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Zini G, Chiusolo P, Rossi E, Di Stasio E, Bellesi S, Za T, Viscovo M, Frioni F, Ramundo F, Pelliccioni N, De Stefano V. Digital morphology compared to the optical microscope: A validation study on reporting bone marrow aspirates. Int J Lab Hematol 2024; 46:474-480. [PMID: 38328984 DOI: 10.1111/ijlh.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION This study aims to evaluate the effectiveness and reliability of the utilization for clinical reporting of the evaluation of digital images of bone marrow aspirates by morphologists and their comparability with the classic microscopic morphological evaluation. METHODS We scanned 180 consecutive bone marrow needle aspirates smears using the "Metafer4 VSlide" whole slide imaging (WSI) digital scanning system. We evaluated the statistical comparability and the risk of bias of the microscopic readings with those performed on the screen on the digitized medullary images. RESULTS The evaluation of cellularity on the screen was equivalent, with a higher frequency of "normal" than the analysis of digital preparations. The means and medians of the percentage values obtained on the different cell populations with the microscopic and digital reading were comparable as the main categories are concerned, with an average difference equal to 0 for the neutrophilic and eosinophilic granulocytic series, at -0.2% for the total myeloid cells, at 1.2% for the erythroid series, at -0.4% for the lymphocytes and at -0.4% for the blasts. Dysplastic features were consistently identified in 69/71 cell lineages. CONCLUSION Our study demonstrated that screen evaluation of digitized bone marrow needle aspirates provides quantitative and qualitative results comparable to traditional microscopic analysis of the corresponding slide smears. Digital images offer significant benefits in reducing the workload of experienced operators, reproducibility and sharing of observations, and image preservation. Even in routine diagnostic activities, their use does not alter the quality of the results obtained in evaluating bone marrow needle aspirates.
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Affiliation(s)
- G Zini
- Department of Radiological and Hematological Sciences, Hematology Section, Catholic University of Sacred Heart Rome, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - P Chiusolo
- Department of Radiological and Hematological Sciences, Hematology Section, Catholic University of Sacred Heart Rome, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - E Rossi
- Department of Radiological and Hematological Sciences, Hematology Section, Catholic University of Sacred Heart Rome, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - E Di Stasio
- Department of Radiological and Hematological Sciences, Hematology Section, Catholic University of Sacred Heart Rome, Rome, Italy
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Bellesi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - T Za
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - M Viscovo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - F Frioni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - F Ramundo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - N Pelliccioni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
| | - V De Stefano
- Department of Radiological and Hematological Sciences, Hematology Section, Catholic University of Sacred Heart Rome, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Hematology Institute, Rome, Italy
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Jiang H, Xu W, Chen W, He J, Jiang H, Mao Z, Liu M, Li M, Liu D, Pan Y, Qu C, Qu L, Sun Z, Sun D, Wang X, Wang J, Wu W, Xing Y, Zhang S, Zhang C, Zheng L, Guan M. Performance of the digital cell morphology analyzer MC-100i in a multicenter study in tertiary hospitals in China. Clin Chim Acta 2024; 555:117801. [PMID: 38296220 DOI: 10.1016/j.cca.2024.117801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND This study investigated the performance of the MC-100i, a pre-commercial digital morphology analyzer utilizing a convolutional neural network algorithm, in a multicentric setting involving up to 11 tertiary hospitals in China. METHODS Blood smears were analyzed by MC-100i, verified by morphologists, and manually differentiated. The classification performance on WBCs and RBCs was evaluated by comparing the classification results using different methods. The PLT and PLT clump counting performance was also assessed. The total assay time including hands-on time was evaluated. RESULTS The agreements between pre- and post-classification were high for normal WBCs (κ > 0.96) and lower for overall abnormal WBCs (κ = 0.90). The post-classification results correlated well with manual differentials for both normal and abnormal WBCs (r > 0.93), except for basophils (r = 0.8480) and atypical lymphocytes (r = 0.8211). The clinical sensitivity and specificity of each RBC abnormality after verification were above 90 % using microscopy reviews as the reference. The PLTs counted by the MC-100i before and after verification correlated well with those measured by the PLT-O mode (r = 0.98). Moreover, PLT clumps were successfully classified by the analyzer in EDTA-dependent pseudothrombocytopenia blood samples. CONCLUSIONS The MC-100i is an accurate and reliable digital cell morphology analyzer, offering another intelligent option for hematology laboratories.
