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Waldrop GE, Cocuzzo K, Schneider CL, Kim CY, Goetz TG, Chomba MS, Delaurentis CE, Smithgall MC, Francis RO, Thakur KT. Accuracy of automated analyzers for the estimation of CSF cell counts: A systematic review and meta-analysis. Int J Lab Hematol 2024; 46:234-242. [PMID: 38323691 DOI: 10.1111/ijlh.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
This systematic review evaluates the evidence for accuracy of automated analyzers that estimate cerebrospinal fluid (CSF) white blood cell counts (WBC) compared to manual microscopy. Inclusion criteria of original research articles included human subjects, English language, and manual microscopy comparator. PUBMED, EMBASE and Cochrane Review databases were searched through 2019 and QUADAS-2 Tool was used for assessment of bias. Data were pooled and analyzed by comparison method, using random effects estimation. Among 652 titles, 554 abstracts screened, 104 full-text review, 111 comparisons from 41 studies were included. Pooled estimates of sensitivity and specificity (n = 7) were 95% (95%-CI 93%-97%) and 84% (95%-CI: 64%-96%), respectively. Pooled R2 estimates (n = 29) were 0.95 (95%-CI: 0.95-0.96); Pooled spearman rho correlation (n = 27) estimates were 0.95 (95% CI 0.95-0.96). Among those comparisons using Bland-Altman analysis (n = 11) pooled mean difference was estimated at 0.98 (95% CI-0.54-2.5). Among comparisons using Passing-Bablok regressions (n = 14) the pooled slope was estimated to be 1.05 (95% CI 1.03-1.07). Q tests of homogeneity were all significant with the exception of the Bland-Altman comparisons (I2 10%, p value 0.35). There is good overall accuracy for CSF WBC by automated hematologic analyzers. These findings are limited by the small sample sizes and inconsistent validation methodology in the reviewed studies.
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Affiliation(s)
- Greer E Waldrop
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Kaitlyn Cocuzzo
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Colleen L Schneider
- Medical Scientist Training Program, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Carla Y Kim
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Teddy G Goetz
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Mashina S Chomba
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
- School of Medicine, University Teaching Hospital and University of Zambia, Lusaka, Zambia
| | - Clare E Delaurentis
- Department of Infectious Disease, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie C Smithgall
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Richard O Francis
- Department of Pathology & Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
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Frater JL, Shirai CL, Brestoff JR. Technological features of blast identification in the cerebrospinal fluid: A systematic review of flow cytometry and laboratory haematology methods. Int J Lab Hematol 2022; 44 Suppl 1:45-53. [PMID: 35785436 PMCID: PMC9463081 DOI: 10.1111/ijlh.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Involvement of the central nervous system (CNS) by acute leukemias (ALs) has important implications for risk stratification and disease outcome. The clinical laboratory plays an essential role in assessment of cerebrospinal fluid (CSF) specimens from patients with ALs at initial diagnosis, at the end of treatment, and when CNS involvement is clinically suspected. The two challenges for the laboratory are 1) to accurately provide a cell count of the CSF and 2) to successfully distinguish blasts from other cell types. These tasks are classically performed using manual techniques, which suffer from suboptimal turnaround time, imprecision, and inconsistent inter-operator performance. Technological innovations in flow cytometry and hematology analyzer technology have provided useful complements and/or alternatives to conventional manual techniques. AIMS We performed a PRISMA-compliant systematic review to address the medical literature regarding the development and current state of the art of CSF blast identification using flow cytometry and laboratory hematology technologies. MATERIALS AND METHODS We searched the peer reviewed medical literature using MEDLINE (PubMed interface), Web of Science, and Embase using the keywords "CSF or cerebrospinal" AND "blasts(s)". RESULTS 108 articles were suitable for inclusion in our systematic review. These articles covered 1) clinical rationale for CSF blast identification; 2) morphology-based CSF blast identification; 3) the role of flow cytometry; 4) use of hematology analyzers for CSF blast identification; and 5) quality issues. 9 /L, which is much lower than the original machine count and platelet transfusion was warranted. DISCUSSION 1) Clinical laboratory testing plays a central role in risk stratification and clinical management of patients with acute leukemias, most clearly in pediatric ALs; 2) studies focused on other patient populations, including adults and patients with AML are less prevalent in the literature; 3) improvements in instrumentation may provide better performance for the classification of CSF specimens. CONCLUSION Current challenges include: 1) more precisely characterizing the natural history of AL involvement of the CNS, 2) improvements in automated cell count technology of low cellularity specimens, 3) defining the role of flow MRD testing of CSF specimens and 4) improved recognition of specimen quality by clinicians and laboratory personnel.
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Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cara Lunn Shirai
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jonathan R Brestoff
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Boldú L, Laguna J, Casanova A, García S, Molina A, Merino A. Serous body fluid evaluation using the new automated haematology analyser Mindray BC-6800Plus. Clin Chem Lab Med 2022; 60:1786-1795. [PMID: 36039597 DOI: 10.1515/cclm-2022-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cellular analysis of body fluids (BF) has clinical relevance in several medical conditions. The objective of this study is twofold: (1) evaluate the analytical performance of the BF mode of Mindray BC-6800 Plus compared to manual counts under microscopy and (2) analyse if the high-fluorescent cell counts provided by the analyser (HF-BF) are useful to detect malignancy. METHODS A total of 285 BF was analysed: 250 corresponding to patients without neoplasia and 35 to patients with malignant diseases. Manual differential counts were performed in BF with ≥250 cells/μL. Percentages and absolute counts were obtained on the BC-6800Plus for total nucleated cells (TC-BF), mononuclear, polymorphonuclear and HF-BF. Statistical analysis was performed using Mann-Whitney U-test, Spearman's correlation, Passing-Bablok regression, Bland-Altman graph and ROC curve. RESULTS To compare manual and automatic total cell counts, samples were divided in three groups: <250, 250-1,000 and >1,000 cells/μL. Correlation was good in all cases (r=0.72, 0.73 and 0.92, respectively) without significant differences between both methods (p=0.65, 0.39 and 0.30, respectively). The concordance between methods showed values of 90%. Considering malignant samples, median HF-BF values showed significant higher values (102 cells/μL) with respect to non-malignant (4 cells/μL) (p<0.001). The cut-off value of 8.5 HF-BF/μL was able to discriminate samples containing malignant cells showing sensitivity and specificity values of 89 and 71%, respectively. Considering both, HF-BF and TC-BF values, sensitivity and specificity values were 100 and 53%, respectively. CONCLUSIONS This study reveals that the Mindray BC-6800Plus offers an accurate and acceptable performance, showing results consistent with the manual method. It is recommended to consider both HF-BF and TC-BF values for the screening of the microscopic evaluation to ensure the detection of all malignant samples.
