Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul;96(7):1105-1112.
doi: 10.1007/s00277-017-3009-7. Epub 2017 May 20.

Cytomorphology review of 100 newly diagnosed lower-risk MDS patients in the European LeukemiaNet MDS (EUMDS) registry reveals a high inter-observer concordance

Louise de Swart  1 , Alex Smith  2 , Marius MacKenzie  1 , Argiris Symeonidis  3 , Judith Neukirchen  4 , Dana Mikulenková  5 , Teresa Vallespí  6 , Gina Zini  7 , Malgorzata Paszkowska-Kowalewska  8 , Anton Kruger  9 , Leonie Saft  10 , Pierre Fenaux  11 , David Bowen  12 , Eva Hellström-Lindberg  13 , Jaroslav Čermák  5 , Reinhard Stauder  14 , Aurelia Tatic  15 , Mette Skov Holm  16 , Luca Malcovati  17 , Krzysztof Mądry  8 , Jackie Droste  1 , Nicole Blijlevens  1 , Theo de Witte  18 , Ulrich Germing  4
Affiliations

Cytomorphology review of 100 newly diagnosed lower-risk MDS patients in the European LeukemiaNet MDS (EUMDS) registry reveals a high inter-observer concordance

Louise de Swart et al. Ann Hematol. 2017 Jul.

Abstract

The European LeukemiaNet MDS (EUMDS) registry is collecting data of myelodysplastic syndrome (MDS) patients belonging to the IPSS low or intermediate-1 category, newly diagnosed by local cytologists. The diagnosis of MDS can be challenging, and some data report inter-observer variability with regard to the assessment of the MDS subtype. In order to ensure that correct diagnoses were made by the participating centres, blood and bone marrow slides of 10% of the first 1000 patients were reviewed by an 11-person panel of cytomorphologists. All slides were rated by at least 3 panel members (median 8 panel members; range 3-9). Marrow slides from 98 out of 105 patients were of good quality and therefore could be rated properly according to the WHO 2001 classification, including assessment of dysplastic lineages. The agreement between the reviewers whether the diagnosis was MDS or non-MDS was strong with an intra-class correlation coefficient (ICC) of 0.85. Six cases were detected not to fit the entry criteria of the registry, because they were diagnosed uniformly as CMML or AML by the panel members. The agreement by WHO 2001 classification was strong as well (ICC = 0.83). The concordance of the assessment of dysplastic lineages was substantial for megakaryopoiesis and myelopoiesis and moderate for erythropoiesis. Our data show that in general, the inter-observer agreement was high and a very low percentage of misdiagnosed cases had been entered into the EUMDS registry. Further studies including histomorphology are warranted.

Keywords: Cytomorphology review; Diagnostics; Inter-observer variability; Myelodysplastic syndromes (MDS).

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Financial support

The work of the EUMDS Registry for low and intermediate-1 MDS is supported by an educational grant from Novartis Oncology Europe.

Figures

Fig. 1
Fig. 1
Proportion of cases reviewed by each panel member and expert diagnoses made
Fig. 2
Fig. 2
Original diagnoses by local cytologists versus expert diagnoses
See this image and copyright information in PMC

References

    1. Germing U, Kobbe G, Haas R, Gattermann N. Myelodysplastic syndromes: diagnosis, prognosis, and treatment. Dtsch Arztebl Int. 2013;110(46):783–790. - PMC - PubMed
    1. Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Solé F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Malcovati L, Cazzola M, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SM, Miyazaki Y, Pfeilstöcker M, Sekeres M, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120(12):2454–2465. doi: 10.1182/blood-2012-03-420489. - DOI - PMC - PubMed
    1. Westers TM, Cremers EM, Oelschlaegel U, Johansson U, Bettelheim P, Matarraz S, Orfao A, Moshaver B, Brodersen LE, Loken MR, Wells DA, Subirá D, Cullen M, Te Marvelde JG, van der Velden VH, Preijers FW, Chu SC, Feuillard J, Guérin E, Psarra K, Porwit A, Saft L, Ireland R, Milne T, Béné MC, Witte BI, Della Porta MG, Kern W, van de Loosdrecht AA, IMDSFlow Working Group Immunophenotypic analysis of erythroid dysplasia in myelodysplastic syndromes. A report from the IMDSFlow working group. Haematologica. 2017;102(2):308–319. doi: 10.3324/haematol.2016.147835. - DOI - PMC - PubMed
    1. Bejar R, Stevenson KE, Caughey BA, Abdel-Wahab O, Steensma DP, Galili N, Raza A, Kantarjian H, Levine RL, Neuberg D, Garcia-Manero G, Ebert BL. Validation of a prognostic model and the impact of mutations in patients with lower-risk myelodysplastic syndromes. J Clin Oncol. 2012;30(27):3376–3382. doi: 10.1200/JCO.2011.40.7379. - DOI - PMC - PubMed
    1. Malcovati L, Hellstrom-Lindberg E, Bowen D, Adès L, Cermak J, Del Cañizo C, Della Porta MG, Fenaux P, Gattermann N, Germing U, Jansen JH, Mittelman M, Mufti G, Platzbecker U, Sanz GF, Selleslag D, Skov-Holm M, Stauder R, Symeonidis A, van de Loosdrecht AA, de Witte T, Cazzola M, Net EL. Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood. 2013;122(17):2943–2964. doi: 10.1182/blood-2013-03-492884. - DOI - PMC - PubMed