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Ann Hematol. 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.

Author information

Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK.
Department of Medicine, Division of Haematology, University of Patras Medical School, Patras, Greece.
Department of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
Department of Clinical Haematology, Institution of Haematology and Blood Transfusion, Praha, Czech Republic.
Department of Haematology, Haematological Cytogenetics Unit, University Hospital of Vall d'Hebron, Barcelona, Spain.
Haematology Institute, Catholic University of Sacred Heart, Rome, Italy.
Department of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warszawa, Poland.
Department of Haematology, Royal Cornwall Hospital, Truro, UK.
Department of Pathology and Cytology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France.
St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK.
Department of Medicine, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.
Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
Centre of Haematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.
Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Department of Tumor Immunology - Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre (TIL, 278), P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.


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.


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

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