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Objective:To investigate the value of artificial intelligence (AI) cytomorphologic analysis system in the cytomorphological diagnosis and therapeutic evaluation of acute myeloid leukemia (AML).Methods:Bone marrow smear samples were collected from 150 patients with newly diagnosed and treated acute myeloid leukemia who were inpatients and outpatients at the Department of Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 1, 2021 to July 31, 2022 for retrospective analysis. Among them, there were 50 patients in the newly diagnosed group, including 28 males and 22 females, with the onset age of 43.5(32.3,58.8)years. There were 100 patients in the post-treatment group, including 36 males and 64 females, with the onset age of 34.5(23.0,47.0)years. The results from cytomorphology expert were used as the gold standard and the Python 3.6.7 was used for analysis to evaluate the accuracy, sensitivity, and specificity of the AI cytomorphologic analysis system for blast cell recognition in AML diagnosis and treatment.Results:The proportion of blasts in AI analysis of 50 samples in the newly diagnosed group was≥20%, which met the diagnostic criteria of AML. AI analysis of blasts had an accuracy of 90.3%, sensitivity of 85.5%, and specificity of 98.0%. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.882, P<0.001). Meanwhile, in the post-treatment group, the sensitivity and specificity of AI analysis of blasts were 89.7% and 99.2%, respectively. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.957, P<0.001). According to AI analysis data, there are 8 samples in this group whose AI efficacy evaluation results on AML are inconsistent with expert analysis. Conclusion:AI cytomorphologic analysis system has high accuracy, sensitivity and specificity for blast cell recognition in AML morphological diagnosis and therapeutic evaluation.
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Advances in digital pathology technology have enabled pathologists and laboratory physicians to perform quick, easy, accurate and reproducible analysis of digital images of tissues and cells with the aid of electronic screens and software tools, rather than relying solely on traditional optical microscopy observations. The conventional clinical cytology testing practice is to be replaced by a digital workflow, which includes both digital imaging and image analysis. This article provides an overview of the basic principles of digital pathology techniques, the advances of development of device in cytology digital pathology, and their clinical applications in bone marrow morphology, and existing problems and prospects of digital pathology application in hematology.
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Bone Marrow , Image Processing, Computer-Assisted , Microscopy , Software , TechnologyABSTRACT
Objective To analyze the epidemiological and clinical data of an imported case of visceral leishmaniasis in Henan Province, and explore the method of laboratory diagnosis of kala-azar. Methods The epidemiological and clinical data of an imported visceral leishmaniasis patient were analyzed. Leishmania donovani bodies in bone marrow smears were observed microscopically. The antibody was detected by using rK39 dipstick test strips. Two pairs of specific primers, K13A-K13B and LITSR-L5.8S, were used to amplify kinetoplast DNA and internal transcribed spacer of rDNA of the parasite, respectively. Results The patient had been in the epidemic area of visceral leishmaniasis, and had symptoms such as irregular fever, splenomegaly, pancytopenia, and inversed ratio of albumin and globulin. The amastigotes of L. donovani were found in the bone marrow smears, and rK39 test strip was positive, and the PCR products of K13A-K13B and LITSR-L5.8S were 87 bp and 285 bp respectively. The similarities of the two fragment sequences to the corresponding sequences of L. donovani were 94% and 100%, respectively. Conclusion The case is diagnosed as visceral leishmaniasis according to the epidemiological data, clinical manifestations and laboratory test results of the patient, and the pathogen is L. donovani.
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Objective To analyze the epidemiological and clinical data of an imported case of visceral leishmaniasis in Henan Province, and explore the method of laboratory diagnosis of kala-azar. Methods The epidemiological and clinical data of an imported visceral leishmaniasis patient were analyzed. Leishmania donovani bodies in bone marrow smears were observed microscopically. The antibody was detected by using rK39 dipstick test strips. Two pairs of specific primers, K13A-K13B and LITSR-L5.8S, were used to amplify kinetoplast DNA and internal transcribed spacer of rDNA of the parasite, respectively. Results The patient had been in the epidemic area of visceral leishmaniasis, and had symptoms such as irregular fever, splenomegaly, pancytopenia, and inversed ratio of albumin and globulin. The amastigotes of L. donovani were found in the bone marrow smears, and rK39 test strip was positive, and the PCR products of K13A-K13B and LITSR-L5.8S were 87 bp and 285 bp respectively. The similarities of the two fragment sequences to the corresponding sequences of L. donovani were 94% and 100%, respectively. Conclusion The case is diagnosed as visceral leishmaniasis according to the epidemiological data, clinical manifestations and laboratory test results of the patient, and the pathogen is L. donovani.
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Objective To Investigation the quality of marrow smear purchased by CDUTCM.Methods The quality and the typ-icality of marrow smears purchased during 2015 -2016 were collectively examined,and then decided whether these smears fit the blood cell morphology experimental teaching requirement.Results Of all the 960 marrow smears purchased these two years, 49.7% failed in smear made or stained,and 16.0% failed to meet the teaching requirements in the typicality of marrow cells.Con-clusion Teaching marrow smears,being different from clinic ones in their preparation and morphological diagnosis,must be of great quality in sustaining and of better typicality in their cell features.
