title: Cost-effective approach to the diagnostic workup of B cell lymphoproliferative disorders via optimal integration of flow cytometric data.
abstract: BACKGROUND
  The workup of lymphoproliferative disorders (LPDs) involves the combined use of flow cytometry (FC) and immunohistochemistry (IHC). This often results in duplicate immunophenotypic testing and adds costs that may not be eligible for reimbursement based on the Medicare National Correct Coding Initiative. We aimed to establish a cost-effective diagnostic algorithm based on initial FC categorization to reduce repetitive immunophenotyping.
  
  
  METHODS
  We retrospectively reviewed 242 cases of suspected LPDs with concurrent FC and IHC testing over a 12-month period. We correlated FC with surgical diagnoses and evaluated the frequency of repeat IHC testing.
  
  
  RESULTS
  Repetitive immunophenotyping was common; overall, 85% of cases had at least one marker repeated. Concordant cases were significantly less likely to have markers repeated than discordant cases. Of concordant B cell malignancies, 57% represented recurrent disease; however, repeat marker usage was not decreased as compared to new diagnoses. The most frequently repeated markers were CD3, CD5, CD10, and CD20.
  
  
  CONCLUSIONS
  We propose that in concordant cases, CD5 and CD10 should not be repeated by IHC; this would decrease the use of these markers by 80% and 76%, respectively. We developed an algorithmic approach to IHC usage that has improved incorporation of FC data at our institution and may reduce healthcare costs.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Mason
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Morgan
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: G S
authors.initials: GS
authors.lastname: Pinkus
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: O
authors.initials: O
authors.lastname: Pozdnyakova
mesh_terms: D000465:Algorithms; D001402:B-Lymphocytes / Q000473:pathology; D015415:Biomarkers; D003362:Cost-Benefit Analysis / Q000379:methods*; D005434:Flow Cytometry; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: B cell lymphoproliferative disorders; Cost-effective approach; duplicate testing; flow cytometry; immunohistochemistry