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. 2023 Dec;45(6):927-934.
doi: 10.1111/ijlh.14158. Epub 2023 Aug 25.

Factors determining whether diffuse large B-cell lymphoma samples are detected by flow cytometry

David Peng  1 , Aruna Kodituwakku  2 , Steven Le  2 , Sandy A B C Smith  2 , Min R Qiu  1   2 , Peter Earls  2 , Andrew S Field  1   2 , Andrew J C Parker  2 , Matthew Law  3 , Samuel T Milliken  1   2 , William A Sewell  1   2   4
Affiliations

Factors determining whether diffuse large B-cell lymphoma samples are detected by flow cytometry

David Peng et al. Int J Lab Hematol. 2023 Dec.

Abstract

Introduction: Flow cytometry (FCM) is widely used in the diagnosis of mature B-cell neoplasms (MBN), and FCM data are usually consistent with morphological findings. However, diffuse large B-cell lymphoma (DLBCL), a common MBN, is sometimes not detected by FCM. This study aimed to explore factors that increase the likelihood of failure to detect DLBCL by FCM.

Methods: Cases with a final diagnosis of DLBCL that were analysed by eight-colour FCM were retrospectively collated. Clinical, FCM, histopathological and genetic data were compared between cases detected and cases not detected by FCM.

Results: DLBCL cases from 135 different patients were analysed, of which 22 (16%) were not detected by FCM. In samples not detected by flow cytometry, lymphocytes were a lower percentage of total events (p = 0.02), and T cells were a higher percentage of total lymphocytes (p = 0.01). Cases with high MYC protein expression on immunohistochemistry were less likely to be missed by FCM (p = 0.011). Detection of DLBCL was not different between germinal centre B-cell (GCB) and non-GCB subtypes, not significantly affected by the presence of necrosis or fibrosis, and not significantly different between biopsy specimens compared to fine-needle aspirates, or between samples from nodal compared to extranodal tissue.

Conclusion: The study identifies several factors which affect the likelihood of DLBCL being missed by FCM. Even with eight-colour analysis, FCM fails to detect numerous cases of DLBCL.

Keywords: diagnosis; diffuse large B-cell lymphoma; flow cytometry; hematopathology; histopathology.

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References

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