4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije
DIAGNOSTIC CHALLENGES IN LYMPHOPROLIFERATIVE DIESASES
Jakšić B, Kardum-Skelin I
University Hospital Merkur, Zagreb, Croatia
46
Klinička citologija - Plenarna i pozvana predavanja
Recent development in diagnostic technology brought up a number of exciting challenges
in lymphoid neoplasms. Traditional diagnostics and classifications, based on
morphological characteristics of involved tissue, are amended with new (non-morphological)
parameters. Current WHO consensus classification includes besides morphology
basis also immunological phenotype and genetic parameters combined with clinical
data to assure reproducible classification that is clinically sound. However, with proliferating
of new diagnostics, a number of conceptual and practical issues are emerging.
On the one hand exponential increase of new data from basic research, translated in
a pletora of new diagnostic parameters that are competing for clinical evaluation of
diagnostic relevance, on the other hand increasing numbers of various treatments are
also competing for clinical evaluation. This is resulting in a complex, multidimensional
system that requires appropriate, methodologically sound clinical research. Clinical relevance
for both diagnosis & treatment should be assessed in longitudinal, interventional
clinical trials including prognostic and survival analysis. Each simple or composite parameter
should be individually tested for clinical relevance, mutual relationship among
parameters should be explored by multivariate analyses. Mere correlation among new
(and old) diagnostic parameters is suboptimal. Poor or inadequate methodology often
translate in biased or invalid results. Practical diagnostic challenges include failure
to address the role of (typical) characteristic sample, to discriminate between „static“
and „dynamic“ parameters , to disregard kinetic parameters , to misuse the clonality
concept disregarding its quantitative aspect, or failure to analyze and manage complex
genetic information etc. All this is of less importance in typical, full blown cases with
predominantly uniform appearance of clonal infiltration. However, especially challenging
are cases with composite cellularity in which clonal cells are scanty and surrounded
with polyclonal or reactive cells. For this reason lymphoproliferative diseases may serve
as an intriguing research model that could help elucidate yet not fully understood interactions
between clonally affected neoplastic cells and other cells in the microenvironment.
Break through in the field requires combined effort of diagnostics experts and
clinicians to perform high quality, productive clinical research. Those experts should be
not sealed in morphological categories unprepared to think “out of box”, but should be
open-minded for paradigm change to come.
bjaksic@mef.hr