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Affiliation(s)
- Laura Boldú
- Haematology and Cytology Unit. CORE Laboratory. Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Centre, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Javier Laguna
- Haematology and Cytology Unit. CORE Laboratory. Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Centre, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Alexandra Casanova
- Haematology and Cytology Unit. CORE Laboratory. Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Centre, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Saray García
- Haematology and Cytology Unit. CORE Laboratory. Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Centre, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Angel Molina
- Haematology and Cytology Unit. CORE Laboratory. Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Centre, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - Anna Merino
- Haematology and Cytology Unit. CORE Laboratory. Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Centre, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
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Comparison of manual and automatic cell count methods for synovial fluid: A prospective study. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.997894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Seghezzi M, Previtali G, Moioli V, Alessio MG, Guerra G, Buoro S. Performance evaluation of automated cell counts compared with reference methods for body fluid analysis. Diagnosis (Berl) 2021; 9:369-378. [PMID: 34599561 DOI: 10.1515/dx-2021-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cellular analysis of body fluids (BFs) can assist clinicians for the diagnosis of many medical conditions. The aim of this work is the evaluation of the analytical performance of the UF-5000 body fluid mode (UF-BF) analyzer compared to the gold standard method (optical microscopy, OM) and to XN-1000 (XN-BF), another analyzer produced by the same manufacturer (Sysmex) and with a similar technology for BF analysis. METHODS One hundred BF samples collected in K3EDTA tubes were analyzed by UF-BF, XN-BF and OM. The agreement was evaluated using Passing and Bablok regression and Bland-Altman plot analysis. The receiver operating characteristic (ROC) curves were selected for evaluating the diagnostic agreement between OM classification and UF-BF parameters. RESULTS Comparison between UF-BF and OM, in all BF types, showed Passing and Bablok's slope comprised between 0.99 (polymorphonuclear cells count, PMN-BF) and 1.39 (mononuclear cells count, MN-BF), the intercepts ranged between 26.47 (PMN-BF parameter) and 226.80 (white blood cell count). Bland-Altman bias was comprised between 7.3% (total cell count, TC-BF) and 52.9% (MN-BF). Comparison between UF-BF and XN-BF in all BF showed slopes ranged between 1.07 (TC-BF and PMN-BF) and 1.16 (MN-BF), intercepts ranged between 8.30 (PMN) and 64.78 (WBC-BF). Bland-Altman bias ranged between 5.8 (TC-BF) and 21.1% (MN-BF). The ROC curve analysis showed an area under the curve ranged between 0.9664 and 1.000. CONCLUSIONS UF-BF shows very good performance for the differential counts of cells in ascitic, pleural and synovial fluids and therefore it is useful to screen and count cells in this type of BF.
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Affiliation(s)
- Michela Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Giovanni Guerra
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sabrina Buoro
- Regional Reference Center for the Quality of Laboratory Medicine Services, Milan, Italy
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Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices-A Critical Appraisal. Cells 2021; 10:cells10051232. [PMID: 34069775 PMCID: PMC8157290 DOI: 10.3390/cells10051232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
The analysis of cells in the cerebrospinal fluid (CSF) is a routine procedure that is usually performed manually using the Fuchs–Rosenthal chamber and cell microscopy for cell counting and differentiation. In order to reduce the requirement for manual assessment, automated analyses by devices mainly used for blood cell analysis have been also used for CSF samples. Here, we summarize the current state of investigations using these automated devices and critically review their limitations. Despite technical improvements, the lower limit for reliable leukocyte counts in the CSF is still at approximately 20 cells/µL, to be validated depending on the device. Since the critical range for clinical decisions is in the range of 5–30 cells/µL this implies that cell numbers < 30/µL require a manual confirmation. Moreover, the lower limit of reliable erythrocyte detection by automated devices is at approximately 1000/µL. However, even low erythrocyte numbers may be of clinical importance. In contrast, heavily hemorrhagic samples from neurosurgery may be counted automatically at an acceptable precision more quickly. Finally, cell differentiation by automated devices provides only a rough orientation for lymphocytes, granulocytes and monocytes. Other diagnostically important cell types such as tumor cells, siderophages, blasts and others are not reliably detected. Thus, although the automation may give a gross estimate sufficient for the emergency room situation, each CSF requires a manual microscopy for cytological evaluation for the final report. In conclusion, although automated analysis of CSF cells may provide a first orientation of the cell profile in an individual sample, an additional manual cell count and a microscopic cytology are still required and represent the gold standard.
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Alcaide Martín MJ, Altimira Queral L, Sahuquillo Frías L, Valiña Amado L, Merino A, García de Guadiana-Romualdo L. Automated cell count in body fluids: a review. ADVANCES IN LABORATORY MEDICINE 2021; 2:149-177. [PMID: 37363326 PMCID: PMC10197423 DOI: 10.1515/almed-2021-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/21/2020] [Indexed: 06/28/2023]
Abstract
Body fluid cell counting provides valuable information for the diagnosis and treatment of a variety of conditions. Chamber cell count and cellularity analysis by optical microscopy are considered the gold-standard method for cell counting. However, this method has a long turnaround time and limited reproducibility, and requires highly-trained personnel. In the recent decades, specific modes have been developed for the analysis of body fluids. These modes, which perform automated cell counting, are incorporated into hemocytometers and urine analyzers. These innovations have been rapidly incorporated into routine laboratory practice. At present, a variety of analyzers are available that enable automated cell counting for body fluids. Nevertheless, these analyzers have some limitations and can only be operated by highly-qualified laboratory professionals. In this review, we provide an overview of the most relevant automated cell counters currently available for body fluids, the interpretation of the parameters measured by these analyzers, their main analytical features, and the role of optical microscopy as automated cell counters gain ground.
