Background/Objectives: Primary central nervous system lymphoma (PCNSL) has a markedly high proliferation rate, making early diagnosis and prompt therapeutic intervention essential. To accelerate diagnosis, our institution adopted flow cytometry (FCM) in conjunction with conventional histopathology, and this study therefore evaluated the diagnostic performance of FCM for PCNSL. Methods: We retrospectively analyzed 67 consecutive patients with suspected PCNSL who underwent intraoperative FCM between 2010 and 2023 based on preoperative imaging. B-cell clonality was defined as ≥20% CD19/CD20-positive cells with a κ/λ ratio of >3.0 or <0.5. Results: Using histopathology, we confirmed the presence of PCNSL in 42 patients, all diagnosed as having diffuse large B-cell lymphoma. Six cases (14.3%) were discordant (FCM-D). The sensitivity, specificity, and positive predictive value of FCM were 85.7%, 100%, and 100%, respectively. T-cell markers were significantly elevated in FCM-D cases (p< 0.01), although these were pathologically diagnosed as diffuse large B-cell lymphoma based on histology and immunohistochemistry. Conclusions: FCM yields reliable diagnostic information within hours of tissue collection and supports early therapeutic decisions in PCNSL. Discordant results may reflect reactive T-cell infiltration. This is the first study to present detailed subset analyses in PCNSL using FCM in correlation with pathology, underscoring its utility as a rapid diagnostic tool.
背景/目的：原发性中枢神经系统淋巴瘤（PCNSL）具有极高的增殖率，因此早期诊断和及时治疗干预至关重要。为加速诊断，本机构采用流式细胞术（FCM）联合传统组织病理学进行检测，本研究旨在评估FCM对PCNSL的诊断效能。方法：我们回顾性分析了2010年至2023年间67例基于术前影像学怀疑PCNSL并接受术中FCM检测的连续病例。B细胞克隆性定义为CD19/CD20阳性细胞≥20%且κ/λ比值>3.0或<0.5。结果：通过组织病理学确诊42例PCNSL，均为弥漫大B细胞淋巴瘤。其中6例（14.3%）存在FCM检测不一致（FCM-D）。FCM的敏感性、特异性和阳性预测值分别为85.7%、100%和100%。FCM-D病例中T细胞标志物显著升高（p<0.01），但根据组织学和免疫组化结果，这些病例病理学仍诊断为弥漫大B细胞淋巴瘤。结论：FCM可在组织取样后数小时内提供可靠的诊断信息，有助于PCNSL的早期治疗决策。检测结果不一致可能反映了反应性T细胞浸润。本研究首次通过FCM结合病理学对PCNSL进行详细亚群分析，证实了其作为快速诊断工具的应用价值。
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