Barge Luani, Gooch Michael, Hendle Michelle, Simleit Erin
Queensland Medical Laboratories, Murarrie, Qld, Australia; University of Queensland, St Lucia, Qld, Australia.
Queensland Medical Laboratories, Murarrie, Qld, Australia.
Pathology. 2023 Oct;55(6):827-834. doi: 10.1016/j.pathol.2023.05.006. Epub 2023 Jul 16.
Monocyte subset partitioning by flow cytometry may be a useful tool in distinguishing chronic myelomonocytic leukaemia (CMML) from other causes of monocytosis, however there has been varying success in real world implementation. Additionally, current assays require an individual tube for analysis despite significant overlap in antibodies used in routine T and NK cell analysis. The objective of this study was to validate a flow cytometry assay for the enumeration of monocyte subsets in our community-based laboratory and compare this to a hybrid panel allowing analysis of monocytes, T cells and NK cells in a single tube. Monocyte subset analysis was performed on peripheral blood samples of patients with monocytosis at the time of bone marrow biopsy or transient monocytosis in the setting of bacteraemia. Cut-offs of >94% classical and <1.13% non-classical monocytes for distinguishing CMML were assessed. Classical monocytes were significantly higher, and non-classical monocytes significantly lower in CMML compared to other causes of monocytosis. The sensitivity and specificity of >94% classical monocytes were 73% [95% confidence interval (CI) 43-90%] and 89% (95% CI 75-96%) regardless of which panel was used. Non-classical monocytes of <1.13% had a sensitivity and specificity of 82% (95% CI 52-97%) and 83% (95% CI 68-92%) with the monocyte panel and 55% (95% CI 28-78%) and 89% (95% CI 75-96%) using the hybrid panel. We have found the estimation of the classical monocyte subset to be the most robust and repeatable variation of this assay with sensitivity and specificity that is clinically useful. A hybrid panel may provide an effective approach to implementing monocyte subsets into practice.
通过流式细胞术对单核细胞亚群进行划分可能是区分慢性粒单核细胞白血病（CMML）与其他单核细胞增多原因的有用工具，然而在实际应用中取得的成功程度各不相同。此外，尽管常规T细胞和NK细胞分析中使用的抗体存在显著重叠，但目前的检测方法仍需要单独的试管进行分析。本研究的目的是在我们基于社区的实验室中验证一种用于单核细胞亚群计数的流式细胞术检测方法，并将其与允许在单个试管中分析单核细胞、T细胞和NK细胞的混合检测方法进行比较。在骨髓活检时对单核细胞增多症患者的外周血样本或菌血症情况下的短暂单核细胞增多进行单核细胞亚群分析。评估了区分CMML时经典单核细胞>94%和非经典单核细胞<1.13%的临界值。与其他单核细胞增多原因相比，CMML患者的经典单核细胞显著更高，而非经典单核细胞显著更低。无论使用哪种检测方法，经典单核细胞>94%的敏感性和特异性分别为73%[95%置信区间（CI）43 - 90%]和89%（95%CI 75 - 96%）。非经典单核细胞<1.13%时，使用单核细胞检测方法的敏感性和特异性分别为82%（95%CI 52 - 97%）和83%（95%CI 68 - 92%），使用混合检测方法时分别为55%（95%CI 28 - 78%）和89%（95%CI 75 - 96%）。我们发现经典单核细胞亚群的估计是该检测方法中最稳健且可重复的变量，其敏感性和特异性在临床上具有实用性。混合检测方法可能为将单核细胞亚群应用于实际提供一种有效的方法。
