Potential for Process Improvement of Clinical Flow Cytometry by Incorporating Real-Time Automated Screening of Data to Expedite Addition of Antibody Panels

OBJECTIVES: We desired an automated approach to expedite ordering additional antibody panels in our clinical flow cytometry lab. This addition could improve turnaround times, decrease time spent revisiting cases, and improve consistency. METHODS: We trained a machine learning classifier to use our screening B-cell panel to predict whether we should order an additional panel to distinguish chronic lymphocytic lymphoma from mantle cell lymphoma. We used data from 2016 to 2018 for training and validation, and cases were restricted to the first case per patient (9,635 cases, 887 with the additional panel). We applied the model in real time over approximately 2.5 months in 2020 to 376 sequential cases, with automated email notifications for positive predictions. RESULTS: Using 80% of the data from 2016 to 2018 to train and 20% for validation, we achieved 95% area under the receiving operating characteristic curve (AUROC) and 94% accuracy in the validation set. Applying the classifier in real time achieved 89% AUROC and 94% real-time prediction accuracy (precision positive predictive value = 51%, recall sensitivity = 78%, and F1 score = 0.62). Fourteen of the 17 false positives had prior diagnoses to which the algorithm was not privy. CONCLUSIONS: As an observational, not interventional study, our system performed well on testing within our laboratory for identifying cases to be flagged but cannot be used without laboratory-specific modifications.