1
|
Wang Y, Ye L, Chen L, Chen Q, Zhang X, Dai Q, Peng L, Lai C, Zhang G. Establishment of Review Criteria Coordinating With the Automated Digital Cell Morphology Identification System in a Specialized Women’s and Children’s Hospital. Lab Med 2022; 54:e77-e84. [PMID: 36124751 DOI: 10.1093/labmed/lmac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
We aimed to establish appropriate review criteria for blood cell analysis in a specialized women’s and children’s hospital. Also, the CellaVision DI-60, was developed as one of the automated digital cell morphology analyzer, we evaluated if it was shown to be most effective under the certain review criteria.
Methods
A total of 2890 blood samples were detected to optimize the previously established review criteria for women and children with the Sysmex XE-2100. A total of 623 samples were used to validate the criteria.
Results
The microscopic-review rate based on the initial review criteria was 51.0%. After optimization, it was reduced to 17.3% and the false-negative rate was 3.85%. There was > 80% consistency between manual review results and CellaVision DI-60 preclassification when samples triggered the platelet- or red cell-related rules. The sensitivity for abnormalities (immature granulocytes, nucleated red blood cells) of reclassification was 90% to 100% and the false-negative rate was < 5%. However, direct microscopic review was required when the “Blasts/AbnLympho?” and “Atypical Lympho?” flags were triggered.
Conclusion
Specialized review criteria are needed for women and children. An automated morphology identification system might help to improve the review criteria.
Collapse
Affiliation(s)
- Yuefang Wang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Lei Ye
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Lan Chen
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Qi Chen
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Xia Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Qingkai Dai
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Luyun Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Chunqi Lai
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| | - Ge Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University , Chengdu , People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education , Chengdu , People’s Republic of China
| |
Collapse
|
2
|
Palur K, Arakeri SU. Effectiveness of the International Consensus Group criteria for manual peripheral smear review. INDIAN J PATHOL MICR 2018; 61:360-365. [PMID: 30004055 DOI: 10.4103/ijpm.ijpm_142_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context The International Consensus Group for Hematology Review (ICGHR) are essentially review criteria designed to reduce the number of manual smear reviews following analysis in automated hematology analyzers (AHAs). Although AHAs are an indispensable part of the present-day clinical laboratory, manual smear reviews still play an integral role in identifying morphological abnormalities and to confirm the results of the analyzers. Aims The aim of this study is to evaluate the efficacy of the ICGHR criteria and our laboratory criteria using the Sysmex XN-1000 for manual peripheral smear review (MSR). Study Design A prospective cross-sectional comparative study between the two sets of criteria for MSR was performed. Material and Methods A total of 860 whole blood samples sent over a period of 19 months for complete blood count testing to our laboratory were collected using systematic random sampling. Truth tables were prepared for each set of criteria. Tests of proportion were used to compare performance specifications between both sets of criteria. Results Using ICGHR criteria, sensitivity was 81.58%, specificity was 84.61%, 83.38% positive predictive value, and 82.92% negative predictive value. The microscopic smear review rate was 47.56% and efficiency was 83.14%. Using our laboratory criteria, sensitivity was 98.80%, specificity was 41.40%, positive predictive value of 61.46%, and negative predictive value of 97.34%. The microscopic smear review rate was 78.14% and efficiency 69.30%. Conclusions There was a significant reduction in the microscopic smear review rates using the ICGHR criteria compared to our laboratory criteria. The ICGHR criteria can thus be adapted to daily laboratory practice provided they are first optimized and locally validated before use.
Collapse
Affiliation(s)
- Katyayani Palur
- Department of Pathology, BLDEU's Shri BM Patil Medical College, Vijayapura, Karnataka, India
| | - Surekha U Arakeri
- Department of Pathology, BLDEU's Shri BM Patil Medical College, Vijayapura, Karnataka, India
| |
Collapse
|
3
|
The development of autoverification rules applied to urinalysis performed on the AutionMAX-SediMAX platform. Clin Chim Acta 2018; 485:275-281. [PMID: 29981288 DOI: 10.1016/j.cca.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fully automated urine analyzers integrated with expert software can help to select samples that need review in routine clinical laboratory. This study aimed to define review rules to be set in the expert software Director for routine urinalysis on the AutionMAX-SediMAX platform. METHODS A set of 1002 urinalysis data randomly extracted from the daily routine was used. The blind on-screen assessment was used as a reference. The data set was used to optimize the standard rules preset in the software to establish review criteria useful to intercept automated microscopy misidentification and particles suggestive of clinically significant profile. The review rate was calculated. The rules-set was also evaluated for the selection of clinically significant samples. RESULTS The review rules established were cross-checked between AutionMAX and SediMAX parameters, element reporting by SediMAX and strip results. For the complete rules-set the review rate was 47.6% and the efficiency for clinically significant sample selection was 58%. Finally, on the basis of the review rules an algorithm for routine practice was created. CONCLUSIONS Review rules applied to the algorithm for routine practice enhance workflow efficiency and optimize sample screening. Revision is not necessary for samples not flagged by the rules.