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Affiliation(s)
- María José Alcaide Martín
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
- Hematologic Biology Committee, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Laura Altimira Queral
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Laura Sahuquillo Frías
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Laura Valiña Amado
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Anna Merino
- Hematologic Biology Committee, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
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Lee J, Cho Y, Kim HS, Kang HJ, Kim M, Lee YK. A comparison of the analysis of 3 types of body fluids using the XN-350 hematology analyzer versus light microscopy assessment. Medicine (Baltimore) 2021; 100:e24852. [PMID: 33725957 PMCID: PMC7982217 DOI: 10.1097/md.0000000000024852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
We evaluated the capacity of the XN-350 instrument to analyze 3 different types of body fluid samples under "body fluid mode."The performance of XN-350 was evaluated in terms of precision, carryover, limit of blank, limit of detection, limit of quantification, and linearity. Cell enumeration and differential data produced by the XN-350 were compared to manual chamber counting results in 63 cerebrospinal fluid (CSF), 51 ascitic fluid, and 51 pleural fluid (PF) samples. Comparisons between XN-350 versus Cytospin data were also performed in PF samples.The precision, carry-over, limit of blank, and linearity of the XN-350 were acceptable. The limits of detection for white blood cells (WBCs) and red blood cells were 1.0/μL, and 1,000.0/μL, respectively; the corresponding limits of quantitation (LOQs) were 5.0/μL and 2,000.0/μL, respectively. The XN-350's cell enumeration and differential counting correlated well with those of manual chamber counting for all 3 sample types (except for differential counting in CSF samples), particularly parameters involving monocytes (r = 0.33) and mononuclear cells (MO- body fluid [BF]; r = 0.26), as well as total cell (TC-BF) enumeration (r = 0.50) and WBC-BF (r = 0.50) in PF samples. The MO-BF in CSF samples differed significantly from manual chamber counting results, but neither TC-BF nor WBC-BF in PF samples did. The XN-350 also showed good correlations with Cytospin analyses for differential counting of neutrophils, lymphocytes, and monocytes in PF samples. The differential counting of eosinophils via the XN-350 and Cytospin were not significantly correlated, but the difference between them was not significant.The XN-350 is an acceptable alternative to manual fluid analysis. Samples with low cellularity around the LOQ should be checked manually. Moreover, manual differential counting should be performed on CSF samples, particularity those with low cell numbers.
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Saadalla A, Jara Aguirre J, Wockenfus AM, Kelley BR, Swanson RL, Howard MT, Karon BS. Evaluation of automated synovial fluid total cell count and percent polymorphonuclear leukocytes on a Sysmex XN-1000 analyzer for identifying patients at risk of septic arthritis. Clin Chim Acta 2020; 510:416-420. [PMID: 32763227 DOI: 10.1016/j.cca.2020.07.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 07/31/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Total cell counts (TC-BF) and percent polymorphonuclear cells (%PMN) of synovial fluid (SF) aspirates provide important cues for the timely diagnosis and management of septic arthritis. To facilitate faster turnaround time, we compared automated to manual TC-BF and differential counts in order to identify reporting cut-offs for automated TC-BF and %PMN that would allow release of automated results concordant with manual counts and differentials. METHODS Automated TC-BF and %PMN counts of a non-validated analyzer (Analyzer-B in STAT laboratory) were compared to a validated analyzer (Analyzer-A) and manual TC-BF counts and cytospin differentials. Concordance and %differences of Analyzer-B versus Analyzer-A and manual counts were assessed by linear regression analysis and Bland-Altman comparison. RESULTS Overall, automated and manual counts displayed good correlation. A majority of samples demonstrated unacceptable (>20%) differences between automated and manual counts at lower TC-BF (<10,000 cells/μl) and %PMN (<60%). CONCLUSIONS Based on good overall correlation and fewer samples with unacceptable (>20%) differences between automated and manual counts, we adopted TC-BF > 10,000 cells/μl and %PMN > 60% as cutoffs for reporting automated counts. These cutoffs minimize differences between automated and manual cell counts and differentials and would allow rapid automated reporting in the vast majority of septic arthritis cases.
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Affiliation(s)
- Abdulrahman Saadalla
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Jose Jara Aguirre
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Amy M Wockenfus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Brandon R Kelley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Rebecca L Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Matthew T Howard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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Sun J, Ding S, Zhu L, Liu Y, Jiang Q, Song S, Chen W, Li S, Ma P. Improving performance of recently introduced flow cytometry-based approach of malignant cell screening in serous cavity effusion. Int J Lab Hematol 2020; 42:612-618. [PMID: 32573949 DOI: 10.1111/ijlh.13269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Microscopy has been recognized as the "gold-standard" cellular analysis of serous cavity effusion. However, this method is time-consuming, labor-intensive, and requires accomplished skills. Here, we investigated the efficiency of hematology analyzer in screening malignant cells in serous cavity effusion. METHODS A total of 991 serous cavity effusion samples and 370 validation specimens collected from different departments were sent to the clinical laboratory for routine cell count using the automated hematology body fluid (BF) mode and exfoliative cytology simultaneously. High-fluorescent cells (HFCs) were measured as the relative count (HF%) and absolute count (HF#) by BF mode. Receiver operating characteristic curve analysis was combined with scattergram rules to screen malignant cells. RESULTS HF# and HF% in malignant samples (subgroup) were significantly higher than those in benign samples, and the HF# and HF% levels were different between ascites and pleural effusion (PE). The area under the curve values were also different between ascites and PE. Positive of malignant cells was very high when the ascites or PE sample touching Rule 1 positive and either Rule 2 negative or positive. The cutoff levels of HF# were 5.5 HFC/μL on the basis of Rules 1 and 2 negative, whereas 83.5 HFC/μL on the basis of Rule 1 negative but Rule 2 positive in ascites. By contrast, the cutoff levels of HF% were 0.55 HFC/100 WBC on the basis of Rules 1 and 2 negative, whereas 4.95 HFC/100 WBC on the basis of Rule 1 negative but Rule 2 positive in PE. CONCLUSIONS Serous cavity effusion will be increasingly analyzed using the automated hematology analyzer BF mode in the future because of its rapidness and convenience. The combined application of HFC with scattergram rules is a feasible and useful approach to screen malignant cells in serous cavity effusion.
