Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach.
Elimination of non-value added testing without compromising high-quality clinical care is an important mandate for laboratories in a value-based reimbursement system. The goal of this study was to determine the optimal combination of flow cytometric markers for a screening approach that balances efficiency and accuracy.



An audit over 9 months of flow cytometric testing was performed, including rereview of all dot plots from positive cases.



Of the 807 cases in which leukaemia/lymphoma testing was performed, 23 were non-diagnostic and 189 represented bronchoalveolar lavage specimens. Of the remaining 595 cases, 137 (23%) were positive for an abnormal haematolymphoid population. Review of the positive cases identified minimum requirements for a screening tube as well as analysis strategies to overcome the diagnostic pitfalls noted. It is estimated that 38% fewer antibodies would be used in a screening approach, representing an opportunity for significant cost savings.



We provide a framework for developing an evidence-based screening combination for cost-effective characterisation of haematolymphoid malignancies, promoting adoption of 'just-in-time' testing systems that tailor the evaluation to the diagnostic need.
Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.
Dawn
D
Williams-Voorbeijtel
Baylor-St Luke's Medical Center, Houston, Texas, USA.
Francisco
F
Sanchez
Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.
Christine G
CG
Roth
D014408:Biomarkers, Tumor / Q000032:analysis*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D019317:Evidence-Based Medicine; D005434:Flow Cytometry / Q000191:economics / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D016130:Immunophenotyping / Q000191:economics / Q000379:methods* / Q000592:standards; D007938:Leukemia / Q000378:metabolism* / Q000473:pathology; D008223:Lymphoma / Q000378:metabolism* / Q000473:pathology; D008485:Medical Audit; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D057188:Workflow
D014408:Biomarkers, Tumor
FLOW CYTOMETRY; IMMUNOPHENOTYPING OF LEUKAEMIAS/LYMPHOMAS; diagnostic screening