{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:44:38Z","timestamp":1791575078187,"version":"4.3.4"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T00:00:00Z","timestamp":1651017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["NRF-2021R1A2C2013359"],"award-info":[{"award-number":["NRF-2021R1A2C2013359"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The Sysmex DI-60 digital morphology analyzer is a fully automated, cell-locating image analysis system. This study aimed to evaluate the analytical performance of DI-60.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 822 peripheral blood smears were used. The diagnostic performance of DI-60 in terms of red blood cell (RBC) morphology characterization, white blood cell (WBC) differentials, and the total assay time including hands-on time was evaluated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In comparison with manual slide review, DI-60 demonstrated acceptable accuracy in recognizing polychromasia, target cells, and ovalocytes. However, for schistocytes, DI-60 demonstrated low specificity (10.4%) despite the high sensitivity (97.2%). In the precision analysis of RBC morphology characterization, borderline samples harboring specific RBCs showed inconsistencies in the positive results among 20 replicates. Particularly, 6 of 10 samples showed inconsistencies in the precision for schistocytes. For WBC differentials, the overall agreement between pre-classification results and user-verified results was 89.4%. Except for basophils, normal WBCs showed a good correlation between DI-60 (after user verification) and manual counts. The sensitivities in detecting immature granulocytes, blasts, atypical lymphocytes, and normoblasts were 85.9%, 92.0%, 37.5%, and 77.6%, respectively. Although the total assay time of DI-60 was longer than that of manual review, the hands-on time was considerably shorter with a difference of 144.1 s\/slide for abnormal samples.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>DI-60 demonstrated acceptable performance for normal samples. However, for abnormal WBC differentials and RBC morphology characterization, it should be utilized carefully. DI-60 may contribute to an improvement in laboratory efficiency with increased feasibility.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0267638","type":"journal-article","created":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T17:32:22Z","timestamp":1651080742000},"page":"e0267638","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":31,"title":["Red and white blood cell morphology characterization and hands-on time analysis by the digital cell imaging analyzer DI-60"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4751-7384","authenticated-orcid":true,"given":"Oh Joo","family":"Kweon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Kwan","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi-Kyung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9229-9665","authenticated-orcid":true,"given":"Hye Ryoun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,27]]},"reference":[{"issue":"3","key":"pone.0267638.ref001","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/ijlh.12327","article-title":"ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features.","volume":"37","author":"L Palmer","year":"2015","journal-title":"International journal of laboratory hematology"},{"key":"pone.0267638.ref002","doi-asserted-by":"crossref","DOI":"10.1136\/jclinpath-2014-202223","article-title":"Immature granulocyte count in peripheral blood by the Sysmex haematology XN series compared to microscopic differentiation","volume":"67","author":"TM Maenhout","year":"2014","journal-title":"Journal of clinical pathology"},{"issue":"5","key":"pone.0267638.ref003","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/ijlh.12364","article-title":"Fragmented red cells reference range for the Sysmex XN\u00ae-series of automated blood cell counters.","volume":"37","author":"JF Lesesve","year":"2015","journal-title":"International journal of laboratory hematology"},{"issue":"2","key":"pone.0267638.ref004","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1515\/cclm-2014-0445","article-title":"Performance evaluation of the digital cell imaging analyzer DI-60 integrated into the fully automated Sysmex XN hematology analyzer system","volume":"53","author":"Y Tabe","year":"2015","journal-title":"Clinical chemistry and laboratory medicine"},{"issue":"2","key":"pone.0267638.ref005","first-page":"311","article-title":"Imprecision of ratio-derived differential leukocyte counts","volume":"11","author":"CL R\u00fcmke","year":"1985","journal-title":"Blood cells"},{"issue":"4","key":"pone.0267638.ref006","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.leukres.2014.01.008","article-title":"Integration of automated morphological features resolves a distinct group of atypical chronic lymphocytic leukemias with chromosomal aberrations","volume":"38","author":"Y Herishanu","year":"2014","journal-title":"Leukemia research"},{"key":"pone.0267638.ref007","article-title":"Could the UKNEQAS program \"Manual Differential Blood Count\" be performed by the use of an automated digital morphology analyzer (Sysmex DI-60)? A feasibility study.","author":"M Rosetti","year":"2020","journal-title":"Clinical chemistry and laboratory medicine"},{"issue":"1","key":"pone.0267638.ref008","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1515\/cclm-2017-0132","article-title":"Performance of automated digital cell imaging analyzer Sysmex DI-60","volume":"56","author":"HN Kim","year":"2017","journal-title":"Clinical chemistry and laboratory medicine"},{"key":"pone.0267638.ref009","volume-title":"Reference Leukocyte (WBC) Differential Count (Proportional) and Evaluation of Instrumental Methods; Approved Standard-Second Edition, CLSI document H20-A2.","author":"CLSI","year":"2007"},{"key":"pone.0267638.ref010","volume-title":"Evaluation of Precision of Quantitative Measurement Procedures; Approved Guideline-Third Edition. CLSI document EP05-A3.","author":"CLSI","year":"2014"},{"issue":"1","key":"pone.0267638.ref011","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"JR Landis","year":"1977","journal-title":"Biometrics"},{"issue":"2","key":"pone.0267638.ref012","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1751-553X.2011.01380.x","article-title":"ICSH recommendations for identification, diagnostic value, and quantitation of schistocytes","volume":"34","author":"G ZINI","year":"2012","journal-title":"International journal of laboratory hematology"},{"issue":"4","key":"pone.0267638.ref013","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1111\/ijlh.12497","article-title":"Evaluation of the Red Blood Cell Advanced Software Application on the CellaVision DM96.","volume":"38","author":"M Criel","year":"2016","journal-title":"International journal of laboratory hematology."},{"issue":"1","key":"pone.0267638.ref014","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1751-553X.2007.01002.x","article-title":"Can automated blood film analysis replace the manual differential? An evaluation of the CellaVision DM96 automated image analysis system.","volume":"31","author":"C Briggs","year":"2009","journal-title":"International journal of laboratory hematology."},{"issue":"1","key":"pone.0267638.ref015","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1136\/jcp.2005.035402","article-title":"Examination of peripheral blood films using automated microscopy; evaluation of Diffmaster Octavia and Cellavision DM96","volume":"60","author":"H Ceelie","year":"2007","journal-title":"J Clin Pathol"},{"issue":"1","key":"pone.0267638.ref016","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4103\/2153-3539.114205","article-title":"Performance of CellaVision DM96 in leukocyte classification","volume":"4","author":"L Lee","year":"2013","journal-title":"Journal of Pathology Informatics"},{"issue":"1","key":"pone.0267638.ref017","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/2153-3539.114207","article-title":"Platelet count estimation using the CellaVision DM96 system","volume":"4","author":"Y Gao","year":"2013","journal-title":"Journal of Pathology Informatics"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T17:32:47Z","timestamp":1651080767000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267638"}},"subtitle":[],"editor":[{"given":"Jeffrey","family":"Chalmers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,27]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0267638","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,27]]}}}