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Affiliation(s)
- Jingfang Sun
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuang Ding
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Liqiang Zhu
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Liu
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qingqing Jiang
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuang Song
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weimin Chen
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shibao Li
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ping Ma
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology Institute, Xuzhou Medical University, Xuzhou, China
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Chun S, Phan MTT, Hong S, Yang J, Yoon Y, Han S, Kang J, Yazer MH, Kim J, Cho D. Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease. PLoS One 2020; 15:e0229724. [PMID: 32214402 PMCID: PMC7098637 DOI: 10.1371/journal.pone.0229724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/13/2020] [Indexed: 11/20/2022] Open
Abstract
Background Transfusion-associated graft-versus-host disease (TA-GvHD) is caused by leukocytes, specifically T cells within a transfused blood product. Currently, the prevention of transfusion-associated graft-versus-host disease is performed by irradiation of blood products. With a sufficient reduction of leukocytes, the risk for TA-GvHD can be decreased. With consistent advances in current state-of-the-art blood filters, we herein propose that double filtration can sufficiently reduce leukocytes to reduce the risk for TA-GvHD. Materials Thirty RBC concentrates were filtered with leukocyte filters, followed by storage at 1–6 oC for 72 hours, and then a second filtration was performed. Residual leukocytes in the double-filtered RBC units (n = 30) were assessed with flow cytometric methods, and an additional assay with isolated peripheral blood mononuclear cells (PBMCs) (n = 6) was done by both flow cytometric methods and an automated hematology analyzer. Quality of the RBCs after filtration was evaluated by hematological and biochemical tests. In vitro T cell expansion was performed using anti-CD3/CD28-coated Dynabeads or anti-CD3 (OKT3). In vivo experiment for GvHD was performed by using NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice. Results Double-filtered blood products showed residual leukocyte levels below detection limits, which calculated to be below 1200–2500 cells per blood unit. In vitro expansion rate of T cells showed that 6x103 and 1x103 cell-seeded specimens showed 60.8±10.6 fold and 10.2±9.7-fold expansion, respectively. Cell expansion was not sufficiently observed in wells planted with 1x102 or 10 cells. In vivo experiments showed that mice injected with 1x105 or more cells cause fatal GvHD. GvHD induced inflammation was observed in mice injected with 1x104 or more cells. No evidence of GvHD was found in mice injected with 103 cells. Conclusions Our study suggests that additional removal of contaminating lymphocytes by a second leukodepletion step may further reduce the risk for TA-GvHD.
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Affiliation(s)
- Sejong Chun
- Department of Laboratory Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Minh-Trang Thi Phan
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Saetbyul Hong
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Jehoon Yang
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Yeup Yoon
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungwon Kang
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jaehyun Kim
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
- * E-mail: (DC); (JK)
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunwan University School of Medicine, Seoul, Korea
- * E-mail: (DC); (JK)
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Gérard D, Henry S, Chatelain B, Lesesve JF. Detection of metastatic cells in body fluids by the automated Sysmex XN-9000 analyzer and flow-cytometric Infinicyt software. Int J Lab Hematol 2020; 42:e146-e149. [PMID: 32202390 DOI: 10.1111/ijlh.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Delphine Gérard
- Service d'hématologie biologique, University Hospital, Nancy, France
| | - Sylvain Henry
- Service d'hématologie biologique, University Hospital, Nancy, France
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13
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Cho J, Oh J, Lee SG, Lee YH, Song J, Kim JH. Performance Evaluation of Body Fluid Cellular Analysis Using the Beckman Coulter UniCel DxH 800, Sysmex XN-350, and UF-5000 Automated Cellular Analyzers. Ann Lab Med 2020; 40:122-130. [PMID: 31650728 PMCID: PMC6822009 DOI: 10.3343/alm.2020.40.2.122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/30/2019] [Accepted: 10/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Automated cellular analyzers are expected to improve the analytical performance in body fluid (BF) analysis. We evaluated the analytical performance of three automated cellular analyzers and established optimum reflex analysis guidelines. METHODS A total of 542 BF samples (88 cerebrospinal fluid [CSF] samples and 454 non-CSF samples) were examined using manual counting and three automated cellular analyzers: UniCel DxH 800 (Beckman Coulter), XN-350 (Sysmex), and UF-5000 (Sysmex). Additionally, 2,779 BF analysis results were retrospectively reviewed. For malignant cell analysis, the receiver operating characteristic (ROC) curve was used, and the detection of high fluorescence-BF cells (HF-BFs) using the XN-350 analyzer was compared with cytology results. RESULTS All three analyzers showed good agreement for total nucleated cell (TNC) and red blood cell (RBC) counts, except for the RBC count in CSF samples using the UniCel DxH 800. However, variable degrees of differences were observed during differential cell counting. For malignant cell analysis, the area under the curve was 0.63 for the XN-350 analyzer and 0.76 for manual counting. We established our own reflex analysis guidelines as follows: HF-BFs <0.7/100 white blood cells (WBCs) is the criterion for quick scans with 100× magnification microscopic examination as a rule-out cut-off, while HF-BFs >83.4/100 WBCs or eosinophils >3.8% are the criteria for mandatory double check confirmation with 1,000× magnification examination. CONCLUSIONS The three automated analyzers showed good analytical performances. Application of reflex analysis guidelines is recommended for eosinophils and HF-BFs, and manual confirmation is warranted.
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Affiliation(s)
- Jooyoung Cho
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joowon Oh
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Guk Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - You Hee Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewoo Song
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Ho Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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14
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Favresse J, Boland L, Schellen M, Fervaille C, Wuestenberghs F, Camboni A, Chatelain B, Mullier F, Defour JP, Jacqmin H. Two-site evaluation of a new workflow for the detection of malignant cells on the Sysmex XN-1000 body fluid analyzer. Int J Lab Hematol 2020; 42:544-551. [PMID: 32163671 DOI: 10.1111/ijlh.13187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The presence of high fluorescent cells (HF-BF) on the Sysmex XN-1000 hematology analyzers has gained interest regarding the prediction of malignant cells in body fluids, but lacks sensitivity. We aimed to increase this sensitivity by combining HF-BF value, automated results, and clinical information. METHODS We evaluated a new workflow for the management of body fluids in the hematology laboratory, including the HF-BF criterion and clinical information. In two laboratories, 1623 serous fluids were retrospectively analyzed on the XN-1000 BF mode. All samples were morphologically screened for malignant cells. Optimal HF-BF cutoffs were determined to predict their presence. Thereafter, the added value of clinical information was evaluated. Other reflex testing rules (eosinophilic count >5% and presence of the WBC Abnormal Scattergram flag) were also used to refine our workflow. RESULTS Optimal HF-BF cutoffs in the two hematology centers were 108 and 45 cells/µL, yielding a sensitivity/specificity of 66.7/93.6% and 86.8/66.6% for malignant cell detection. When adding clinical information, sensitivity/specificity evolved to 100.0/68.9% and 100.0%/not determined. Of 104 samples containing malignant cells, 97 had positive clinical information; the remainder had a HF-BF > cutoff. CONCLUSION Combining clinical information and HF-BF reached 100% sensitivity for malignant cell detection in body fluid analysis. Lack of robustness of the optimal HF-BF cutoff deserves the use of local cutoffs. Rapid automated results reporting from the XN-1000 BF mode are also feasible in clinical practice. Prospective evaluation of the workflow is needed before its implementation in clinical practice.
