American Society for Clinical Pathology
View all recommendations from this societySeptember 25, 2018
Do not perform peripheral blood flow cytometry to screen for hematological malignancy in the settings of mature neutrophilia, basophilia, erythrocytosis, thrombocytosis, isolated anemia, or isolated thrombocytopenia.
The role of peripheral blood flow cytometry for hematologic neoplasia is limited to settings in which either there are morphologically abnormal cells identified on a peripheral blood smear review (blasts, lymphoma cells) or there are clinical and/or laboratory findings that suggest a high pre-test probability for the presence of a disorder amenable to the immunophenotypic detection of neoplastic cells in the blood. The latter includes patients with neutropenia, absolute lymphocytosis, lymphadenopathy, or splenomegaly. The likelihood of flow cytometry of blood producing diagnostic results in the settings enumerated in the recommendation above is extremely low; bone marrow sampling with morphologic analysis (and appropriate ancillary diagnostic testing) may be indicated in those scenarios.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
1-5: The American Society for Clinical Pathology (ASCP) list was developed under the leadership of the chair of ASCP’s Institute Advisory Committee and Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The review panel examined hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and, eliminating it or changing to another test is within the control of the clinician. The final list is not exhaustive (many other tests/procedures were also identified and were also worthy of consideration), but the recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our laboratory resources and personnel.
6–15: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Choosing Wisely Ad Hoc Committee. This committee is chaired by an ASCP Past President and comprises subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered an initial list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees, and councils. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and
eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs, and a more effective use of our laboratory resources and personnel.
16-35 The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s newly formed Advisory Board seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.
ASCP’s disclosure and conflict of interest policy can be found at www.ascp.org.
Sources
Davis BH, Holden JT, Bene MC, et al. 2006 Bethesda international consensus recommendations on the flow cytometric immunophenotypic analysis of hematolymphoid neoplasia: medical indications. Cytometry B Clin Cytom. 2007;72:S5-S13.
Oberley MJ, Fitzgerald S, Yang, DT, et al. Value-based flow testing of chronic lymphoproliferative disorders. A quality improvement project to develop an algorithm to streamline testing and reduce costs. Am J Clin Pathol. Sept 2014;142:411-418.
Healey R, Naugler C, de Koning L, et al. A classification tree approach for improving the utilization of flow cytometry testing of blood specimens for B-cell non-Hodgkin lymphoproliferative disorders. Leukemia and Lymphoma 2015; 56(9): 2619-2624.
Andrews JM, Cruser DL, Myers JB, et al. Using peripheral smear review, age and absolute lymphocyte count as predictors of abnormal peripheral blood lymphocytosis diagnosed by flow cytometry. Leukemia and Lymphoma 2008; 49(9):1731-1737.
Lim HY and Hong FS. Maximising yield of peripheral blood flow cytometry for chronic lymphoproliferative disorders. Int J Lab Hem 2018; 1-5.
Paolo Strati P and Shanafelt TD. Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification. Blood. 2015;126(4):454-462.
