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Tytuł:
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Improving Malignancy Detection Rates in Body Fluids Submitted to the Hematology Laboratory for Nucleated Cell Count and Differential: A Quality Improvement Study.
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Autorzy:
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Zhang ML; From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Zhang, Maglantay).
Maglantay RJ; From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Zhang, Maglantay).; the Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada (Maglantay).
Cunningham VL; the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe).
Goodwin MT; the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe).
Feeney MW; the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe).
Keefe J; the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe).
Tambouret RH; the Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston (Tambouret, Sohani).
Sohani AR; the Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston (Tambouret, Sohani).
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Źródło:
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Archives of pathology & laboratory medicine [Arch Pathol Lab Med] 2021 Feb 01; Vol. 145 (2), pp. 201-207.
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Typ publikacji:
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Comparative Study; Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: Northfield, Ill. : College of American Pathologists
Original Publication: Chicago, American Medical Assn.
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MeSH Terms:
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Body Fluids/*cytology
Carcinoma/*diagnosis
Laboratories/*standards
Cytodiagnosis ; Erythroblasts/cytology ; Hematologic Tests ; Hematology ; Humans ; Quality Improvement ; Specimen Handling
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Entry Date(s):
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Date Created: 20210127 Date Completed: 20210301 Latest Revision: 20210301
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Update Code:
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20240105
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DOI:
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10.5858/arpa.2019-0617-OA
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PMID:
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33501495
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Context.—: Body fluid specimens are regularly submitted to the hematology laboratory for cell count and differential. Unless there is high clinical suspicion for malignancy, most cases lack concurrent cytology review and may not benefit from more focused examination for malignancy.
Objective.—: To compare rates of malignancy detection before and after fluid-focused training for hematology technologists as part of a quality improvement initiative.
Design.—: During an 8-week pretraining period, body fluids submitted to the cytology laboratory were correlated with concurrent hematology specimens. After slide review and training sessions for the hematology technologists, the same data were collected for a 4-week period. Discrepant cases were reviewed by hematology laboratory supervisors and pathologists.
Results.—: We collected 465 pretraining and 249 posttraining body fluids with concurrent cytology and hematology evaluation. In the pretraining cohort, 48 cases (10.3%) were diagnosed as malignant by cytology; of those, 33 were detected by hematology. In the posttraining cohort, 30 cases (12.0%) were diagnosed as malignant by cytology of which 27 were detected by hematology. Of the 18 discrepant cases (all carcinomas), hematology slide review showed definite features of malignancy in 15 and no tumor cells in 3. The malignancy detection rate by the hematology laboratory significantly improved after training (68.8% versus 90.0%, P = .01).
Conclusions.—: We demonstrate the comparatively lower malignancy detection rate for body fluid specimens processed in our hematology laboratory, particularly for carcinomas. Hematology technologist education/training improved the malignancy detection rate, an important quality improvement given the large proportion of body fluids undergoing hematology evaluation without concurrent cytology reviews.
Competing Interests: The authors have no relevant financial interest in the products or companies described in this article.