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Affiliation(s)
- Julien Favresse
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
| | - Lidvine Boland
- Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium
| | - Marie Schellen
- Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium
| | - Caroline Fervaille
- Pathology Department, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Fabien Wuestenberghs
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Godinne University Hospital, UCLouvain, Yvoir, Belgium
| | - Alessandra Camboni
- Pathology Department, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium
| | - Bernard Chatelain
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
| | - François Mullier
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
| | - Jean-Philippe Defour
- Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium.,Ludwig Cancer Research and de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Hugues Jacqmin
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
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15
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Favresse J, Fervaille C, Wuestenberghs F, Chatelain B, Mullier F, Jacqmin H. Utility of the XN‐1000 research mode for leukocytes counting in ascitic and pleural fluids. Int J Lab Hematol 2019; 42:e92-e95. [DOI: 10.1111/ijlh.13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Julien Favresse
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Caroline Fervaille
- Pathology Department Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Fabien Wuestenberghs
- Department of Gastroenterology and Hepatology Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Bernard Chatelain
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - François Mullier
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Hugues Jacqmin
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
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16
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Rastogi L, Dass J, Arya V, Kotwal J. Evaluation of high-fluorescence body fluid (HF-BF) parameter as a screening tool of malignancy in body fluids. INDIAN J PATHOL MICR 2019; 62:572-577. [PMID: 31611442 DOI: 10.4103/ijpm.ijpm_802_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Automated body fluid (BF) analysis is gradually replacing the traditional methods of cell counting in all BFs. This study was done to analyze the high-fluorescence (HF)-BF parameter generated on Sysmex XN-1000 and study its correlation with the presence of malignant cells in the body fluids. A correlation between manual and automated differential counts was also done. Materials and Methods A total of 1985 samples including 797 ascitic fluids (AF), 532 pleural fluids (PF), and 656 cerebrospinal fluids (CSF) were run on Sysmex XN-1000 in BF mode and cytopathology was available for 924 BFs including 389 AF, 379 PF, and 156 CSF. Both manual and automated methods were used for cell differential and cell morphology. Results Of the 924 samples with corresponding cytopathology, malignancy was found in 59 samples. The HF-BF%/100 WBCs (24.8 ± 72.5) and HF-BF#/μL (329.86 ± 932.35) for malignant BF samples were found to be significantly higher than the nonmalignant samples (4.41 ± 8.1) and (19.57 ± 61.91), respectively. Receiver-operator-characteristic curve cutoffs for all BF for percentage and absolute HF-BF were 2.85%/100 WBCs and >12/μL. A good correlation was found between the manual and automated WBC differential counts in all fluids except CSF with total count < 5/μL. Conclusions BFs can be reliably analyzed on automated analyzers. HF-BF parameter is helpful in identifying malignant samples but cannot be totally relied upon. If HF-BF%/# are above the lab-generated cutoffs, microscopy should be done. A complete validation study on HF-BF parameter in BF mode is desired to set the standards for the analysis of serious effusions.
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Affiliation(s)
- Loveena Rastogi
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jasmita Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vandana Arya
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jyoti Kotwal
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
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17
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Yamatani K, Tabe Y, Ai T, Kimura K, Takemura H, Tsuchiya K, Yang H, Konishi A, Uchihashi K, Horii T, Miida T, Ohsaka A. Performance evaluation of the Sysmex DI-60 overview application for tumor cell detection in body fluid samples. Int J Lab Hematol 2019; 41:e134-e138. [PMID: 31034145 DOI: 10.1111/ijlh.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/17/2019] [Accepted: 04/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kotoko Yamatani
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomohiko Ai
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Konobu Kimura
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sysmex, Hematology-Product Engineering, Product Development, Kobe, Japan
| | - Hiroyuki Takemura
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Koji Tsuchiya
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan.,Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haeun Yang
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Aya Konishi
- Sysmex, Hematology-Product Engineering, Product Development, Kobe, Japan
| | - Kinya Uchihashi
- Sysmex, Hematology-Product Engineering, Product Development, Kobe, Japan
| | - Takashi Horii
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akimichi Ohsaka
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan.,Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
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18
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Buoro S, Seghezzi M, Dominoni P, Moioli V, Manenti B, Previtali G, Ottomano C, Lippi G. Lack of harmonization in high fluorescent cell automated counts with body fluids mode in ascitic, pleural, synovial, and cerebrospinal fluids. Int J Lab Hematol 2019; 41:277-286. [PMID: 30758900 DOI: 10.1111/ijlh.12968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cellular analysis in body fluids (BFs) provides important diagnostic information in various pathological settings. This study was hence aimed at comparing automated cell count obtained with Mindray BC-6800 (BC-BF) vs Sysmex XN-series (XN-BF) and evaluating other quantitative and qualitative information provided by these analyzers in ascitic (AF), pleural (PF), synovial (SF), and cerebrospinal (CSF) fluids. METHODS Three hundred and fifty-one samples (99 AFs, 45 PFs, 75 SFs, and 132 CSFs) were analyzed in parallel with BC-BF, XN-BF, and optical microscopy (OM). The study also included the assessment of diagnostic agreement among BC-BF, XN-BF, and OM. RESULTS The comparison of BC-BF vs XN-BF yielded slopes of Passing and Bablok regression always comprised between 0.9 and 1.0 except for EO-BF and HF-BF, whilst the intercepts ranged from -0.4 for MN-BF and 12.0 for PMN-BF. The bias was comprised between -103.3% and 67.1% for HF-BF and EO-BF, respectively. A significant bias was found for TC-BF, WBC-BF, HF-BF (negative bias) and for PMN-BF and EO-BF (positive bias). The agreement (Cohen's kappa) between XN-BF and BC-BF was always ≥0.7, ranging between 0.87 in CSFs and 0.94 in AFs, and that with OM was similar (ie, 0.85 and 0.96). CONCLUSION The cytometric analysis of BF samples using BC-BF and XN-BF is clinically favorable when appropriately combined with OM. Quantitative and qualitative parameters displayed optimal agreement, whilst instrument-specific cut-offs should be defined and implemented for HF-BF and EO-BF. Further efforts should be made for achieving better harmonization in cytometric analysis of BF samples.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Seghezzi
