Comparative Evaluation of Immunohistochemistry and Flow Cytometry in Diagnosing Clonality in B-Cell Lymphoid Malignancies

Abstract

Objective: To assess various methods for clonality detection in patients with B-cell lymphoblastic leukemia.

Study Design: A diagnostic study
Place and Duration of Study: This study was conducted at the Department of Pathology and Forensic Medicine, Faculty of Medicine, University of Kufa from 1st January 2024 to 30th June 2024.

Methods: Diagnoses were based on the gold-standard flow cytometry test for B-cell acute lymphoblastic leukemia. Patient data, including age, gender, clinical features, complete blood count, blood smear, and bone marrow morphology reports, were collected. Immunohistochemistry panel (CD19, 20, 10, 34, MPO & TdT) was used on BM biopsies.

Results: The mean age was 30.74 years, with a male-to-female ratio of 1:2.04. Four diagnostic marker panels, incorporating IHC and cytochemistry, were evaluated. The first panel of five markers (CD10, 19, 20, 34, and TdT) showed a sensitivity of 46.27% and a specificity of 53.73%, second panel with three markers (CD10, 19, 20, and 34), demonstrated 52.24% sensitivity and 47.76% specificity and third panel (CD10, 19, 20, and TdT) yielded 53.73% sensitivity and 46.27% specificity.

Conclusion: The four-marker IHC panel (CD10, 19, 20, and TdT) is effective for diagnosing B-cell ALL, especially in settings where flow cytometry is inaccessible or unaffordable offers valuable diagnostic utility in low-resource laboratories lacking access to flow cytometry.