探讨网织纤维染色在评估成人淋巴瘤骨髓侵犯中的价值  

Values of reticulin fiber staining in evaluation of bone marrow involvement in adult lymphoma

作　　者：曹友俊 李宁宁 李向红[1] 廉沈沂[1] 谢彦[2] 宋卫卫[2] 赖玉梅[1] 刁新婷 时云飞[1] Cao Youjun;Li Ningning;Li Xianghong;Lian Shenyi;Xie Yan;Song Weiwei;Lai Yumei;Diao Xinting;Shi Yunfei(Department of Pathology,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education)/Peking University Cancer Hospital and Institute,Beijing 100142,China;Department of Lymphoma,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education)/Peking University Cancer Hospital and Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所病理科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所淋巴肿瘤内科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华病理学杂志》2025年第4期361-367,共7页Chinese Journal of Pathology

基　　金：北京市海淀区卫生健康发展科研培育计划(HP2021-31-50302)。

摘　　要：目的探讨成人淋巴瘤患者骨髓活检样本中应用网织纤维染色及分级评估淋巴瘤骨髓侵犯的价值。方法回顾性收集2023年11月至2024年5月北京大学肿瘤医院诊断的成人淋巴瘤病例共354例。骨髓样本同步进行了骨髓穿刺活检标本的网织纤维染色、免疫组织化学染色及骨髓液的流式细胞学检测。网织纤维染色按照欧洲分级共识进行分级,高分级(2~3级)提示存在骨髓侵犯。研究设定的骨髓侵犯综合评估标准为网织纤维染色、免疫组织化学染色和流式细胞学检测中≥2个结果提示侵犯。本研究采用SPSS V23.0软件完成统计学分析。结果本组淋巴瘤患者男性占52.3%(185/354);>60岁者占35.0%(124/354)。其中网织纤维染色提示骨髓侵犯率为34.5%(122/354),按照组别依次是:淋巴母细胞白血病/淋巴瘤组(4/4),惰性B细胞淋巴瘤组(49.1%,53/108),转化的B细胞淋巴瘤组(2/5),侵袭性B细胞淋巴瘤组(26.5%,41/155),T和NK细胞淋巴瘤组(27.3%,12/44),经典型霍奇金淋巴瘤组(26.3%,10/38)等;若按照具体类型则常见的为T淋巴母细胞白血病/淋巴瘤(2/2)、B淋巴母细胞白血病/淋巴瘤(2/2)和慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(8/10)。不同性别及年龄分组网织纤维染色分级差异无统计学意义(χ2=3.416,P=0.032;χ2=4.200,P=0.241);但不同病理组别和类型的网织纤维染色阳性率差异有统计学意义(χ2=29.961,P=0.012;χ2=102.546,P=0.001)。同步进行的免疫组织化学染色及流式细胞学检测提示骨髓侵犯率依次为25.4%(90/354)及13.8%(49/354),综合评估总体骨髓侵犯率为24.3%(86/354),网织纤维染色、免疫组织化学染色及流式细胞学检测3种方法的灵敏度依次为90.8%、97.8%、55.8%;特异度依次为84.1%、99.6%、98.9%;网织纤维染色与免疫组织化学染色及流式细胞学检测的总体符合率为83.6%及74.0%。其中侵袭性B细胞淋巴瘤组为85.8%及74.2%;惰性B细胞淋巴瘤组为79.6%及75.0%;T�ObjectiveTo explore the values of reticulin fiber staining(RFS)in evaluating bone marrow(BM)involvement of lymphoma and in grading of BM biopsy from adult lymphoma patients.MethodsRetrospectively,354 cases of adult lymphoma were collected from November 2023 to May 2024 at Peking University Cancer Hospital.BM samples were stained with RFS and immunohistochemical staining(IHC),and flow cytometry(FCM)was also performed with the BM aspirations simultaneously.RFS was graded according to the European Consensus,as high grade(grade 2-3)indicating BM involvement in the study.BM involvement was considered as definite if no less than two positive findings among IHC,FCM,and RFS.Statistical analyses were performed via SPSS software(V23.0).ResultsIn this series,52.3%(185/354)of the patients were male;35.0%(124/354)aged>60 years;BM involvements were found in 34.5%(122/354)cases with high grade of RFS,which,in turn,were lymphoblastic leukemia/lymphoma(ALL/LBL)group(4/4),indolent B-cell lymphoma(IndBCL)group(49.1%,53/108),transformed B-cell lymphoma(TrBCL)group(2/5),invasive B-cell lymphoma(InvBCL)group(26.5%,41/155),T and NK cell lymphoma(TNKCL)group(27.3%,12/44)and classical Hodgkin lymphoma(CHL)group(26.3%,10/38);if classified by specific types,T-ALL/LBL(2/2),B-ALL/LBL(2/2)and CLL/SLL(8/10)ranked top three.In terms of the positive rate of BM involvement evaluated by RFS,no significant difference was seen between either gender or age groups(χ2=3.416,P=0.332 andχ2=4.200,P=0.241);however,significant differences were observed between different lymphoma groups and types(χ2=29.961,P=0.012 andχ2=102.546,P<0.001,respectively).BM invasion rates indicated by IHC and FCM were 25.4%(90/354)and 13.8%(49/354),respectively.The overall BM invasion rate was 24.3%(86/354),and the sensitivity of RFS,IHC,and FCM was 90.8%,97.8%,and 55.8%,and specificity was 84.1%,99.6%,and 98.9%,respectively.Overall,the concordance rate of RFS with IHC and FCM was 83.6%and 74.0%,respectively,including 85.8%and 74.2%for InvBCL group,79.6%and 75.0%for IndBCL gr

关 键 词：淋巴瘤 骨髓 免疫组织化学染色 流式细胞学 网织纤维染色 染色与标记 

分 类 号：R733.1[医药卫生—肿瘤]