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Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach
  1. Dawn Williams-Voorbeijtel1,
  2. Francisco Sanchez2,
  3. Christine G Roth1
  1. 1 Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Baylor-St Luke's Medical Center, Houston, Texas, USA
  1. Correspondence to Dr Christine G Roth, Department of Pathology & Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Christine.Roth{at}


Aims 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.

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

Results 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.

Conclusions 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.

  • diagnostic screening

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  • Correction notice This article has been corrected since it was published Online First. The first author’s name has been corrected.

  • Handling editor Mary Frances McMullin

  • Contributors CGR conceptualised the study and drafted the work. CGR and DWV were involved in the design and data collection. All authors contributed to the interpretation of data, critical revision and final approval of the manuscript.

  • Competing interests None declared.

  • Ethics approval Baylor College of Medicine Institutional Review Board and Baylor St Luke’s Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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