{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:52:15Z","timestamp":1773913935940,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,25]],"date-time":"2018-09-25T00:00:00Z","timestamp":1537833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recent data have demonstrated the high sensitivity and specificity of peripheral blood flow cytometry (PBFC) for the diagnosis of pediatric leukemia; however, diagnostically significant immunophenotypic discrepancies between PBFC and bone marrow (BM) evaluation, which result in different lineage assignment and treatment protocols, can rarely occur. Here, we sought to further characterize the performance of PBFC for pediatric leukemia and highlight the exceptions when PBFC can result in misdiagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An institutional database was searched between 2012 and 2016 for cases of acute leukemia with concurrent PBFC and BM evaluation. Immunophenotyping results from the peripheral blood and BM using four or eight color flow cytometry, as well as BM cytochemical staining and immunohistochemistry, were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred ninety PBFC samples with concurrent BM evaluation were identified. Based on the final immunophenotypic classification, the cases were distributed as follows: 108 B\u2010lymphoblastic leukemia (B\u2010ALL), 57 T\u2010lymphoblastic leukemia (T\u2010ALL), 116 acute myeloid leukemia (AML), and 9 mixed\u2010phenotype acute leukemia (MPAL). Among all cases, five had a diagnostically significant discrepancy between PBFC and BM evaluation. In three cases, the immunophenotype by PBFC was consistent with early T\u2010cell precursor ALL (ETP\u2010ALL), whereas BM evaluation demonstrated MPAL. Two cases were suspicious for acute megakaryoblastic leukemia (AMKL) and MPAL, T\/myeloid by PBFC but were diagnosed as B\u2010ALL and T\u2010ALL in the BM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Immunophenotypic classification by PBFC is accurate (&gt;98%) in almost all cases of pediatric leukemia with the rare exceptions of suspected ETP\u2010ALL, MPAL, and AMKL. These PBFC diagnoses should be confirmed with BM immunophenotyping.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.27453","type":"journal-article","created":{"date-parts":[[2018,9,26]],"date-time":"2018-09-26T04:09:43Z","timestamp":1537934983000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Peripheral blood flow cytometry for the diagnosis of pediatric acute leukemia: Highly reliable with rare exceptions"],"prefix":"10.1002","volume":"66","author":[{"given":"Jinjun","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Tennessee Health Science Center  Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4463-0835","authenticated-orcid":false,"given":"Matthew M.","family":"Klairmont","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Tennessee Health Science Center  Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John K.","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Pathology St. Jude Children's Research Hospital  Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26526"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26738"},{"key":"e_1_2_7_4_1","volume-title":"WHO classification of tumours of haematopoietic and lymphoid tissues (IARC WHO classification of tumours) Revised Fourth Edition","author":"Swerdlow SH","year":"2017"},{"issue":"10","key":"e_1_2_7_5_1","first-page":"1783","article-title":"Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL)","volume":"9","author":"Bene MC","year":"1995","journal-title":"Leukemia."},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.21072"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-12-324004"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70314-0"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2017-0218-RA"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqx021"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-09-807602"},{"key":"e_1_2_7_12_1","article-title":"AML with MDS\u2010related changes and blasts of mixed lineage: time for a new provisional entity?","volume":"1","author":"Klairmont MM","year":"2018","journal-title":"Leuk Lymphoma"},{"key":"e_1_2_7_13_1","first-page":"150","volume-title":"WHO classification of tumours of haematopoietic and lymphoid tissues, Revised Fourth Edition","author":"Arber DA","year":"2017"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-018-0058-4"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V79.9.2399.2399"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqy074"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpbc.27453","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.27453","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T16:38:31Z","timestamp":1694709511000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.27453"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,25]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1002\/pbc.27453"],"URL":"https:\/\/doi.org\/10.1002\/pbc.27453","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,25]]},"assertion":[{"value":"2018-05-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e27453"}}