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

Abstract

Over the years, with the advancement in hematology analyzer technology, the use of fluid analysis method has seen a drastic increase in clinical examinations. Cell counting and classification in independent body fluid analysis method are conducted by semiconductor laser flow cytometry and nucleic acid fluorescence staining techniques. This study is to evaluate the efficacy of Sysmex XN-1000 hematology analyzer in cell counting and to screen malignant cells with serous cavity effusion. Specimens (N = 206) with serous cavity effusion from our hospital were included in this study. Manual and instrumental methods for cell counting, nucleated cell classification, and high-fluorescent cells (HFC) were used in this study. The correlation between RBC, nucleated cell count (NUC), the percentages of polymorphonuclear cell (PMN%), and mononuclear cells (MN%) was statistically analyzed using manual and instrumental methods. The regression equations of RBC, NUC, PMN%, and MN% in the manual and instrumental methods were RBC y = 0.88x + 426.4; NUC y = 0.85x + 33.4; PMN% y = 0.91x + 4.2; and MN% y = 0.91x + 5.1. Correlation coefficient R2 was 0.99, 0.98, 0.90, and 0.90 (P < .001). ROC curve analysis showed that when the cut-off value of HFC% was 4.4% and HFC# was 24.5/μL, area under curve (AUC), sensitivity, specificity, and 95% confidence interval were 0.707, 0.792, 0.558, 0.637–0.777; 0.708, 0.753, 0.550, 0.635–0.780, respectively. XN-1000 hematology analyzer body fluid method can accurately and rapidly count cell and nucleated cell classification with serous cavity effusion. HFC can indicate the possible existence of malignant cells; however, further investigations are required to validate its efficacy.

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

“…However, sample analysis by OM remains often necessary for confirming quantitative and qualitative abnormalities found with automated samples analysis . The Sysmex XN‐BF and Mindray BC‐BF modes use an identical technique for cell count and classification (ie, optic fluorescence readings preceded by selective lysis and hydrodynamic focusing) and are among the commercially available platforms displaying the best analytical performance for cytometric analysis of BF samples, as also confirmed in the present investigation.…”

“…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 …”

“…[1][2][3] 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. [1][2][3][19][20][21][22][23] All these cells share some common morphological features, including medium-large size, biological activity (eg, replication or activation) and medium or high cytoplasmic complexity. Using May-Grunwald staining, the cytoplasm of these cells is variably basophilic, whilst the ratio between nucleus and cytoplasm varies according to the cell type.…”