Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma

• Published in: Blood Vol. 103; no. 8; pp. 3208 - 3215
• Main Authors: Zompi, Simona, Couderc, Louis-Jean, Cadranel, Jacques, Antoine, Martine, Epardeau, Bernard, Fleury-Feith, Jocelyne, Popa, Natalia, Santoli, François, Farcet, Jean-Pierre, Delfau-Larue, Marie-Hélène
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15-04-2004; The Americain Society of Hematology
• Subjects: B-Lymphocytes - immunology; B-Lymphocytes - pathology; Base Sequence; Biological and medical sciences; Bronchoalveolar Lavage Fluid - cytology; Bronchoalveolar Lavage Fluid - immunology; Clone Cells - immunology; Clone Cells - pathology; Complementarity Determining Regions - genetics; DNA, Neoplasm - genetics; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung Neoplasms - diagnosis; Lung Neoplasms - genetics; Lung Neoplasms - immunology; Lung Neoplasms - pathology; Lymphoma, Non-Hodgkin - diagnosis; Lymphoma, Non-Hodgkin - genetics; Lymphoma, Non-Hodgkin - immunology; Lymphoma, Non-Hodgkin - pathology; Medical sciences; Polymerase Chain Reaction - methods; Polymerase Chain Reaction - statistics & numerical data; Predictive Value of Tests; Pulmonary Alveoli - immunology; Pulmonary Alveoli - pathology; Sensitivity and Specificity; Human; Clonality; Bronchoalveolar lavage; Lymphoproliferative syndrome; Lung; Exploration; Malignant hemopathy; B-Lymphocyte; Diagnosis; Respiratory system; Lymphoma
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2003-07-2335

The diagnostic procedure of chronic pulmonary opacities may envisage the search for non-Hodgkin lymphoma (NHL). Previous retrospective studies have shown that clonality analysis of bronchoalveolar B lymphocytes could reflect the clonality of pulmonary lymphocytes. Our objective was to define the diagnostic usefulness of bronchoalveolar lavage (BAL) B-lymphocyte clonality analysis in the setting of a clinical suspicion of both primary and secondary pulmonary lymphoma. A prospective BAL fluid B-cell clonality analysis was performed by polymerase chain reaction (PCR) in 106 consecutive patients presenting with a clinical suspicion of pulmonary NHL. Diagnosis was pulmonary B-cell lymphoma for 22 patients (13 primary and 9 secondary). When compared, pulmonary biopsy and BAL fluid have clonal identity. The detection of a strong B-cell clonal population in BAL fluid was associated with the diagnosis of pulmonary NHL (P< .0001), with a 97% specificity and a 95% negative predictive value. Thus, the absence of a dominant B-cell clone detection in BAL fluid could help to dismiss invasive investigations of pulmonary lesions. The detection of a dominant B-cell clone would lead to the performance of a pulmonary biopsy to get histologic diagnosis in primary pulmonary lymphoma and, by contrast, would avoid the need for biopsy in the setting of a secondary pulmonary lymphoma. (Blood. 2004;103: 3208-3215)