Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach

Williams-Voorbeijtel, Dawn; Sánchez, Francisco; Roth, Christine

doi:10.1136/jclinpath-2016-204316

J Clin Pathol

2017

DOI: 10.1136/jclinpath-2016-204316

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Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach

Dawn Williams-Voorbeijtel

Francisco Sánchez

Christine Roth

Abstract: 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.

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2019

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Cited by 2 publications

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“…There has been an increasing concern regarding costs of medical assistance for patients with different chronic diseases, including primary immunodeficiencies (PID) , which are not so rare and often underdiagnosed. In PID, several studies have shown that costs are often associated with delayed diagnosis .…”

mentioning

confidence: 99%

Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references

Dias

Silva

Cunha

et al. 2019

APMIS

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Dias ALA, da Silva RG, Cunha FGP, Morcillo AM, Lorand-Metze I, Vilela MMS, Riccetto AGL. Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references. APMIS 2019; 127: 228-235.Our aim was to evaluate the cost-effectiveness of a minimal lymphocyte subset quantification (LSQ) by flow cytometry as the first screening in children with clinically suspected primary immunodeficiency (PID). Two hundred sixty-eight Brazilian patients (0-21 years old) were studied. They were divided by clinical and phenotypical features into those fulfilling criteria for PID (PID phenotype) according to the 2017 International Union of Immunological Societies (IUIS) classification and those not fulfilling these criteria (non-PID phenotype). We evaluated how many patients had values below the 10th percentile for five lymphocyte subsets in peripheral blood, (suggestive of PID) according to reference values for Brazil, Italy and USA. Three lymphocyte subsets (T CD3/CD4, B CD19 and NK CD16/CD56) had p-value < 0.05 and Odds Ratio (OR) indicating a risk at least two times higher for the diagnosis of a PID phenotype. The application of Kappa coefficient (k) on Brazilian vs Italian and Brazilian vs US data sets resulted in k compatible with strong or excellent level of agreement between the three classification systems. The authors conclude that a number of CD3 + / CD4 + , CD19 + and CD16 + /CD56 + (NK) cells in peripheral blood <10th percentile represented a significant risk for the diagnosis of PID in this cohort. Natural killer (NK) deficiency is quite rare and has a very specific clinical profile. So, the analysis of these cells could be requested only in some cases, saving even more costs. The minimal immunophenotyping, with quantification of T CD4 + , CD19 + and in some cases CD16 + /CD56 + cells, may be a useful tool for the first screening of PID, saving costs, especially in developing countries.

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mentioning

confidence: 99%

Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references

Dias

Silva

Cunha

et al. 2019

APMIS

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Evaluation of a 10color protocol as part of a 2tube screening panel for flow cytometric assessment of peripheral blood leukocytic subsets

Gounari

Tsavdaridou

Ioakeimidou

et al. 2019

Scandinavian Journal of Clinical and Laboratory Investigation

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Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach

Abstract: 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.

Cited by 2 publications

References 12 publications

Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references

Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references

Evaluation of a 10color protocol as part of a 2tube screening panel for flow cytometric assessment of peripheral blood leukocytic subsets

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