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Objective To investigate the diagnostic significance of bone marrow smear combined with bone marrow biopsy in pancytopenia.Methods The clinical data of 94 pancytopenia patients who were detected by bone marrow smear and bone marrow biopsy synchronously were retrospectively analyzed.Results In 94 pancytopenia patients,leukemia was in 29 cases (30.85％),myelodysplastic syndrome (MDS)was in 20 cases (21.28％),aplastic anemia (AA) was in 18 cases (19.15％),multiple myeloma (MM) was in 4 cases (4.26％),primary myelofibrosis (MF) was in 2 cases (2.13％),metastatic cancer was in 3 cases (3.19％),lymphoma in bone marrow infiltration was in 3 cases (3.19％),megaloblastic anemia (MA) was in 10 cases (10.64％),and iron deficiency anemia (IDA) was in 5 cases (5.32％).In 29 leukemia patients,acute myeloid leukemia-M2 (AML-M2) was in 5 cases,acute myeloid leukemia-M3 (AML-M3) was in 9 cases,acute myeloid leukemia-M5 (AML-M55) was in 6 cases,acute myeloid leukemia-M4 (AML-M4) was in 2 cases,acute lymphoblastic leukemia (ALL) was in 3 cases,chronic lymphocytic leukemia (CLL) was in 3 cases,and hairy cell leukemia was in 1 case.The diagnostic accuracy of bone marrow smear was 88.30％ (83/94),the diagnostic accuracy of bone marrow biopsy was 92.55％ (87/94),and the diagnostic accuracy of bone marrow smear combined with bone marrow biopsy was 98.94％ (93/94).The diagnostic accuracy of bone marrow biopsy was higher than that of bone marrow smear,but there was no statistical difference (x2 =0.89,P ＞ 0.05).The diagnostic accuracy of bone marrow smear combined with bone marrow biopsy was higher than that of bone marrow smear,and there was statistical difference (x2 =8.70,P ＜ 0.01).There was no statistical difference in the misdiagnosis rate between bone marrow smear and bone marrow biopsy:11.70％ (11/94) vs.7.45％(7/94),x2 =0.89,P ＞ 0.05.Conclusions The bone marrow smear combined with the bone marrow biopsy can improve the diagnostic accuracy of the blood system diseases,especially in pancytopenia,and has a very important diagnostic significance.It should be included in routine testing project.
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Objective To compare the effectiveness,correlativity,and acceptability of the three methods:bone marrow smear,biopsy and flow cytometry in diagnosis of lymphoma patients with bone marrow involvement.Methods 68 cases of early stage lymphoma were studied by observing and comparing positive rates of the three methods:bone marrow smear,biopsy and flow cytometry.Results After confirming the bone marrow involvement,the positive rates for the 68 cases using bone marrow smear,biopsy and flow cytometry were 16.2 ％ (11/68),33.8 ％ (23/68) and 10.3 ％ (7/68) respectively.Bone marrow biopsy had the highest positive rate compared to the other methods.It was statistically significant when comparing the differences of the 3 methods (P ＜ 0.05).According to the correlativity analysis of the 3 methods,bone marrow smear and biopsy correlated with each other (P =0.002),while flow cytometery did not (P =0.270).Conclusions Morphological examination of the bone marrow smear is a fundamental method to test bone marrow involvement in lymphoma.Bone marrow biopsy creates the highest positive rate and has clear advantage compared to the other methods,however,bone marrow smear must be used at the same time as a complement.
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Objective To investigate the diagnostic significance of synchronous observation on bone marrow biopsy,bone marrow smear and peripheral blood smear in stubborn hematonosis.Methods Thirty-seven patients with difficult and complicated hematologic diseases were detected by peripheral blood smear,bone marrow smear and bone marrow biopsy.Those slides and smears were observed.Results The 37 cases with blood disease was diagnosed of aplastic anemia in 3 cases,5 cases of myelodysplastic syndrome,6 cases of primary myelofibrosis,13 cases of secondary myelofibrosis,7 cases of lymphoma with bone marrow infiltration and 3 cases of metastatic carcinoma of bone marrow.In the diagnosis of aplastic anemia,myelodysplastic syndrome,primary and secondary myelofibrosis,lymphoma and metastatic carcinoma of bone marrow diagnosis,bone marrow biopsy is superior to smear.Conclusion Bone marrow biopsy,bone marrow smear and peripheral blood smear synchronous observation can effectively increase the diagnostic rate,decrease misdiagnosis rate,and correctly identify the stage of the disease.
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Objective:To investigate the clinical value of bone marrow smears for the diagnosis of disseminated histoplasmosis(PDH).Methods:The clinical manifestation,laboratory test,diagnoses and treatment of 7 cases were analyzed.Results:The clinical manifestations varied.7 cases were diagnosed on the basis of careful examination of bone marrow smears,and treated with amphotericin B,fluconazole or itraconazole respectively.All of the 3 drugs were effective.Conclusion:The cellular examination of bone marrow smears is simple,and it has important clinical value for the diagnosis of PDH.