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Affiliation(s)
- Hong Jiang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610044, China
| | - Wei Xu
- Department of Laboratory Medicine, The First Bethune Hospital of Jilin University, Jilin 130061, China
| | - Wei Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jun He
- Department of Laboratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Haoqin Jiang
- Department of Laboratory Medicine, Huashan Hospital Fudan University, Shanghai 200040, China
| | - Zhigang Mao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610044, China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510062, China
| | - Mianyang Li
- Department of Laboratory Medicine, Chinese PLA Ceneral Hospital, Beijing 100080, China
| | - Dandan Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yuling Pan
- Department of Laboratory Medicine, Chinese PLA Ceneral Hospital, Beijing 100080, China
| | - Chenxue Qu
- Department of Laboratory Medicine, Peking University First Hospital, Beijing 100034, China
| | - Linlin Qu
- Department of Laboratory Medicine, The First Bethune Hospital of Jilin University, Jilin 130061, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College of Hust, Wuhan 430030, China
| | - Dehua Sun
- Department of Laboratory Medicine, Nanfang Hospital, Guangzhou 516006, China
| | - Xuefeng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jianbiao Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Wenjing Wu
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ying Xing
- Department of Laboratory Medicine, Peking University First Hospital, Beijing 100034, China
| | - Shihong Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510062, China
| | - Chi Zhang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College of Hust, Wuhan 430030, China
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Guangzhou 516006, China.
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital Fudan University, Shanghai 200040, China.
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Lincz LF, Makhija K, Attalla K, Scorgie FE, Enjeti AK, Prasad R. A comparative evaluation of three consecutive artificial intelligence algorithms released by Techcyte for identification of blasts and white blood cells in abnormal peripheral blood films. Int J Lab Hematol 2024; 46:92-98. [PMID: 37786915 DOI: 10.1111/ijlh.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Digital pathology artificial intelligence (AI) platforms have the capacity to improve over time through "deep machine learning." We have previously reported on the accuracy of peripheral white blood cell (WBC) differential and blast identification by Techcyte (Techcyte, Inc., Orem, UT, USA), a digital scanner-agnostic web-based system for blood film reporting. The aim of the current study was to compare AI protocols released over time to assess improvement in cell identification. METHODS WBC differentials were performed using Techcyte's online AI software on the same 124 digitized abnormal peripheral blood films (including 64 acute and 22 chronic leukaemias) in 2019 (AI1), 2020 (AI2), and 2022 (AI3), with no reassignment by a morphologist at any time point. AI results were correlated to the "gold standard" of manual microscopy, and comparison of Lin's concordance coefficients (LCC) and sensitivity and specificity of blast identification were used to determine the superior AI version. RESULTS AI correlations (r) with manual microscopy for individual cell types ranged from 0.50-0.90 (AI1), 0.66-0.86 (AI2) and 0.71-0.91 (AI3). AI3 concordance with manual microscopy was significantly improved compared to AI1 for identification of neutrophils (LCC AI3 = 0.86 vs. AI1 = 0.77, p = 0.03), total granulocytes (LCC AI3 = 0.92 vs. AI1 = 0.82, p = 0.0008), immature granulocytes (LCC AI3 = 0.67 vs. AI1 = 0.38, p = 0.0014), and promyelocytes (LCC AI3 = 0.53 vs. AI1 = 0.16, p = 0.0008). Sensitivity for blast identification (n = 65 slides) improved from 97% (AI1), to 98% (AI2), to 100% (AI3), while blast specificity decreased from 24% (AI1), to 14% (AI2) to 12% (AI3). CONCLUSION Techcyte AI has shown significant improvement in cell identification over time and maintains high sensitivity for blast identification in malignant films.
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Affiliation(s)
- Lisa F Lincz
- Haematology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Karan Makhija
- Haematology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Khaled Attalla
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- New South Wales Health Pathology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Fiona E Scorgie
- Haematology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Anoop K Enjeti
- Haematology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- New South Wales Health Pathology, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing
| | - Ritam Prasad
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- New South Wales Health Pathology, John Hunter Hospital, New Lambton, New South Wales, Australia
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Lapić I, Miloš M, Dorotić M, Drenški V, Coen Herak D, Rogić D. Analytical validation of white blood cell differential and platelet assessment on the Sysmex DI-60 digital morphology analyzer. Int J Lab Hematol 2023; 45:668-677. [PMID: 37255419 DOI: 10.1111/ijlh.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/07/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Digital morphology analyzers are increasingly replacing light microscopy in laboratory hematology practice. This study aimed to perform the analytical validation of the white blood cell (WBC) differential and of reliability of platelet assessment on Sysmex DI-60 (Kobe, Japan). METHODS Validation included determination of within-run and between-run precision for WBC differential according to the CLSI EP15-A3 protocol, accuracy and method comparison with light microscopy and with the automated WBC differential from the Sysmex XN-10 hematology analyzer, reliability of platelet clump detection and platelet count estimation. RESULTS Standard deviations of both pre- and post-classification mostly satisfied manufacturer's criteria for imprecision. Accuracy assessment revealed that only eosinophil count (1.4%) in one peripheral blood smear (PBS) remained outside the declared range (2-10%) after reclassification. Method comparison between DI-60 and light microscopy yielded Spearman's correlation coefficients from 0.37 (basophils) to 0.94 (neutrophils and lymphocytes), minor proportional difference for bands, constant difference for monocytes, both constant and proportional difference for lymphocytes and statistically significant biases for bands, lymphocytes, monocytes and basophils. Diagnostic sensitivity (Se) and specificity (Sp) of DI-60 in detecting immature/pathological cells were 88.7% (95%CI:81.1-94.0) and 83.0% (95%CI:78.7-86.7), respectively, with the area under the curve (AUC) of 0.86 (95%CI:0.82-0.89). Agreement in detection of platelet clumps was 94.8% (kappa coefficient = 0.67, 95%CI:0.53-0.80). Se and Sp of DI-60 to detect platelet clumps were 65.7% (95%CI: 47.8-80.9) and 96.9% (95%CI: 93.9-98.6), respectively, while AUC was 0.81 (95%CI: 0.76-0.86). CONCLUSION DI-60 provides reliable WBC differential and platelet assessment. In doubtful cases, the use of light microscopy is still mandatory.
