cytometry in the diagnosis of non-Hodgkin′s lymphoma(NHL)bone marrow invasion.Methods A total of 150 patients with suspected NHL bone marrow invasion admitted to the First Hospital of Lanzhou University from Jun.2015 to Nov.2018 were included.The results and diagnostic efficacy of cytomorphology,flow cytometry and combined detection of the two methods in bone marrow specimens were retrospectively analyzed.Results The positive rate of combined detection of bone marrow cell morphology and flow cytometry was 30.67%(46/150),higher than that of single bone marrow cell morphology[22.67%(34/150)],and flow cytometry[27.33%(41/150)].The sensitivity,specificity,Yoden index,accuracy,positive predictive value,negative predictive value and positive likelihood ratio of bone marrow cell morphology in diagnosis of NHL bone marrow invasion were lower than those of flow cytometry,and the negative likelihood ratio was higher than that of flow cytometry.The sensitivity,Yoden index and negative predictive value of combined detection were higher than those of the two methods alone,and the specificity,positive predictive value,positive likelihood ratio and negative likelihood were lower than those of the two methods alone.Conclusion Although the detection rate of cell morphology is low and the diagnostic value has certain limitation,the morphology of lymphoma cells has certain characteristics,so it is a suggestive diagnosis by careful observation of the morphological characteristics of lymphoma cells.The combined detection of flow cytometry and bone marrow cell morphology is superior to separate detection,which can improve the diagnostic value of NHL bone marrow invasion.