Original Article
Mod Pathol 2000;13(7):788–796
Image Analysis and Flow Cytometric DNA Studies of Benign and Malignant Body Cavity Fluids: Reappraisal of the Role of Current Methods in the Differential Diagnosis of Reactive Versus Malignant Conditions
Oscar Lazcano M.D.2, Li-Mien Chen M.D.1,3, Cheng Tsai M.D.2, Chin-Yang Li M.D.1, Jerry A Katzmann Ph.D.1, Thomas J Sebo M.D., Ph.D.1, Teresa K Kimlinger B.A.1 and Julie Baker M.T.(A.S.C.P.)2
- 1Department of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
- 2Immunocytometrics Laboratory of Forest Park Hospital, Department of Pathology, St. Louis, Missouri
- 3Visiting Clinician, Division of Hematopathology from the Division of Hematology/Oncology, Department of Medicine, 803 Army General Hospital, Taichung, and National Defense Medical Center, Taipei, Taiwan, Republic of China
Correspondence: Chin-Yang Li, M.D., Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
Accepted 5 January 2000.
Abstract
Cytologic examination of body fluids is commonly performed in the clinical laboratory. Determination of the presence of malignancy may sometimes be difficult. In this study, we prospectively studied 60 body fluids with a panel of antibodies, including MOC-31, epithelial membrane antigen, carcinoembryonic antigen, B72.3, keratin, desmin, and CA-125. DNA and S-phase studies were performed both by flow cytometry and image analysis. Thirty-seven fluids were classified as benign and 23 were classified as malignant. The sensitivity of the antibodies for identification of carcinoma in descending order of percentage detection rate were MOC-31 (95%), epithelial membrane antigen (93%), B72.3 (84%), and carcinoembryonic antigen (80%). Desmin stained mesothelial cells in all cases. CA-125 gave similar results but was less specific. Flow cytometry detected 14 of 20 malignant fluids and image analysis 17 of 23 by identifying an aneuploid population. Benign reactive mesothelial cells were not aneuploid. Tetraploidy due to reactive mesothelial cells was found in 9 of 37 body fluids. Their S-phase fraction was low (average, 3.2%). Tetraploidy in malignant cells was distinguished from the reactive mesothelial cells by high S-phase (average, 25.95). S-phase had some use as a discriminating factor, because no benign reactive cases had more than 17%. However, 7 of 23 malignant cases had a value below 17%. DNA analysis by image was more sensitive and specific than flow. Either may be used when immunocytochemistry is nondiagnostic or cannot be performed.
Keywords:
Body cavity fluids, Cytology, DNA ploidy, Flow cytometry, Image analysis, Mesothelial cells
