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世界卫生组织/国际癌症研究机构的骨髓增生异常肿瘤/综合征分类在亚型细胞形态学诊断方面表现更佳?

WHO/ICC Classification for Myelodysplastic Neoplasms/Syndromes Performs Better for Subtype Cytomorphological Diagnosis?

作者信息

Vicente Ana Isabel, Luna Irene, Ruiz Juan Carlos, Remigia María José, Jerez Andrés, Lluch Rafael, Llopis Inmaculada, Marco María Josefa, Benet Carmen, Alonso Carmen, Linares María Dolores, Serrano Luis, Orero María Teresa, Ortuño Francisco José, Senent María Leonor

机构信息

Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain.

Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain.

出版信息

Diagnostics (Basel). 2024 Jul 29;14(15):1631. doi: 10.3390/diagnostics14151631.

Abstract

The International Consensus Classification of Myeloid Neoplasms and Acute Leukemias (ICC) and the 5th edition of the WHO classification (WHO 2022) have refined the diagnosis of myelodysplastic syndromes (MDS). Both classifications segregate MDS subtypes based on molecular or cytogenetic findings but rely on the subjective assessment of blast cell percentage and dysplasia in hematopoietic cell lineages. This study aimed to evaluate interobserver concordance among 13 cytomorphologists from eight hospitals in assessing blast percentages and dysplastic features in 44 MDS patients. The study found fair interobserver agreement for the PB blast percentage and moderate agreement for the BM blast percentage, with the best concordance in cases with <5% BM blasts and >10% BM blasts. Monocyte count agreement was fair, and dysplasia assessment showed moderate concordance for megakaryocytic lineage but lower concordance for erythroid and granulocytic lineages. Overall, interobserver concordance for MDS subtypes was moderate across all classifications, with slightly better results for WHO 2022. These findings highlight the ongoing need for morphological evaluation in MDS diagnosis despite advances in genetic and molecular techniques. The study supports the blast percentage ranges established by the ICC but suggests refining BM blast cutoffs. Given the moderate interobserver concordance, a unified classification approach for MDS is recommended.

摘要

国际骨髓增殖性肿瘤和急性白血病共识分类(ICC)以及世界卫生组织第5版分类(WHO 2022)对骨髓增生异常综合征(MDS)的诊断进行了细化。这两种分类均根据分子或细胞遗传学结果对MDS亚型进行分类,但依赖于对造血细胞系中原始细胞百分比和发育异常的主观评估。本研究旨在评估来自八家医院的13位细胞形态学家在评估44例MDS患者的原始细胞百分比和发育异常特征方面的观察者间一致性。研究发现,外周血原始细胞百分比的观察者间一致性一般,骨髓原始细胞百分比的一致性为中等,在骨髓原始细胞<5%和>10%的病例中一致性最佳。单核细胞计数的一致性一般,发育异常评估显示巨核细胞系的一致性中等,但红系和粒系的一致性较低。总体而言,所有分类中MDS亚型的观察者间一致性为中等,WHO 2022的结果略好。这些发现凸显了尽管遗传和分子技术取得了进展,但MDS诊断中形态学评估仍持续需要。该研究支持ICC确定的原始细胞百分比范围,但建议完善骨髓原始细胞临界值。鉴于观察者间一致性中等,推荐采用统一的MDS分类方法。

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