From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Zhang, Maglantay).
the Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada (Maglantay).
Arch Pathol Lab Med. 2021 Feb 1;145(2):201-207. doi: 10.5858/arpa.2019-0617-OA.
CONTEXT.—: Body fluid specimens are regularly submitted to the hematology laboratory for cell count and differential. Unless there is high clinical suspicion for malignancy, most cases lack concurrent cytology review and may not benefit from more focused examination for malignancy.
OBJECTIVE.—: To compare rates of malignancy detection before and after fluid-focused training for hematology technologists as part of a quality improvement initiative.
DESIGN.—: During an 8-week pretraining period, body fluids submitted to the cytology laboratory were correlated with concurrent hematology specimens. After slide review and training sessions for the hematology technologists, the same data were collected for a 4-week period. Discrepant cases were reviewed by hematology laboratory supervisors and pathologists.
RESULTS.—: We collected 465 pretraining and 249 posttraining body fluids with concurrent cytology and hematology evaluation. In the pretraining cohort, 48 cases (10.3%) were diagnosed as malignant by cytology; of those, 33 were detected by hematology. In the posttraining cohort, 30 cases (12.0%) were diagnosed as malignant by cytology of which 27 were detected by hematology. Of the 18 discrepant cases (all carcinomas), hematology slide review showed definite features of malignancy in 15 and no tumor cells in 3. The malignancy detection rate by the hematology laboratory significantly improved after training (68.8% versus 90.0%, P = .01).
CONCLUSIONS.—: We demonstrate the comparatively lower malignancy detection rate for body fluid specimens processed in our hematology laboratory, particularly for carcinomas. Hematology technologist education/training improved the malignancy detection rate, an important quality improvement given the large proportion of body fluids undergoing hematology evaluation without concurrent cytology reviews.
体液标本经常提交给血液学实验室进行细胞计数和分类。除非有高度的恶性肿瘤临床怀疑，否则大多数病例缺乏同时的细胞学检查，并且可能不需要对恶性肿瘤进行更有针对性的检查。
作为质量改进计划的一部分，比较血液学技术员在专注于体液的培训前后对恶性肿瘤的检测率。
在 8 周的培训前期间，细胞学实验室提交的体液与同时的血液学标本相关联。在血液学技术员进行幻灯片审查和培训课程后，在 4 周的时间内收集相同的数据。有差异的病例由血液学实验室主管和病理学家进行审查。
我们收集了 465 份培训前和 249 份培训后具有同时细胞学和血液学评估的体液。在培训前队列中，48 例（10.3%）被细胞学诊断为恶性；其中 33 例被血液学检测到。在培训后队列中，30 例（12.0%）被细胞学诊断为恶性，其中 27 例被血液学检测到。在 18 例（均为癌）有差异的病例中，血液学幻灯片审查显示 15 例有明确的恶性特征，3 例无肿瘤细胞。培训后血液学实验室的恶性肿瘤检测率显著提高（68.8%比 90.0%，P =.01）。
我们证明了我们的血液学实验室处理的体液标本的恶性肿瘤检测率相对较低，特别是对于癌症。血液学技术员的教育/培训提高了恶性肿瘤的检测率，这是一个重要的质量改进，因为大量的体液在没有同时进行细胞学检查的情况下进行血液学评估。
