形态学和多参数流式细胞术相结合,用于小体积样本的淋巴瘤综合诊断:可能性和局限性。
Morphology and multiparameter flow cytometry combined for integrated lymphoma diagnosis on small volume samples: possibilities and limitations.
发表日期:2024 May 28
作者:
Mats Ehinger, Marie C Béné
来源:
Bone & Joint Journal
摘要:
淋巴瘤的诊断主要依靠临床检查和实验室探查。在后者中,组织活检的形态学和免疫组织化学分析是疾病正确识别和分类的基石。对于累及血液和/或骨髓的淋巴瘤,多参数流式细胞术很有用。该技术也可应用于从活检样本中释放的新鲜细胞。为了充分了解淋巴瘤,手术活检是最好的,并且确实是血液病理学界推荐的。然而,目前全球趋势是微创手术,导致样本较小,例如芯针活检或细针抽吸,这使得诊断相当具有挑战性。在这篇综述中,介绍了在如此小体积的材料上进行准确淋巴瘤诊断的可能性和局限性。在回顾淋巴瘤诊断的主要步骤后,讨论了组织学、细胞学和流式细胞术各自的价值,包括小样本的处理。然后提出综合方法的好处,然后讨论在不同情况下采取哪种态度。也许与许多病理学家的普遍观点相反,对小体积材料的全面诊断,结合相关的辅助技术,通常是可能的,并且确实得到了最近文献的支持。最终提供了对未来发展的一瞥,特别是人工智能工具的优点。总而言之,本文件旨在为病理学家提供淋巴瘤患者在面对小体积材料(例如芯针活检或细针穿刺活检)时诊断可能性的概述。© 2024。作者。
The diagnosis of lymphoma relies mainly on clinical examination and laboratory explorations. Among the latter, morphological and immunohistochemical analysis of a tissue biopsy are the cornerstones for proper identification and classification of the disease. In lymphoma with blood and/or bone marrow involvement, multiparameter flow cytometry is useful. This technique can also be applied to fresh cells released from a biopsy sample. For full comprehension of lymphomas, surgical biopsies are best and indeed recommended by the hematopathological community. Currently, however, there is a global trend towards less invasive procedures, resulting in smaller samples such as core needle biopsies or fine needle aspirations which can make the diagnosis quite challenging. In this review, the possibilities and limitations to make an accurate lymphoma diagnosis on such small volume material are presented. After recalling the major steps of lymphoma diagnosis, the respective value of histology, cytology, and flow cytometry is discussed, including handling of small specimens. The benefits of an integrated approach are then evoked, followed by discussion about which attitude to adopt in different contexts. Perhaps contrary to the prevailing view among many pathologists, a full diagnosis on small volume material, combined with relevant ancillary techniques, is often possible and indeed supported by recent literature. A glimpse at future evolutions, notably the merit of artificial intelligence tools, is finally provided. All in all, this document aims at providing pathologists with an overview of diagnostic possibilities in lymphoma patients when confronted with small volume material such as core needle biopsies or fine needle aspirations.© 2024. The Author(s).