Inter-observer variance with the diagnosis of myelodysplastic syndromes (MDS) following the 2008 WHO classification
Inter-observer variance with the diagnosis of myelodysplastic syndromes (MDS) following the 2008 WHO classification
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DOI：
10.1007/s00277-012-1565-4
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发表时间：
2013-01-01
影响因子：
3.5
通讯作者：
Villegas, A.
中科院分区：
文献类型：
--
作者：
Font, P.;Loscertales, J.;Villegas, A.
形态学是诊断骨髓增生异常综合征（MDS）的基础。世界卫生组织分类提供预后信息并有助于治疗决策。然而，形态变化可能会受到观察者间潜在差异的影响。我们研究的目的是探讨 2008 年 WHO MDS 分类的可靠性，回顾了之前使用 2001 年 WHO 标准诊断为 MDS 的 100 个样本。标本采集自 10 家医院，并由 10 名形态学家（五对）进行评估。每个观察者评估 20 个样本，每个样本由两名形态学家独立分析。除了外周血（PB）计数外，第二位观察者对临床和实验室数据不知情。根据 2001 年 WHO 分类，19 例病例被视为未分类 MDS（MDS-U），但根据 2008 年 WHO 建议，只有 3 例仍为 MDS-U。在 95 个被认为合适的样本中，有 26 个样本出现不一致 (27%)。尽管参与观察的人数很多，但五对之间的不一致率相当相似。对于 1 型原始细胞过多的难治性贫血 (RAEB-1)（12 例中的 10 例，84%）、RAEB-2（10 例中的 9 例，90%），观察者间一致性非常好，对于难治性血细胞减少伴多系发育不良（50 例中的 37 例，74%），观察者间一致性也很好。然而，在大多数情况下，单系发育不良的类别是不可重复的。难治性血细胞减少症与单系发育不良的一致性率为 40%（五例中的两例），与环状铁粒幼细胞的 RA 的一致性率为 25%（八例中的两例）。我们的结果表明，2008 年 WHO 分类对 MDS 进行了更准确的分层，但也说明了诊断单系不典型增生 MDS 的难度。
Morphology is the basis of the diagnosis of myelodysplastic syndromes (MDS). The WHO classification offers prognostic information and helps with the treatment decisions. However, morphological changes are subject to potential inter-observer variance. The aim of our study was to explore the reliability of the 2008 WHO classification of MDS, reviewing 100 samples previously diagnosed with MDS using the 2001 WHO criteria. Specimens were collected from 10 hospitals and were evaluated by 10 morphologists, working in five pairs. Each observer evaluated 20 samples, and each sample was analyzed independently by two morphologists. The second observer was blinded to the clinical and laboratory data, except for the peripheral blood (PB) counts. Nineteen cases were considered as unclassified MDS (MDS-U) by the 2001 WHO classification, but only three remained as MDS-U by the 2008 WHO proposal. Discordance was observed in 26 of the 95 samples considered suitable (27 %). Although there were a high number of observers taking part, the rate of discordance was quite similar among the five pairs. The inter-observer concordance was very good regarding refractory anemia with excess blasts type 1 (RAEB-1) (10 of 12 cases, 84 %), RAEB-2 (nine of 10 cases, 90 %), and also good regarding refractory cytopenia with multilineage dysplasia (37 of 50 cases, 74 %). However, the categories with unilineage dysplasia were not reproducible in most of the cases. The rate of concordance with refractory cytopenia with unilineage dysplasia was 40 % (two of five cases) and 25 % with RA with ring sideroblasts (two of eight). Our results show that the 2008 WHO classification gives a more accurate stratification of MDS but also illustrates the difficulty in diagnosing MDS with unilineage dysplasia.