Appropriate use of flow cytometric immunophenotyping for hematolymphoid malignancies: choosing wisely
Project Description: Flow cytometric immunophenotyping (FCI) is a valuable tool in the diagnosis and classification of hematolymphoid neoplasms. These include lymphoma, chronic lymphoid leukemias, plasma cell disorders, acute leukemias, mast cell disease, myelodysplastic syndromes and myeloproliferative disorders. Starting in 2001, the World Health Organization (WHO) standardized FCI criteria for each disease. As FCI technology evolved, there emerged a gap between practicing clinicians and laboratory technologists. Specifically, under what clinical circumstances is FCI appropriate? Recognizing this need to communicate diagnostic utility, in 2006, the Bethesda International Consensus defined medical indications for flow cytometric testing (presented in protocol). FCI is not indicated in all patients with leukocytosis or lymphocytosis, and the Bethesda International Consensus also highlighted indications for which FCI is inappropriate. We performed a search of MedLine/PubMed and Google Scholar databases and were unable to find any studies examining the appropriate utilization of FCI in clinical practice. To the best of our knowledge, the use of flow cytometry has never been examined from a high value care or quality improvement viewpoint. In this study, we will use a pre- and post- intervention design. In the initial phase we will investigate whether peripheral FCI is being utilized in clinical scenarios where it is not indicated, as defined by the Bethesda Consensus. If it is indeed found after retrospective review that a significant percentage of FCI testing is inappropriate, then an intervention is warranted. Optimizing the use of FCI has benefits to payers of medical services, clinical and laboratory staff and ultimately the organization (UF Health Jacksonville and the UFCOM-Jacksonville). It also espouses the concept of “high value care” promoted by the American College of Physicians (ACP) for internal medicine physicians.
QPI: Satish, Maharaj, (email@example.com)
Collaborators: Karan, Seegobin, (firstname.lastname@example.org)
Advisors: Fauzia, Rana, (email@example.com); (firstname.lastname@example.org); Jeffrey, House, (email@example.com)
UF Health Big Aims: Increase Value None
MeSH Keywords: Cost-Benefit Analysis, Flow Cytometry, Hematologic Diseases, Leukocytosis, Polycythemia, Thrombocytosis