A retrospective study to assess the relative value of peripheral blood, bone marrow aspirate and biopsy morphology, immunohistochemical stains, and flow cytometric analysis in the diagnosis of chronic B cell lymphoproliferative neoplasms.

Introduction The successful diagnosis of chronic B cell lymphoproliferative neoplasms (B-CLPN) requires the integration of multiple parameters, beginning with clinical information, CBC data, and morphology review. Immunophenotyping is essential and genetic testing may also be necessary. However, the relative value of each specimen or ancillary study in the diagnosis and classification has not been systematically established. We have performed a blinded retrospective review to assess what in our laboratory was the relative value of each specimen type and ancillary study in the diagnostic workup of B-CLPN. Methods A total of 185 cases of PB, BM, spleen and lymph nodes were analyzed for relative value of morphology, IHC, flow cytometry study in the diagnosis of B-CLPN. Results 'High yield' specimen was identified in most B-CLPN categories, which was highly predictive of the final WHO diagnosis. Conclusion The goal of this retrospective study was to attempt to assess what was the relative value of morphology, immunophenotype, and molecular/cytogenetic study in various sites in the overall diagnostic process in our institution. We investigated the utility of the 'high yield' specimens in achieving the correct final diagnosis. In our study, some B-CLPNs notably splenic marginal zone lymphoma and hairy cell leukemia variant, required all studies for a 'best fit' type of diagnosis. In other cases, the morphology of a single specimen type was highly predictive of the final diagnosis, although confirmatory studies are recommended for definitive diagnosis. [ABSTRACT FROM AUTHOR]

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