CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium.
Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium.
Int J Lab Hematol. 2020 Oct;42(5):544-551. doi: 10.1111/ijlh.13187. Epub 2020 Mar 12.
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.
Sysmex XN-1000 血液分析仪上高荧光细胞（HF-BF）的存在引起了人们对体液中恶性细胞预测的兴趣，但缺乏敏感性。我们旨在通过结合 HF-BF 值、自动化结果和临床信息来提高这种敏感性。
我们评估了一种新的血液学实验室体液管理工作流程，包括 HF-BF 标准和临床信息。在两个实验室中，对 XN-1000 BF 模式下的 1623 例浆膜液进行了回顾性分析。所有样本均进行形态学筛查以寻找恶性细胞。确定最佳 HF-BF 截止值以预测其存在。然后，评估临床信息的附加值。还使用其他反射测试规则（嗜酸性粒细胞计数>5%和存在 WBC 异常散射图标志）来完善我们的工作流程。
两个血液学中心的最佳 HF-BF 截止值分别为 108 和 45 个细胞/μL，用于检测恶性细胞的灵敏度/特异性分别为 66.7/93.6%和 86.8/66.6%。当添加临床信息时，灵敏度/特异性演变为 100.0/68.9%和 100.0%/未确定。在包含恶性细胞的 104 个样本中，97 个样本具有阳性临床信息；其余样本的 HF-BF>截止值。
将临床信息与 HF-BF 相结合，可实现体液分析中恶性细胞检测的 100.0%灵敏度。最佳 HF-BF 截止值的不稳定性值得使用本地截止值。XN-1000 BF 模式的快速自动结果报告在临床实践中也是可行的。在将该工作流程应用于临床实践之前，需要对其进行前瞻性评估。