Collapse
|
4
|
Gupta M, Chauhan K, Singhvi T, Kumari M, Grover RK. Useful information provided by graphic displays of automated cell counter in hematological malignancies. J Clin Lab Anal 2018; 32:e22392. [PMID: 29356090 DOI: 10.1002/jcla.22392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/29/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Automated cell counters have become more and more sophisticated with passing years. The numerical and graphic data both provide useful clues for suspecting a diagnosis especially when the workload is very high. AIM We present our experience of useful information provided by graphic displays of an automated cell counter in hematological malignancies in a cancer hospital where a large number of complete blood count (CBC) requests are received either before or during chemotherapy. This study was conducted to assess the usefulness of hematology cell counter, viz. WBC-Diff (WBC differential), WBC/BASO (WBC basophil) and IMI (immature myeloid information) channel scatter plots, and the flaggings generated in various hematological malignancies. MATERIAL & METHODS The graphic displays have been compiled over a period of 1 year (October 2015-September 2016) from blood samples of various solid and hematological malignancies (approximately 400 per day) received for routine CBC in the laboratory. Approximately 50 000 scattergrams have been analyzed during the study period. The findings were confirmed by peripheral blood smear examination. RESULTS The scattergram analysis on XE-2100 is very sensitive as well as specific for diagnosing acute leukemia, viz. acute myeloid leukemia, acute lymphoblastic leukemia; chronic myeloproliferative disorders, viz. chronic myeloid leukemia; and chronic lymphoproliferative disorder especially chronic lymphocytic leukemia. CONCLUSION It is suggested that the laboratories using the hematology analyzers be aware of graphic display patterns in addition to flaggings generated which provide additional information and give clue toward the diagnosis even before peripheral smear examination.
Collapse
Affiliation(s)
- Monica Gupta
- Department of Oncopathology, Delhi State Cancer Institute, Delhi, India
| | - Kriti Chauhan
- Department of Oncopathology, Delhi State Cancer Institute, Delhi, India
| | - Tanvi Singhvi
- Department of Oncopathology, Delhi State Cancer Institute, Delhi, India
| | - Manisha Kumari
- Department of Oncopathology, Delhi State Cancer Institute, Delhi, India
| | | |
Collapse
|
5
|
Kweon OJ, Lee MK, Kim HR. Evaluation of the Flagging Performance of the Hematology Analyzer Sysmex XN Series on the Basis of “Q Values”. Arch Pathol Lab Med 2017; 142:83-88. [DOI: 10.5858/arpa.2016-0502-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
In the XN series of hematology analyzers (Sysmex, Kobe, Japan), the probability of the presence of abnormal cells is indicated by flags based on Q values.
Objective.—
To evaluate the Q value performance of the Sysmex XN-20 modular analyzer.
Design.—
The interinstrumental concordance, intrainstrumental precision, and diagnostic accuracy of Q values, with tested flags of “blasts/abnormal lymphocytes,” “atypical lymphocytes,” and “blasts,” were investigated.
Results.—
Absolute concordance rates in flagging between 2 analyzers ranged from 69.8% to 80.8%, and κ values ranged from 0.43 to 0.61. In samples with absolute related cell counts lower than 100/μL, the values ranged from 0.31 to 0.52. For intrainstrumental precision, standard deviations ranged from 4.8 to 23.9 for the blasts/abnormal lymphocytes, from 18.7 to 59.1 for the blasts, and from 11.0 to 23.0 for the atypical lymphocytes. Using a default Q value cutoff, diagnostic accuracy values based on the area under the curve, sensitivity, and specificity were, respectively, 0.910, 90.9%, and 72.2% for blasts/abnormal lymphocytes; 0.927, 84.9%, and 89.8% for blasts; and 0.865, 74.4%, and 84.9% for atypical lymphocytes. The diagnostic accuracy of Q values was much lower in samples with absolute related cell counts lower than 100/μL than in those 100/μL or higher.
Conclusions.—
Q values of the Sysmex XN-20 analyzer were found to be imprecise and irreproducible, especially with samples containing a small number of pathologic cells. Adjustments in the Q value threshold may help in the detection of these cells.
