Incorporation of the Sysmex DI-60 Into the Laboratory's Manual Slide Review Criteria: Assessment of Laboratory Efficiency in a Routine Practice.

INTRODUCTION: Digital morphology (DM) analyzers may improve laboratory efficiency; however, their practical integration into manual slide review (MSR) criteria and the resulting impact on overall efficiency remain underexplored. We evaluated the efficiency of the DI-60 (Sysmex, Kobe, Japan) by assessing its potential to modify or replace existing MSR criteria in a routine practice and comparing its turnaround time (TAT) with that of manual counting. METHODS: A total of 907 samples were consecutively selected based on our laboratory's MSR criteria. We simulated modified MSR criteria incorporating the DI-60 to assess the potential reduction in laboratory workload. We compared TATs of the DI-60 and manual counting according to white blood cell (WBC) counts (range, 0.01-158.6 × 109/L). RESULTS: DI-60 achieved complete analysis in 717/907 samples (79.1%), showing stable performance in samples with normal WBC counts. However, the overall TAT of the DI-60 was significantly longer than that of manual counting (263 vs. 120 s, p < 0.001). Incomplete analysis (< 200-cell count) occurred in 190 samples (20.9%), predominantly in hematology-oncology samples (94.7%) and samples with severe leukopenia. Simulation of modified MSR criteria incorporating the DI-60 demonstrated a potential workload reduction of 11.6% (105/907). CONCLUSIONS: DM analyzers may have the potential to reduce laboratory workload by being incorporated into each laboratory's MSR criteria. With incomplete analyses in specific sample types, however, DM analyzers cannot fully replace MSR. The effective use of DM analyzers requires streamlined integration into the existing laboratory workflow and further optimization considering each laboratory's situation and unmet needs.