Fluorescence in situ hybridization (FISH) is a microscopy technique which uses a fluorescent probe to detect DNA sequences and is generally performed on metaphase spreads or interphase nuclei of intact cells on a slide. In a diagnostic laboratory, cells are hybridized with fluorescent probes and up to 200 cells counted for the number of cells with probe "spots." Recent modifications to standard FISH include immuno-FISH, where chromosomal abnormalities are detected only in cells by their phenotype, and S-FISH where probe hybridization is performed on whole cells in suspension. Here we describe the development of an immuno-S-FISH method that combines immunophenotyping and FISH analysis of cells in suspension followed by analysis on an imaging flow cytometer. This single platform technique couples microscopy with flow cytometry and "spot" detection of bound FISH probe. Automated immuno-S-FISH enables large numbers of analyzed cells to be identified by phenotype and assessed for specific chromosomal determinants by FISH. This novel robust method enables quantitative cell population analysis and "spot" counting for large numbers of cells. We report method optimization of this imaging immuno-S-FISH flow cytometry protocol which has capability for many clinical applications. V C 2016 International Society for Advancement of Cytometry Key terms imaging cytometry; S-FISH; immunophenotyping; hematological malignancy CYTOGENETIC analysis is an integral component in the assessment of many constitutional and neoplastic disorders, particularly those of hemopoietic origin. This has traditionally been performed by full chromosomal analysis (karyotyping) which provides a global analysis of the entire genome; however, this has limitations due to low resolution and the need to have cells in metaphase of the cell cycle. Fluorescence in situ hybridization (FISH) is more sensitive than karyotyping in identifying specific genomic defects and can be performed in nondividing cells (1,2). FISH is based on fluorescently-labeled single-stranded DNA probe annealing to its complementary sequence in a target genome to detect DNA sequences and submicroscopic genetic changes (3). The probes are designed to target genes of interest to identify rearrangements, deletions, and gains in both whole cells in interphase and metaphase. The probes can be whole chromosome paints or locus-specific and these bind to the parts of the chromosome with which they show a high degree of sequence homology. Locus-specific probes are most frequently used and are of three main types:1. Copy number probes: centromeric probes are used to detect loss or gain of whole chromosomes and ploidy changes. These are used to enumerate specific chromosomes in interphase cells, providing an accurate method to ascertain chromosome copy number (4). 2. Breakapart probes (e.g. MLL locus located to chromosome band 11q23) (5) 3. Dual-fusion probes (e.g. BCR-ABL1 fusion gene resulting from t(9;22)(q34;q11)) (6,7)