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Dominoni
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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19
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Larruzea A, Aguadero V, Orellana R, Berlanga E. High-fluorescent cells: A marker of malignancy in the analysis of body fluid samples. Int J Lab Hematol 2018; 40:e43-e45. [DOI: 10.1111/ijlh.12793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A. Larruzea
- Clinical Biochemistry Department; Institut d'Investigació i Innovació Parc Taulí I3PT; Parc Taulí Hospital Universitari; Universitat Autònoma de Barcelona; Sabadell Spain
| | - V. Aguadero
- Clinical Biochemistry Department; Institut d'Investigació i Innovació Parc Taulí I3PT; Parc Taulí Hospital Universitari; Universitat Autònoma de Barcelona; Sabadell Spain
| | - R. Orellana
- Pathology Department; Institut d'Investigació i Innovació Parc Taulí I3PT; Parc Taulí Hospital Universitari; Universitat Autònoma de Barcelona; Sabadell Spain
| | - E. Berlanga
- Clinical Biochemistry Department; Institut d'Investigació i Innovació Parc Taulí I3PT; Parc Taulí Hospital Universitari; Universitat Autònoma de Barcelona; Sabadell Spain
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20
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Ai T, Tabe Y, Takemura H, Kimura K, Takahashi T, Yang H, Tsuchiya K, Konishi A, Uchihashi K, Horii T, Ohsaka A. Novel flowcytometry-based approach of malignant cell detection in body fluids using an automated hematology analyzer. PLoS One 2018; 13:e0190886. [PMID: 29425230 PMCID: PMC5806859 DOI: 10.1371/journal.pone.0190886] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/21/2017] [Indexed: 11/23/2022] Open
Abstract
Morphological microscopic examinations of nucleated cells in body fluid (BF) samples are performed to screen malignancy. However, the morphological differentiation is time-consuming and labor-intensive. This study aimed to develop a new flowcytometry-based gating analysis mode “XN-BF gating algorithm” to detect malignant cells using an automated hematology analyzer, Sysmex XN-1000. XN-BF mode was equipped with WDF white blood cell (WBC) differential channel. We added two algorithms to the WDF channel: Rule 1 detects larger and clumped cell signals compared to the leukocytes, targeting the clustered malignant cells; Rule 2 detects middle sized mononuclear cells containing less granules than neutrophils with similar fluorescence signal to monocytes, targeting hematological malignant cells and solid tumor cells. BF samples that meet, at least, one rule were detected as malignant. To evaluate this novel gating algorithm, 92 various BF samples were collected. Manual microscopic differentiation with the May-Grunwald Giemsa stain and WBC count with hemocytometer were also performed. The performance of these three methods were evaluated by comparing with the cytological diagnosis. The XN-BF gating algorithm achieved sensitivity of 63.0% and specificity of 87.8% with 68.0% for positive predictive value and 85.1% for negative predictive value in detecting malignant-cell positive samples. Manual microscopic WBC differentiation and WBC count demonstrated 70.4% and 66.7% of sensitivities, and 96.9% and 92.3% of specificities, respectively. The XN-BF gating algorithm can be a feasible tool in hematology laboratories for prompt screening of malignant cells in various BF samples.
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Affiliation(s)
- Tomohiko Ai
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoko Tabe
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- * E-mail:
| | - Hiroyuki Takemura
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Konobu Kimura
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sysmex, Hematology-Product Engineering, Product Development, Kobe, Japan
| | - Toshihiro Takahashi
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Haeun Yang
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Tsuchiya
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Aya Konishi
- Sysmex, Hematology-Product Engineering, Product Development, Kobe, Japan
| | - Kinya Uchihashi
- Sysmex, Hematology-Product Engineering, Product Development, Kobe, Japan
| | - Takashi Horii
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Akimichi Ohsaka
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
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21
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Cho YU, You E, Jang S, Park CJ. Validation of reflex testing rules and establishment of a new workflow for body fluid cell analysis using a Sysmex XN-550 automatic hematology analyzer. Int J Lab Hematol 2018; 40:258-267. [DOI: 10.1111/ijlh.12774] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Y.-U. Cho
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul Korea
| | - E. You
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul Korea
| | - S. Jang
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul Korea
| | - C.-J. Park
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul Korea
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22
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Buoro S, Peruzzi B, Fanelli A, Seghezzi M, Manenti B, Lorubbio M, Biagioli T, Nannini S, Ottomano C, Lippi G. Two-site evaluation of the diagnostic performance of the Sysmex XN Body Fluid (BF) module for cell count and differential in Cerebrospinal Fluid. Int J Lab Hematol 2017; 40:26-33. [PMID: 28866874 DOI: 10.1111/ijlh.12723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/26/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cellular analysis in cerebrospinal fluid (CSF) provides important diagnostic information in many pathological settings. The aim of this two-site study was to evaluate the Sysmex XN Body Fluid mode (XN-BF) for cell analysis of CSF compared to light microscopy (LM). METHODS Two hundred and seven consecutive CSF samples were analyzed in parallel with XN-BF and LM. The study also included the estimation of the limit of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ), carry-over and linearity of XN-BF module. RESULTS LoQ of white blood cells (WBC) was 3×106 cells/L; linearity was good and carry-over negligible. XN-BF parameters were compared to LM for the following cell classes: total cells, WBC, polymorphonuclear (PMN), and mononuclear (MN) cells. The bias ranged from 1.3 to 15.2×106 cells/L. The receiver operating characteristics curve analysis for WBC showed an area under the curve of 0.98, and the global diagnostic agreement was 95% at a cutoff of 5×106 cells/L. CONCLUSIONS XN-BF provides rapid and accurate counts in clinically relevant ranges of CSF values, thus providing a valuable alternative to conventional LM analysis. However, microscopic review remains advisable in samples with abnormal cell counts or high fluorescent (HF-BF) cell parameter exceeding 5×106 cells/L.