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Affiliation(s)
- Ivana Lapić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marija Miloš
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
- Faculty of Pharmacy, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Dorotić
- Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Valentina Drenški
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Désirée Coen Herak
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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Kim H, Lee GH, Yoon S, Hur M, Kim HN, Park M, Kim SW. Performance of digital morphology analyzer Medica EasyCell assistant. Clin Chem Lab Med 2023; 61:1858-1866. [PMID: 37084402 DOI: 10.1515/cclm-2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES The EasyCell assistant (Medica, Bedford, MA, USA) is one of the state-of-the-art digital morphology analyzers. We explored the performance of EasyCell assistant in comparison with manual microscopic review and Pentra DX Nexus (Horiba ABX Diagnostics, Montpellier, France). METHODS In a total of 225 samples (100 normal and 125 abnormal samples), white blood cell (WBC) differentials and platelet (PLT) count estimation by EasyCell assistant were compared with the results by manual microscopic review and Pentra DX Nexus. The manual microscopic review was performed according to the Clinical and Laboratory Standards Institute guidelines (H20-A2). RESULTS WBC differentials between pre-classification by EasyCell assistant and manual counting showed moderate correlations for neutrophils (r=0.58), lymphocytes (r=0.69), and eosinophils (r=0.51) in all samples. After user verification, they showed mostly high to very high correlations for neutrophils (r=0.74), lymphocytes (r=0.78), eosinophils (r=0.88), and other cells (r=0.91). PLT count by EasyCell assistant highly correlated with that by Pentra DX Nexus (r=0.82). CONCLUSIONS The performance of EasyCell assistant for WBC differentials and PLT count seems to be acceptable even in abnormal samples with improvement after user verification. The EasyCell assistant, with its reliable performance on WBC differentials and PLT count, would help optimize the workflow of hematology laboratories with reduced workload of manual microscopic review.
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Affiliation(s)
- Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Gun-Hyuk Lee
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sumi Yoon
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyeong Nyeon Kim
- Department of Laboratory Medicine, Samkwang Medical Laboratories, Seoul, Korea
| | - Mikyoung Park
- Department of Laboratory Medicine, Unpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Wan Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Lewis JE, Pozdnyakova O. Digital assessment of peripheral blood and bone marrow aspirate smears. Int J Lab Hematol 2023. [PMID: 37211430 DOI: 10.1111/ijlh.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
The diagnosis of benign and neoplastic hematologic disorders relies on analysis of peripheral blood and bone marrow aspirate smears. As demonstrated by the widespread laboratory adoption of hematology analyzers for automated assessment of peripheral blood, digital analysis of these samples provides many significant benefits compared to relying solely on manual review. Nonetheless, analogous instruments for digital bone marrow aspirate smear assessment have yet to be clinically implemented. In this review, we first provide a historical overview detailing the implementation of hematology analyzers for digital peripheral blood assessment in the clinical laboratory, including the improvements in accuracy, scope, and throughput of current instruments over prior generations. We also describe recent research in digital peripheral blood assessment, particularly in the development of advanced machine learning models that may soon be incorporated into commercial instruments. Next, we provide an overview of recent research in digital assessment of bone marrow aspirate smears and how these approaches could soon lead to development and clinical adoption of instrumentation for automated bone marrow aspirate smear analysis. Finally, we describe the relative advantages and provide our vision for the future of digital assessment of peripheral blood and bone marrow aspirate smears, including what improvements we can soon expect in the hematology laboratory.
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Affiliation(s)
- Joshua E Lewis
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Olga Pozdnyakova
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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