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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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Cho HE, Kim YJ, Cho SY, Park TS, Park KS. Clinical application of an algorithm to screen for malignant cells in body fluids using an automated hematology analyzer. Int J Lab Hematol 2022; 44:483-489. [PMID: 35174970 DOI: 10.1111/ijlh.13813] [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: 09/05/2021] [Revised: 01/10/2022] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The detection of malignant cells in body fluids (BF) with an automated hematology analyzer has been proposed as an alternative to morphological examination owing to its various advantages; however, its limitations have also been highlighted. In this study, we devised a practical algorithm to screen for malignant cells in BFs using an automated hematology analyzer. METHODS A total of 558 BF samples, including 232 cerebrospinal fluid (CSF) samples and 326 non-CSF samples, were consecutively collected. Thereafter, the results obtained using the BF mode of Sysmex XN-350 (Sysmex, Kobe, Japan) were compared with the cytological diagnosis. A cutoff was also established to screen for malignant cells using receiver operating characteristic (ROC) curve analysis based on the final clinical judgment. RESULTS The automated hematology analyzer showed a moderate correlation or good agreement with the existing cytological diagnosis. Further, of the ROC curves for detecting malignant cells, the absolute value of highly fluorescent cells on BF (HF-BF) in total body fluids showed the highest area under the curve (0.85 [95% confidence interval 0.82-88], p < .0001, Youden index >7×106 /L, sensitivity 93%, and specificity 65%). CONCLUSION An automated hematology analyzer could function as a complement to cytological examination. We propose a practical and comprehensive algorithm for cytological examination that requires low- and high-resolution microscopy based on the absolute value of HF-BF in BF samples suspected of malignancy. This algorithm can more usefully detect malignant cells while taking advantage of the automated analyzer and cytological examination.
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Affiliation(s)
- Ha-Eun Cho
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Young Jin Kim
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea.,Department of Laboratory Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sun Young Cho
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea.,Department of Laboratory Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Tae Sung Park
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea.,Department of Laboratory Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Sun Park
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea
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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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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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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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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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Wu W, Zhao C, Shen T, Tong X, Chen W. The diagnostic ability of high-fluorescent cells combined with carcinoembryonic antigen for malignant pleural effusion. Int J Lab Hematol 2019; 41:509-512. [PMID: 31018036 DOI: 10.1111/ijlh.13034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/08/2019] [Accepted: 03/30/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION High-fluorescent cells (HFCs) that are detected with an automated hematology analyzer may be useful for the detection of tumor cells; however, the diagnostic ability of HFCs for differentiating malignant pleural effusion is limited. The aim of this study was to investigate the diagnostic value of the combined detection of HFCs with the tumor marker carcinoembryonic antigen (CEA) for the identification of malignant hydrothorax. METHODS A total of 115 pleural effusions were collected. HFCs, including the relative counts (HF-BF%) and absolute counts (HF-BF#), were analyzed using the BF mode of a Sysmex XN9000 hematology analyzer. Simultaneously, the CEA level from the same patient was measured by an electrochemiluminescence method. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of HFCs separately or combined with CEA analysis for malignant diseases. RESULTS The levels of HF-BF#, HF-BF%, and CEA in the malignant effusion group were significantly higher than those in the benign control group. The diagnostic value of the HF-BF# and HF-BF% for malignant pleural effusion was low to moderate, and the area under the curve (AUC) was 0.663 and 0.715, respectively. The CEA detection showed a moderate diagnostic ability, and the AUC was 0.832. The AUC for the combined methods was 0.860 and 0.890, respectively. The cutoff levels of the HF-BF#, HF-BF%, and CEA levels were 29.5 × 106 /L, 5.6/100 WBC, and 4.795 ng/mL, respectively. CONCLUSIONS The combined detection of high-fluorescent cells with the BF mode and CEA testing may be a good indication for malignancy.
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Affiliation(s)
- Wenjing Wu
- Department of Clinical Laboratory, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Chedong Zhao
- Department of Clinical Laboratory, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Tao Shen
- Department of Clinical Laboratory, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoning Tong
- Department of Clinical Laboratory, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wei Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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