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Blood, 15 April 2004, Vol. 103, No. 8, pp. 3208-3215.
Prepublished online as a Blood First Edition Paper on January 8, 2004; DOI 10.1182/blood-2003-07-2335.
Submitted July 15, 2003
Accepted December 9, 2003
Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma
Simona Zompi, Louis-Jean Couderc, Jacques Cadranel, Martine Antoine, Bernard Epardeau, Jocelyne Fleury-Feith, Natalia Popa, Francois Santoli, Jean-Pierre Farcet, and Marie-Helene Delfau-Larue*
Service de Pneumologie, Hopital Foch, Suresnes, France; Service de Pneumologie, Hopital Tenon, AP-HP, Paris, France
Service de Pneumologie, Hopital Foch, Suresnes, France
Service de Pneumologie, Hopital Tenon, AP-HP, Paris, France; UPRES EA 3493, Universite Paris VI, Paris, France
Service d'Anatomopathologie, Hopital Tenon, AP-HP, Paris, France
Service d'Anatomopathologie, Hopital Foch, Suresnes, France
Service d' Histologie-Biologie Tumorale, Hopital Tenon, AP-HP, Paris, France
Service d'Immunologie biologique, Hopital Henri-Mondor, AP-HP, Creteil, France; EA2348, Universite Paris XII, Creteil, France
* Corresponding author; email: marie-helene.delfau{at}hmn.ap-hop-paris.fr.
The diagnostic procedure of chronic pulmonary opacities may envisage the search for non-Hodgkin's 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 diagnosis 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 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<10-4), 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 perform a pulmonary biopsy to get histological diagnosis in primary pulmonary lymphoma, and by contrast would avoid the need for biopsy in the setting of a secondary pulmonary lymphoma.
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