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Affiliation(s)
- S Buoro
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - B Peruzzi
- Clinical Chemistry Laboratory Hospital Careggi Firenze, University of Firenze, Firenze, Italy
| | - A Fanelli
- Clinical Chemistry Laboratory Hospital Careggi Firenze, University of Firenze, Firenze, Italy
| | - M Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - B Manenti
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Lorubbio
- Clinical Chemistry Laboratory Hospital Careggi Firenze, University of Firenze, Firenze, Italy
| | - T Biagioli
- Clinical Chemistry Laboratory Hospital Careggi Firenze, University of Firenze, Firenze, Italy
| | - S Nannini
- Clinical Chemistry Laboratory Hospital Careggi Firenze, University of Firenze, Firenze, Italy
| | - C Ottomano
- Clinical Chemistry Laboratory, Synlab, Monza, Italy
| | - G Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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23
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Aguadero V, Cano-Corres R, Berlanga E, Torra M. Evaluation of biological fluid analysis using the sysmex XN automatic hematology analyzer. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:680-688. [PMID: 28834596 DOI: 10.1002/cyto.b.21587] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/25/2017] [Accepted: 08/19/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hematological cytometers with a biological fluid module could potentially correct the limitations of the manual chamber method. This study evaluates the agreement between the manual technique and the Sysmex XN-1000 analyzer for white blood cell (WBC) and red blood cell (RBC) counts, as well as for leukocyte differentiation in different types of fluids. This study also evaluates the advantages of incorporating the technique in routine laboratory work. METHODS One hundred and three fluid samples examined were 45 ascite (AF), 21 synovial (SF), 33 pleural (PF), and 31 cerebrospinal (CSF) fluid samples. All cell counting was performed with a Sysmex XN-1000 and a Fuchs-Rosenthal counting chamber. May Gründwald-Giemsa stain was used for manual WBC differentiation. The manual analysis data were obtained in duplicate by the same two observers. Passing-Bablok regression and the Kappa index were used to evaluate the interchangeability and concordance. RESULTS Good agreement was observed for WBC differentiation in all fluids and for WBC counts in SF and PF. An optimal Kappa index was obtained, which indicated agreement and clinical significance for WBC and RBC counts in CSF and for RBC counts in PF. There was disagreement for WBC and RBC analysis in AF, with significantly higher results from the Sysmex XN-1000 than from the manual method. A reduction in laboratory response time was observed when using the automatic method. CONCLUSIONS Except for AF, the Sysmex XN-1000 results agree with those of the manual method, although to different degrees depending on the fluid type. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
- Vicente Aguadero
- Department of Biochemistry, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ruth Cano-Corres
- Department of Biochemistry, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Eugenio Berlanga
- Department of Biochemistry, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Montserrat Torra
- Department of Biochemistry, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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Xu W, Yu Q, Xie L, Chen B, Zhang L. Evaluation of Sysmex XN-1000 hematology analyzer for cell count and screening of malignant cells of serous cavity effusion. Medicine (Baltimore) 2017; 96:e7433. [PMID: 28682907 PMCID: PMC5502180 DOI: 10.1097/md.0000000000007433] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Over the years, with the advancement in hematology analyzer technology, the use of fluid analysis method has seen a drastic increase in clinical examinations. Cell counting and classification in independent body fluid analysis method are conducted by semiconductor laser flow cytometry and nucleic acid fluorescence staining techniques. This study is to evaluate the efficacy of Sysmex XN-1000 hematology analyzer in cell counting and to screen malignant cells with serous cavity effusion. Specimens (N = 206) with serous cavity effusion from our hospital were included in this study. Manual and instrumental methods for cell counting, nucleated cell classification, and high-fluorescent cells (HFC) were used in this study. The correlation between RBC, nucleated cell count (NUC), the percentages of polymorphonuclear cell (PMN%), and mononuclear cells (MN%) was statistically analyzed using manual and instrumental methods. The regression equations of RBC, NUC, PMN%, and MN% in the manual and instrumental methods were RBC y = 0.88x + 426.4; NUC y = 0.85x + 33.4; PMN% y = 0.91x + 4.2; and MN% y = 0.91x + 5.1. Correlation coefficient R was 0.99, 0.98, 0.90, and 0.90 (P < .001). ROC curve analysis showed that when the cut-off value of HFC% was 4.4% and HFC# was 24.5/μL, area under curve (AUC), sensitivity, specificity, and 95% confidence interval were 0.707, 0.792, 0.558, 0.637-0.777; 0.708, 0.753, 0.550, 0.635-0.780, respectively. XN-1000 hematology analyzer body fluid method can accurately and rapidly count cell and nucleated cell classification with serous cavity effusion. HFC can indicate the possible existence of malignant cells; however, further investigations are required to validate its efficacy.
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Affiliation(s)
- Weiyi Xu
- Department of Laboratory Medicine,The First Affiliated Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou
| | - Qian Yu
- Department of Laboratory Medicine,The First Affiliated Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou
| | - Lixia Xie
- Department of Laboratory Medicine,The First Affiliated Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou
| | - Baode Chen
- Department of Laboratory Medicine,The First Affiliated Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou
| | - Ling Zhang
- Renji College, Wenzhou Medical University, Wenzhou, China
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Fuster O, Andino B, Pardo A, Laiz B. Continuous ambulatory peritoneal dialysis, ascitic and pleural body fluids evaluation with the Mindray BC-6800 hematology analyzer. J Clin Lab Anal 2017; 32. [PMID: 28444939 DOI: 10.1002/jcla.22240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/25/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Accurate evaluation of hematology analyzers is recommended before these devices can be broadly introduced for the routine testing of continuous ambulatory peritoneal dialysis (CAPD), ascitic, and pleural fluids. METHODS We evaluated the performance of Mindray BC-6800 for white blood cell (WBC) and differential cell count in 50 CAPD, 60 ascitic and 40 pleural compared with manual microscopy. Within-run precision, limit of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ), and carryover were assessed. RESULTS The Passing-Bablok regression in all fluids showed the following equations: yWBC =1.05x+3.31 (95%CI slope 0.95 to 1.12; intercept -0.25 to 5.52); yMN =0.85x+15.63 (95%CI slope 0.72 to 1.05; intercept -24.18 to 84.47); and yPMN =1.21x+13.37 (95%CI slope 1.03 to 1.35; intercept 4.00 to 32.47) with bias 78 cells/μL. The AUC for clinical PMN cut-off was 0.88 (95%CI: 0.77 to 0.98). In ascitic, pleural, and CAPD fluids the AUC for clinical PMN cut-off were 0.88 (95%CI: 0.63 to 1.00), 0.83 (95%CI: 0.68 to 0.99), and 1.00 (95%CI: 1.00 to 1.00) respectively. CV ranged from 3%-34%. LoB of 3 cell/μL was verified. LoD and LoQ reported the same result (8 cells/μL). Carry over never exceeded 0.05%. CONCLUSION The effectiveness of BC-6800 to categorize cells from different body fluids was not compromised by the slight positive bias observed. This conclusion is supported by the high AUC and agreement between the automated method and the reference method. The results show that BC-6800 offers rapid, accurate, and reproducible results for clinical management of CAPD, ascitic, and pleural fluids.