Collapse
Affiliation(s)
- Oh Joo Kweon
- From the Department of Laboratory Medicine, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Republic of Korea (Dr Kweon); and the Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea (Drs Kweon, Lee, and Kim)
| | - Mi-Kyung Lee
- From the Department of Laboratory Medicine, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Republic of Korea (Dr Kweon); and the Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea (Drs Kweon, Lee, and Kim)
| | - Hye Ryoun Kim
- From the Department of Laboratory Medicine, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Republic of Korea (Dr Kweon); and the Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea (Drs Kweon, Lee, and Kim)
| |
Collapse
|
6
|
|
7
|
Khejonnit V, Pratumvinit B, Reesukumal K, Meepanya S, Pattanavin C, Wongkrajang P. Optimal criteria for microscopic review of urinalysis following use of automated urine analyzer. Clin Chim Acta 2015; 439:1-4. [DOI: 10.1016/j.cca.2014.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/18/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
|
8
|
Eilertsen H, Vøllestad NK, Hagve TA. The usefulness of blast flags on the Sysmex XE-5000 is questionable. Am J Clin Pathol 2013; 139:633-40. [PMID: 23596115 DOI: 10.1309/ajcpduzvrn5vy9wz] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hematology analyzers generate suspect flags that involve microscopic reviews to confirm the presence of pathologic cells. This study investigated the reliability of the blast flag in a side-by-side evaluation of 3 Sysmex XE-5000 instruments (Sysmex, Kobe, Japan). The repeatability of the Q values reported by each instrument for 10 replicates of the same blood samples was low (intraclass correlation coefficient [ICC] values, 0.62-0.74). The reproducibility of the Q values obtained by analyzing 408 samples on all 3 instruments was reasonable (ICC value, 0.85). In addition, a systematic difference was observed among the instruments in the level of reported Q values. With cutoff commonly being 100, the observed reproducibility of the blast flagging among the instruments was evaluated as poor (κ = 0.73). Based on the observed low performances, we question the usefulness of the Q value as a predictor of blasts and whether a blast flag reported by the XE-5000 is sufficient as a criterion for performing a microscopic review.
Collapse
Affiliation(s)
- Heidi Eilertsen
- Division of Diagnostics and Technology, Akershus University Hospital, Lorenskog, Norway
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo
| | - Nina K. Vøllestad
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo
| | - Tor-Arne Hagve
- Division of Diagnostics and Technology, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
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; 137:408-14. [PMID: 23451752 DOI: 10.5858/arpa.2011-0535-oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Each laboratory should have criteria for manual smear review that limit workload without affecting patient care. The International Consensus Group for Hematology Review established guidelines for action after automated blood cell analysis in 2005. OBJECTIVE To compare the consensus group criteria with our laboratory criteria and optimize them for better efficiency. DESIGN A total of 2114 first-time samples were collected consecutively from daily workload and were used to compare 2 criteria as well as establish the optimized criteria. Another set of 891 samples was used to validate the optimized criteria. All samples were run on either Sysmex XE-5000 or Coulter LH750 hematology analyzers and were investigated by manual smear review. The efficiency of each set of criteria was compared and optimized to obtain better efficiency, an acceptable review rate, and a low false-negative rate. RESULTS From 2114 samples, 368 (17.40%) had positive smear results. Compared with that of our laboratory criteria, the efficiency of the consensus group criteria was higher (83.63% versus 78.86%, P < .001), the review rate was higher (29.33% versus 22.37%, P < .001), and the false-negative rate was lower (2.22% versus 8.09%, P < .001). After optimizing the rules, we obtained an efficiency of 87.13%, a review rate of 24.22%, and a false-negative rate of 2.98%. We validated the optimized criteria with another set of samples, and the efficiency, review rate, and false-negative rate were 87.32%, 25.25%, and 1.12%, respectively. CONCLUSIONS Each laboratory should verify the criteria for smear review, based on the International Consensus Group for Hematology Review, and optimize them to maximize efficiency.
Collapse
Affiliation(s)
- Busadee Pratumvinit
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | | |
Collapse
|
10
|
Kim SJ, Kim Y, Shin S, Song J, Choi JR. Comparison Study of the Rates of Manual Peripheral Blood Smear Review From 3 Automated Hematology Analyzers, Unicel DxH 800, ADVIA 2120i, and XE 2100, Using International Consensus Group Guidelines. Arch Pathol Lab Med 2012; 136:1408-13. [DOI: 10.5858/arpa.2010-0757-oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—In the clinical laboratory, it is important both to reduce the number of peripheral blood slide reviews to save time and money and to avoid reporting false results.
Objective.—To determine differences in the slide review rates of 3 widely used automated hematologic analyzers, the Unicel DxH 800 (Beckman Coulter Inc, Fullerton, California), ADVIA 2120i (Siemens Diagnostics, Tarrytown, New York), and XE 2100 (Sysmex, Kobe, Japan), using International Consensus Group for Hematology Review guidelines.
Design.—A total of 1485 samples were tested, and 300 were manually reviewed. Slide review rates, sensitivity, specificity, and false-positive and false-negative rates were estimated using consensus group rules and compared using χ2 tests, Fisher exact tests, or generalized estimating equations.
Results.—Unicel DxH 800, ADVIA 2120i, and XE 2100 showed 22.8%, 20.2%, and 28.6% slide review rates; 14.3%, 14.3%, and 9.7% false-negative rates; and 13.7, 11.3%, and 17.3% false-positive rates, respectively. All analyzers showed significantly higher false-negative rates than that of the consensus group (2.9%).
Conclusions.—False-negative rates were higher than the recommended levels. Among 3 automated hematologic analyzers, XE 2100 showed the highest rate of slide review. Because the present study clearly shows that the slide review rates have distinct characteristics among the studied analyzers, each individual laboratory should consider selecting the most appropriate analyzer according to clinical characteristics. Analyzers with high sensitivity may be advantageous in outpatient settings for screening patients, whereas analyzers with high specificity may be beneficial in inpatient settings for efficient patient care.
Collapse
|