Two-site evaluation of a new workflow for the detection of malignant cells on the Sysmex XN-1000 body fluid analyzer.
Sysmex XN-1000
body fluids
cell count
malignant cell detection
reflex testing rules
Journal
International journal of laboratory hematology
ISSN: 1751-553X
Titre abrégé: Int J Lab Hematol
Pays: England
ID NLM: 101300213
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
29
12
2019
revised:
12
02
2020
accepted:
23
02
2020
pubmed:
13
3
2020
medline:
9
2
2021
entrez:
13
3
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
544-551Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
European Association for the Study of the Liver. Electronic address easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406-460.
Hooper C, Lee YCG, Maskell N. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4-ii17.
Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology. 1988;8:1104-1109.
Garcia LW, Ducatman BS, Wang HH. The value of multiple fluid specimens in the cytological diagnosis of malignancy. Mod Pathol. 1994;7:665-668.
Buoro S, Peruzzi B, Fanelli A, et al. 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. 2018;40:26-33.
Fleming C, Brouwer R, Lindemans J, de Jonge R. Validation of the body fluid module on the new Sysmex XN-1000 for counting blood cells in cerebrospinal fluid and other body fluids. Clin Chem Lab Med. 2012;50:1791-1798.
Roccaforte V, Daves M, Proserpio V, et al. Evaluation of body fluid mode of Sysmex XN-9000 for white blood cell counts in cerebrospinal fluid. J Lab Precis Med. 2018;3:22.
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. https://doi.org/10.1111/ijlh.13128. [Epub ahead of print].
Fleming C, Russcher H, Lindemans J, de Jonge R. Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease. Clin Chem Lab Med. 2015;53:1689-1706.
Sandhaus LM. Body fluid cell counts by automated methods. Clin Lab Med. 2015;35:93-103.
Lippi G, Plebani M. Opportunities and drawbacks of nonstandard body fluid analysis. Clin Chem Lab Med. 2017;55:907-909.
Buoro S, Mecca T, Azzara G, et al. Cell population data and reflex testing rules of cell analysis in pleural and ascitic fluids using body fluid mode on Sysmex XN-9000. Clin Chim Acta. 2016;452:92-98.
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.
Cho YU, Chi HS, Park SH, Jang S, Kim YJ, Park CJ. Body fluid cellular analysis using the Sysmex XN-2000 automatic hematology analyzer: focusing on malignant samples. Int J Lab Hematol. 2015;37:346-356.
Barnes PW, McFadden SL, Machin SJ, Simson E, International Consensus Group for Hematology. The International consensus group for hematology review: suggested criteria for action following automated CBC and WBC differential analysis. Lab Hematol. 2005;11:83-90.
Pratumvinit B, Wongkrajang P, Reesukumal K, Klinbua C, Niamjoy P. Validation and optimization of criteria for manual smear review following automated blood cell analysis in a large university hospital. Arch Pathol Lab Med. 2013;137:408-414.
Buoro S, Appassiti Esposito S, Vavassori M, et al. Reflex testing rules for cell count and differentiation of nucleated elements in pleural and ascitic fluids on Sysmex XE-5000. J Lab Autom. 2016;21:297-304.
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.
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;37:715-722.
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.
Clinical Laboratory Standards Institute. Body Fluid Analysis for Cellular Composition; Approved Guideline. CLSI Document H56-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2006.
Kjeldsberg C, Knight J. Body Fluids: Laboratory Examination of Cerebrospinal S, Serous & Synovial Fluids (3rd ed.). Chicago, IL: American Society of Clinical Pathologists Press. 1993. pp 436.
Favresse J, van Dievoet MA, De Wolf H, Rodriguez-Villalobos H, Defour JP Characterization of Candida spp. interference on the Sysmex XN-1000 body fluid mode. Int J Lab Hematol. 2018;40:e28-e32.
Brierley JDGM, Wittekind C. editors. The TNM classification of malignant tumours (8th ed.). Oxford, UK: Wiley Blackwell; 2017.
Coccolini F, Gheza F, Lotti M, et al. Peritoneal carcinomatosis. World J Gastroenterol. 2013;19:6979-6994.
Wu SG, Yu CJ, Tsai MF, et al. Survival of lung adenocarcinoma patients with malignant pleural effusion. Eur Respir J. 2013;41:1409-1418.
Buoro S, Seghezzi M, Dominoni P, et al. 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(2):277-286.