Went P, Mayer S, Oberholzer M, Dirnhofer S
Institute for Pathology, University of Basel, University Hospital, Schönbeinstrasse 40, 4031 Basel, Switzerland.
Histol Histopathol. 2006 Sep;21(9):951-6. doi: 10.14670/HH-21.951.
Minor and major criteria for the diagnosis of multiple meloma according to the definition of the WHO classification include different categories of the bone marrow plasma cell count: a shift from the 10-30% group to the > 30% group equals a shift from a minor to a major criterium, while the < 10% group does not contribute to the diagnosis. Plasma cell fraction in the bone marrow is therefore critical for the classification and optimal clinical management of patients with plasma cell dyscrasias. The aim of this study was (i) to establish a digital image analysis system able to quantify bone marrow plasma cells and (ii) to evaluate two quantification techniques in bone marrow trephines i.e. computer-assisted digital image analysis and conventional light-microscopic evaluation. The results were compared regarding inter-observer variation of the obtained results.
Eighty-seven patients, 28 with multiple myeloma, 29 with monoclonal gammopathy of undetermined significance, and 30 with reactive plasmocytosis were included in the study. Plasma cells in H&E- and CD138-stained slides were quantified by two investigators using light-microscopic estimation and computer-assisted digital analysis. The sets of results were correlated with rank correlation coefficients. Patients were categorized according to WHO criteria addressing the plasma cell content of the bone marrow (group 1: 0-10%, group 2: 11-30%, group 3: > 30%), and the results compared by kappa statistics.
The degree of agreement in CD138-stained slides was higher for results obtained using the computer-assisted image analysis system compared to light microscopic evaluation (corr.coeff. = 0.782), as was seen in the intra- (corr.coeff. = 0.960) and inter-individual results correlations (corr.coeff. = 0.899). Inter-observer agreement for categorized results (SM/PW: kappa 0.833) was in a high range.
Computer-assisted image analysis demonstrated a higher reproducibility of bone marrow plasma cell quantification. This might be of critical importance for diagnosis, clinical management and prognostics when plasma cell numbers are low, which makes exact quantifications difficult.
根据世界卫生组织分类定义，多发性骨髓瘤诊断的次要和主要标准包括骨髓浆细胞计数的不同类别：从10%-30%组转变为>30%组相当于从次要标准转变为主要标准，而<10%组对诊断无贡献。因此，骨髓中的浆细胞比例对于浆细胞异常增生患者的分类和最佳临床管理至关重要。本研究的目的是：（i）建立一个能够量化骨髓浆细胞的数字图像分析系统；（ii）评估骨髓切片中的两种量化技术，即计算机辅助数字图像分析和传统光学显微镜评估。比较了所得结果在观察者间的差异。
本研究纳入了87例患者，其中28例患有多发性骨髓瘤，29例患有意义未明的单克隆丙种球蛋白病，30例患有反应性浆细胞增多症。两名研究人员使用光学显微镜估计和计算机辅助数字分析对苏木精-伊红（H&E）染色和CD138染色切片中的浆细胞进行量化。结果集采用等级相关系数进行关联。根据世界卫生组织关于骨髓浆细胞含量的标准对患者进行分类（第1组：0-10%，第2组：11-30%，第3组：>30%），并通过kappa统计比较结果。
与光学显微镜评估相比，使用计算机辅助图像分析系统在CD138染色切片中获得的结果一致性程度更高（相关系数=0.782），在个体内（相关系数=0.960）和个体间结果相关性方面也是如此（相关系数=0.899）。分类结果的观察者间一致性（SM/PW：kappa 0.833）处于较高水平。
计算机辅助图像分析显示骨髓浆细胞量化具有更高的可重复性。当浆细胞数量较低时，这对于诊断、临床管理和预后可能至关重要，因为此时精确量化较为困难。
