Detection of malignant cells in serous body fluids by counting high‐fluorescent cells on the Sysmex XN‐2000 hematology analyzer

Abstract

As serous body fluids will be more analyzed on automated analyzers in the future, HFC count can be a useful tool to select samples for microscopic review. Microscopic evaluation should be performed if HFC values are above a certain threshold (e.g. ≥17 HFC/μL) or in case of clinical suspicion of malignancy.

Evaluation of biological fluid analysis using the sysmex XN automatic hematology analyzer

“…However, Cho et al (23) reported a cutoff of 6.9 cells/100 WBC, whereas Labaere et al (24) reported a cutoff of 17 cells/ 100 WBC. Two studies have recently been published about the sensitivity of the HF-BF cells ratio for the detection of tumor cells in serous fluids, but the results are conflicting.…”

Evaluation of Sysmex XN-1000 hematology analyzer for cell count and screening of malignant cells of serous cavity effusion

“…The cut-off values of HFC% and HFC# were 4.4% and 24.5/μL, respectively, whereas the values for AUC and sensitivity and specificity were 0.707, 0.792, 0.558 and 0.708, 0.753, 0.550, respectively, which were slightly lower than what was reported in the literature. [6,7] During chronic inflammation, the number of mesothelial cells and macrophages were significantly increased in the effusion, and their nuclei contained more nucleic acids, which can be combined with more nucleic acid fluorescent dyes, and thus can be classified as high-fluorescent nucleated cells. In this experiment, we observed that liver cirrhosis ascites specimens contained many high-fluorescence nucleated cells, which were mainly classified as mesothelial cells and/or macrophages by microscopic examination Fig.…”

Lack of harmonization in high fluorescent cell automated counts with body fluids mode in ascitic, pleural, synovial, and cerebrospinal fluids

“…The XN‐BF module uses fluorescent flow cytometry with hydrodynamic focusing for generating total count (and classification) of RBC, WBC (XN‐WBC‐BF), and TC (XN‐TC‐BF) in BF samples. Briefly, a total volume of 88 µL is used for each BF sample . In the BF‐mode, the combination of laser side scatter (SSC), forward scatter (FSC), and fluorescence analysis (SFL) allows classifying nucleated cells, which are clustered in the WDF‐scattergram according to their complexity ( x ‐axis), size ( z ‐axis), and nucleic acid content ( y ‐axis).…”

“…The cytometric assessment of BFs is typically performed in modern hemocytometers using a dedicated channel, conventionally known as BF mode (BF‐mode) . The presence of certain types of cells, usually absent in peripheral blood but occasionally identifiable in BFs (eg, macrophages, mesothelial cells, not hematological neoplastic cells, and synoviocytes), is perhaps the most important limitation of automated cell counting . All these cells share some common morphological features, including medium‐large size, biological activity (eg, replication or activation) and medium or high cytoplasmic complexity.…”

“…The BC‐6800 in BF mode (BC‐BF) generate TC (BC‐TC‐BF), WBC (BC‐WBC‐BF), PMN (BC‐PMN‐BF), MN (BC‐MN‐BF), and high fluorescent cells (BC‐HF‐BF) counts, along with other research parameters such as neutrophil (BC‐NE‐BF) and eosinophil (BC‐EO‐BF) counts . For both XN‐BF and BC‐BF modes, the number of cells classified as HF‐BF is significantly correlated with the presence of mesothelial and/or various neoplastic cells . According to the origin of the BF, the presence of a variable number of cells classified as HF‐BF can then suggest microscopic revision of the sample …”