The diagnostic ability of high‐fluorescent cells combined with carcinoembryonic antigen for malignant pleural effusion

Abstract

Introduction High‐fluorescent cells (HFCs) that are detected with an automated hematology analyzer may be useful for the detection of tumor cells; however, the diagnostic ability of HFCs for differentiating malignant pleural effusion is limited. The aim of this study was to investigate the diagnostic value of the combined detection of HFCs with the tumor marker carcinoembryonic antigen (CEA) for the identification of malignant hydrothorax. Methods A total of 115 pleural effusions were collected. HFCs, including the relative counts (HF‐BF%) and absolute counts (HF‐BF#), were analyzed using the BF mode of a Sysmex XN9000 hematology analyzer. Simultaneously, the CEA level from the same patient was measured by an electrochemiluminescence method. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of HFCs separately or combined with CEA analysis for malignant diseases. Results The levels of HF‐BF#, HF‐BF%, and CEA in the malignant effusion group were significantly higher than those in the benign control group. The diagnostic value of the HF‐BF# and HF‐BF% for malignant pleural effusion was low to moderate, and the area under the curve (AUC) was 0.663 and 0.715, respectively. The CEA detection showed a moderate diagnostic ability, and the AUC was 0.832. The AUC for the combined methods was 0.860 and 0.890, respectively. The cutoff levels of the HF‐BF#, HF‐BF%, and CEA levels were 29.5 × 106/L, 5.6/100 WBC, and 4.795 ng/mL, respectively. Conclusions The combined detection of high‐fluorescent cells with the BF mode and CEA testing may be a good indication for malignancy.

Improving performance of recently introduced flow cytometry‐based approach of malignant cell screening in serous cavity effusion

“…Here, we investigated the HFC counting ability on Sysmex XN‐1000 to predict the presence of malignant cells in serous cavity effusion. Consistent with previous studies, 2,4,5 the absolute and relative HFC counts in malignant effusions were markedly higher than those in nonmalignant effusions. Subgroup analysis also showed the same tendency.…”

“…HFC is a new parameter used in the BF mode of hematology analyzer that can indicate the existence of malignant cells. Several researchers have examined the significance of detecting malignant cells in the BF mode 2‐6 . Here, we investigated the HFC counting ability on Sysmex XN‐1000 to predict the presence of malignant cells in serous cavity effusion.…”

“…One or more of these parameters can reflect the existence of malignant cells, such as high‐fluorescent cells (HFCs). Few studies have conducted the performance evaluation of BF mode and malignant cell screening 2‐7 …”

“…Few studies have conducted the performance evaluation of BF mode and malignant cell screening. [2][3][4][5][6][7] In this study, we initially collected 991 serous cavity effusion samples for routine cell count and exfoliative cytology simultaneously. Subsequently, we analyzed the results under different rules in scattergram.…”

El recuento automatizado de células en líquidos biológicos: una revisión

“…Esta alarma es un indicador de la presencia de células con una elevada relación núcleo-citoplasma y un elevado contenido en ácidos nucleicos y su presencia ha sido propuesta como criterio para la revisión mediante microscopía óptica de la celularidad de la muestra por un experto cualificado, dado que su recuento se ha correlacionado de forma significativa con la presencia de células mesoteliales y/o malignas [33]. Sin embargo, son todavía varias las limitaciones para la implantación de las HF-cells, incluyendo la falta de estandarización entre las diferentes metodologías [33] y la falta de consenso respecto a que recuento o porcentaje de las mismas debe ser considerado como criterio para la revisión microscópica manual, probablemente debido a diferencias en los criterios utilizados en los estudios para establecer la positividad de la microscopía óptica y en los objetivos finales de estos estudios, realizados principalmente con analizadores Sysmex [17,[56][57][58][59][60][61][62][63][64][65] (Tabla 3). En el HF-BF, además de células de origen neoplásico, se clasifican otros tipos de células benignas como macrófagos y células mesoteliales, que reducirían la especificidad de esta magnitud para la detección de malignidad [66], con valores que varían entre el 55% y el 87% [61][62][63]; la modificación del algoritmo utilizado por el analizador Sysmex-XN 1000 para la detección de HF-cells en base a las características de la célula maligna puede ser útil para mejorar la especificidad en la detección de dicho tipo de células [67].…”