Computerized texture analysis of atypical immature myeloid precursors in patients with myelodysplastic syndromes: an entity between blasts and promyelocytesReport as inadecuate

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Diagnostic Pathology

, 6:93

First Online: 29 September 2011Received: 03 August 2011Accepted: 29 September 2011


BackgroundBone marrow BM blast count is an essential parameter for classification and prognosis of myelodysplastic syndromes MDS. However, a high degree of cell atypias in bone marrow hemopoietic cells may be found in this group of clonal disorders, making it difficult to quantify precisely myeloblasts, and to distinguish them from promyelocytes and atypical immature myeloid precursors. Our aim was to investigate whether computerized image analysis of routine cytology would help to characterize these cells.

MethodsIn May-Grünwald-Giemsa stained BM smears of 30 newly diagnosed MDS patients and 19 cases of normal BM, nuclei of blasts and promyelocytes were digitalized and interactively segmented. The morphological classification of the cells was done by consensus of two observers. Immature granulocytic precursors, which could not be clearly classified either as blasts or promyelocytes, were called -atypic myeloid precursors-. Nuclear morphometry and texture features derived from the co-occurrence matrix and fractal dimension FD were calculated.

ResultsIn normal BM, when compared to myeloblasts, nuclei of promyelocytes showed significant increase in perimeter and local texture homogeneity and a decrease in form factor, chromatin gray levels, Haralick-s entropy, inertia, energy, contrast, diagonal moment, cluster prominence, the fractal dimension according to Minkowski and its goodness-of-fit. Compared to normal myeloblast nuclei, the chromatin texture of MDS myeloblasts revealed higher local homogeneity and goodness-of-fit of the FD, but lower values of entropy, contrast, diagonal moment, and fractal dimension. The same differences were found between nuclei of normal promyelocytes and those of MDS. Nuclei of atypical myeloid precursors showed intermediate characteristics between those of blasts and promyelocytes according to the quantitative features perimeter, form factor, gray level and its standard deviation, but were similar to promyelocytes according to the texture variables inertia, energy, contrast, diagonal moment, cluster prominence, and Minkowski-s fractal dimension.

ConclusionBM atypical immature myeloid precursors are difficult to be correctly classified in routine cytology. Although their cytoplasm is more similar to that of myeloblasts, computerized texture analysis indicates a nuclear chromatin remodeling more close to the promyelocyte, thus indicating an asynchronous intermediate maturation stage between blast and promyelocyte.

Keywordsmyelodysplastic syndromes bone marrow nuclear texture cell atypias karyometry morphometry fractal chromatin co-occurrence matrix computerized pathology Electronic supplementary materialThe online version of this article doi:10.1186-1746-1596-6-93 contains supplementary material, which is available to authorized users.

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Author: Joyce R Vido - Randall L Adam - Irene GH Lorand-Metze - Konradin Metze


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