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Affiliation(s)
- Oscar Fuster
- Hematology Unit, Department of Clinical Chemistry, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Belinda Andino
- Hematology Unit, Department of Clinical Chemistry, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Pardo
- Hematology Unit, Department of Clinical Chemistry, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Begoña Laiz
- Hematology Unit, Department of Clinical Chemistry, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Huang WH, Lu LP, Wu K, Guo FY, Guo J, Yu JL, Zhou DY, Sun Y, Deng AM. Extent of agreement between the body fluid model of Sysmex XN-20 and the manual microscopy method. J Clin Lab Anal 2016; 31. [PMID: 27925284 DOI: 10.1002/jcla.22101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/29/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although the correlations concerning cellular component analysis between the Sysmex XN-20 body fluid (BF) model and manual microscopy have been investigated by several studies, the extent of agreement between these two methods has not been investigated. METHODS A total of 90 BF samples were prospectively collected and analyzed using the Sysmex XN-20 BF model and microscopy. The extent of agreement between these two methods was evaluated using the Bland-Altman approach. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of high-fluorescence (HF) BF cells for malignant diseases. RESULTS The agreements of white blood cell (WBC), red blood cell (RBC), and percentages of neutrophils, lymphocytes, and monocytes between the Sysmex XN-20 BF model and manual microscopy were imperfect. The areas under the ROC curves for absolute and relative HF cells were 0.67 (95% confidence interval [CI]: 0.56-0.78) and 0.60 (95% CI: 0.48-0.72), respectively. CONCLUSION Due to the Sysmex XN-20 BF model's imperfect agreement with manual microscopy and its weak diagnostic accuracy for malignant diseases, the current evidence does not support replacing manual microscopy with this model in clinical practice.
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Affiliation(s)
- Wei-Hua Huang
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lin-Peng Lu
- Department of Laboratory Medicine, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Kang Wu
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Fang-Yu Guo
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jie Guo
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jing-Long Yu
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dao-Yin Zhou
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yi Sun
- Department of Laboratory Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - An-Mei Deng
- Clinical Research Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Buoro S, Seghezzi M, Mecca T, Vavassori M, Crippa A, La Gioia A. Evaluation of Mindray BC-6800 body fluid mode for automated cerebrospinal fluid cell counting. ACTA ACUST UNITED AC 2016; 54:1799-1810. [DOI: 10.1515/cclm-2015-1092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/04/2016] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Cellular analysis in cerebrospinal fluid (CSF) provides important diagnostic information in various medical conditions. The aim of this study was to evaluate the application of Mindray BC-6800 body fluid (BF) mode in cytometric analysis of CSF compared to light microscopy (LM).Methods:One hundred and twenty-nine consecutive CSF samples were analyzed by BC-6800-BF mode as well as by LM. The study also included limits of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ), carryover and linearity.ResultsWhite blood cells LoQ was 4.0×10Conclusions:BC-6800-BF offers rapid and accurate counts in clinically relevant concentration ranges, replacing LM for most samples. However, in samples with abnormal cell counts or with abnormal white blood cell differential scattergrams the need to microscopic review for a correct clinical outcome remains.
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Labaere D, Boeckx N, Geerts I, Moens M, Van den Driessche M. Detection of malignant cells in serous body fluids by counting high-fluorescent cells on the Sysmex XN-2000 hematology analyzer. Int J Lab Hematol 2015; 37:715-22. [PMID: 26074270 DOI: 10.1111/ijlh.12393] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/15/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The body fluid mode of the Sysmex XN-2000 hematology analyzer differentiates cells into mononuclear and polymorphonuclear white blood cells (WBC) and high-fluorescent cells (HFC). The aim of this study was to evaluate the performance of the HFC count for detecting malignant cells in serous body fluids. METHODS Two-hundred and thirty serous fluids were analyzed on the Sysmex XN body fluid mode. HFC were measured as relative count (HFC/100 WBC) and absolute count (HFC/μL). All samples were microscopically screened on cytospin slides for the presence of malignant cells. RESULTS Malignant cells were found by microscopic examination in 49 of 230 samples (21.3%). Malignant samples contained significantly higher percentages (10.2 vs. 2.6/100 WBC) and absolute numbers (65 vs. 10/μL) of HFC than nonmalignant samples (P < 0.001). Areas under the ROC curve for relative and absolute HFC count were 0.69 and 0.77, respectively. A cutoff level of ≥17 HFC/μL showed the best performance to predict malignancy, with 88% sensitivity and 61% specificity. CONCLUSION As serous body fluids will be more analyzed on automated analyzers in the future, HFC count can be a useful tool to select samples for microscopic review. Microscopic evaluation should be performed if HFC values are above a certain threshold (e.g. ≥17 HFC/μL) or in case of clinical suspicion of malignancy.
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Affiliation(s)
- D Labaere
- Department of Laboratory Medicine, Imelda Hospital, Bonheiden, Belgium
| | - N Boeckx
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Catholic University of Leuven, Leuven, Belgium
| | - I Geerts
- Department of Laboratory Medicine, Imelda Hospital, Bonheiden, Belgium
| | - M Moens
- Department of Laboratory Medicine, Imelda Hospital, Bonheiden, Belgium
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