Role of Immunohistochemistry in Staging Diffuse Large B-cell Lymphoma (DLBCL)

Dipti Talaulikar ^1*, Jane Esther Dahlstrom ¹, Bruce Shadbolt ¹, Amy Broomfield ¹, Anne McDonald ¹ and Michael Pidcock ¹

¹ Department of Haematology (DT,MP), Australian National University Medical School (DT,JED,BS), Department of Anatomical Pathology (JED,AB), and Department of Epidemiology (BS), The Canberra Hospital, Canberra, Australia, and National Capital Private Hospital, Canberra, Australia (AM)

^* To whom correspondence should be addressed. E-mail: dipti.talaulikar{at}act.gov.au.

Submitted on February 11, 2008
Accepted on 11 June 2008

	Abstract

The use of immunohistochemistry in staging bone marrow in Non-Hodgkin’s Lymphoma (NHL) is largely limited to ambiguous cases, particularly those with lymphoid aggregates. Its role in routine clinical practice remains unestablished. This study aimed to determine if the routine use of immunohistochemistry (IHC) in Diffuse Large B-cell lymphoma (DLBCL) would improve the detection of lymphomatous involvement in the bone marrow. It also sought to determine the impact of IHC on predicting survival as compared to routine histological diagnosis using Haematoxylin and Eosin (H&E), Giemsa and reticulin staining. The bone marrow trephines of 156 histologically proven DLBCL cases were assessed on routine histology, and IHC using two T-cell markers (CD45RO and CD3), two B-cell markers (CD20 and CD79a) and Kappa and lambda light chains. IHC detected lymphomatous involvement on an additional 11% cases as compared to histology alone. Although both routine histology and IHC were good predictors of survival, IHC was better at predicting survival on stepwise multivariate Cox regression analysis. Immunohistochemistry performed routinely on bone marrow trephines has the ability to improve detection of occult lymphoma in experienced hands. Furthermore, it is a better predictor of survival as compared to routine histological examination alone.

Key Words: immunohistochemistry, histology, staging, bone marrow trephine biopsy, diffuse large B-cell lymphoma, International Prognostic Index

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