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Higher rate of central nervous system involvement by flow cytometry than morphology in acute lymphoblastic leukemia
Author(s) -
Dass J.,
Dayama A.,
Mishra P. C.,
Mahapatra M.,
Seth T.,
Tyagi S.,
Pati H. P.,
Saxena R.
Publication year - 2017
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.12694
Subject(s) - cerebrospinal fluid , medicine , flow cytometry , lactate dehydrogenase , lymphoblastic leukemia , receiver operating characteristic , pathology , gastroenterology , central nervous system , leukemia , cytopathology , immunology , biology , cytology , biochemistry , enzyme
Central nervous system ( CNS ) involvement in acute lymphoblastic leukemia ( ALL ) is diagnosed traditionally by cytopathology ( CP ) of the cerebrospinal fluid ( CSF ). Role of flow cytometry ( FC ) to diagnose CNS involvement has not been extensively investigated. Methods We aimed to detect CNS involvement in 42 ALL patients (33 B‐ ALL , nine T‐ ALL ) at diagnosis by FC and comparing it with CP and to correlate it with known risk factors for CNS disease like Lactate dehydrogenase ( LDH ). A receiver operating characteristic curve was used to determine the cutoff of LDH to predict CSF involvement. For the analysis of categorical/quantitative variables, Fisher's exact test was used. For the analysis of continuous variables, Mann‐Whitney test was used. A P value of <.05 was taken as significant. Results CP and FC were positive in five (11.9%) and 11 patients (26.14%) respectively with FC detecting a significantly higher level of involvement ( P =.001). All CP ‐positive cases were FC positive. A LDH value of >472 U/L had a sensitivity of 61% and specificity of 62.5% for diagnosis of CSF involvement by FC . Conclusions CSF FC detects CNS disease in ALL patients at diagnosis at a rate double than CP alone and is statistically associated with an elevated LDH level. It should be incorporated in the evaluation of CSF to detect CNS involvement.