Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study
Enumeration of blasts and promonocytes is essential for World Health Organization (WHO) classification of myelomonocytic neoplasms. The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to a...
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| Veröffentlicht in: | International journal of laboratory hematology 2020-08, Vol.42 (4), p.418-422 |
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| creator | Foucar, Kathryn Hsi, Eric D. Wang, Sa A. Rogers, Heesun J. Hasserjian, Robert P. Bagg, Adam George, Tracy I. Bassett, Roland L. Peterson, LoAnn C. Morice, William G. Arber, Daniel A. Orazi, Attilio Bueso‐Ramos, Carlos E. |
| description | Enumeration of blasts and promonocytes is essential for World Health Organization (WHO) classification of myelomonocytic neoplasms. The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to assess concordances between experienced hematopathologists in classifying cells as blasts, promonocytes, and monocytes according to WHO criteria. Each of 11 hematopathologists assessed glass slides from 20 patients [12 with chronic myelomonocytic leukemia (CMML) and 8 with acute myeloid leukemia (AML)] including blood and BM aspirate smears, and limited nonspecific esterase (NSE) stains. All cases were blindly reviewed. Fleiss’ extension of Cohen's kappa for multiple raters was used on these variables, separately for peripheral blood (PB) and bone marrow (BM). Spearman's rank correlation was used to assess correlations between each pair of hematopathologists for each measurement. For the classification based on the sum of blasts and promonocytes in the BM, Fleiss’ kappa was estimated as 0.744. For PB, categorizing patients according to the sum of blasts and promonocytes, Fleiss’ kappa was estimated as 0.949. Distinction of abnormal monocytes from normal monocytes in PB did not achieve a good concordance and showed strong evidence of differences between hematopathologists (P |
| doi_str_mv | 10.1111/ijlh.13212 |
| format | Article |
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The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to assess concordances between experienced hematopathologists in classifying cells as blasts, promonocytes, and monocytes according to WHO criteria. Each of 11 hematopathologists assessed glass slides from 20 patients [12 with chronic myelomonocytic leukemia (CMML) and 8 with acute myeloid leukemia (AML)] including blood and BM aspirate smears, and limited nonspecific esterase (NSE) stains. All cases were blindly reviewed. Fleiss’ extension of Cohen's kappa for multiple raters was used on these variables, separately for peripheral blood (PB) and bone marrow (BM). Spearman's rank correlation was used to assess correlations between each pair of hematopathologists for each measurement. For the classification based on the sum of blasts and promonocytes in the BM, Fleiss’ kappa was estimated as 0.744. For PB, categorizing patients according to the sum of blasts and promonocytes, Fleiss’ kappa was estimated as 0.949. Distinction of abnormal monocytes from normal monocytes in PB did not achieve a good concordance and showed strong evidence of differences between hematopathologists (P < .0001). The hematopathologists achieved a good concordance rate of 74% in CMML vs AML classification and a high k rate, confirming that criteria for defining the blasts equivalents (blasts plus promonocytes) could be applied consistently. Identification of monocyte subtypes (abnormal vs normal) was not concordant. Our results support the practice of combining blasts/promonocytes into a single category.</description><identifier>ISSN: 1751-5521</identifier><identifier>EISSN: 1751-553X</identifier><identifier>DOI: 10.1111/ijlh.13212</identifier><identifier>PMID: 32297416</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>abnormal monocyte ; Acute myeloid leukemia ; Adult ; Blast Crisis - classification ; Blast Crisis - metabolism ; Blast Crisis - pathology ; Bone marrow ; Bone Marrow - metabolism ; Bone Marrow - pathology ; Chronic myelomonocytic leukemia ; Classification ; concordance ; Enumeration ; Esterase ; Female ; Humans ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - classification ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - metabolism ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology ; Leukemia, Myelomonocytic, Chronic - classification ; Leukemia, Myelomonocytic, Chronic - metabolism ; Leukemia, Myelomonocytic, Chronic - pathology ; Male ; Middle Aged ; monoblast ; Monocyte-Macrophage Precursor Cells - classification ; Monocyte-Macrophage Precursor Cells - metabolism ; Monocyte-Macrophage Precursor Cells - pathology ; Monocytes ; Myeloid leukemia ; Myelomonocytic leukemia ; Peripheral blood ; promonocyte</subject><ispartof>International journal of laboratory hematology, 2020-08, Vol.42 (4), p.418-422</ispartof><rights>2020 John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3572-5988c05ac79c38dea481acc8132204a5d068bb80262e499117fa0caa5060a63d3</citedby><cites>FETCH-LOGICAL-c3572-5988c05ac79c38dea481acc8132204a5d068bb80262e499117fa0caa5060a63d3</cites><orcidid>0000-0001-5143-4835 ; 0000-0001-8491-224X ; 0000-0001-5478-7847 ; 0000-0001-8623-4067</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fijlh.13212$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fijlh.13212$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32297416$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Foucar, Kathryn</creatorcontrib><creatorcontrib>Hsi, Eric D.</creatorcontrib><creatorcontrib>Wang, Sa A.</creatorcontrib><creatorcontrib>Rogers, Heesun J.</creatorcontrib><creatorcontrib>Hasserjian, Robert P.</creatorcontrib><creatorcontrib>Bagg, Adam</creatorcontrib><creatorcontrib>George, Tracy I.</creatorcontrib><creatorcontrib>Bassett, Roland L.</creatorcontrib><creatorcontrib>Peterson, LoAnn C.</creatorcontrib><creatorcontrib>Morice, William G.</creatorcontrib><creatorcontrib>Arber, Daniel A.</creatorcontrib><creatorcontrib>Orazi, Attilio</creatorcontrib><creatorcontrib>Bueso‐Ramos, Carlos E.</creatorcontrib><creatorcontrib>Bone Marrow Pathology Group</creatorcontrib><creatorcontrib>for the Bone Marrow Pathology Group</creatorcontrib><title>Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study</title><title>International journal of laboratory hematology</title><addtitle>Int J Lab Hematol</addtitle><description>Enumeration of blasts and promonocytes is essential for World Health Organization (WHO) classification of myelomonocytic neoplasms. The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to assess concordances between experienced hematopathologists in classifying cells as blasts, promonocytes, and monocytes according to WHO criteria. Each of 11 hematopathologists assessed glass slides from 20 patients [12 with chronic myelomonocytic leukemia (CMML) and 8 with acute myeloid leukemia (AML)] including blood and BM aspirate smears, and limited nonspecific esterase (NSE) stains. All cases were blindly reviewed. Fleiss’ extension of Cohen's kappa for multiple raters was used on these variables, separately for peripheral blood (PB) and bone marrow (BM). Spearman's rank correlation was used to assess correlations between each pair of hematopathologists for each measurement. For the classification based on the sum of blasts and promonocytes in the BM, Fleiss’ kappa was estimated as 0.744. For PB, categorizing patients according to the sum of blasts and promonocytes, Fleiss’ kappa was estimated as 0.949. Distinction of abnormal monocytes from normal monocytes in PB did not achieve a good concordance and showed strong evidence of differences between hematopathologists (P < .0001). The hematopathologists achieved a good concordance rate of 74% in CMML vs AML classification and a high k rate, confirming that criteria for defining the blasts equivalents (blasts plus promonocytes) could be applied consistently. Identification of monocyte subtypes (abnormal vs normal) was not concordant. Our results support the practice of combining blasts/promonocytes into a single category.</description><subject>abnormal monocyte</subject><subject>Acute myeloid leukemia</subject><subject>Adult</subject><subject>Blast Crisis - classification</subject><subject>Blast Crisis - metabolism</subject><subject>Blast Crisis - pathology</subject><subject>Bone marrow</subject><subject>Bone Marrow - metabolism</subject><subject>Bone Marrow - pathology</subject><subject>Chronic myelomonocytic leukemia</subject><subject>Classification</subject><subject>concordance</subject><subject>Enumeration</subject><subject>Esterase</subject><subject>Female</subject><subject>Humans</subject><subject>Leukemia</subject><subject>Leukemia, Myelogenous, Chronic, BCR-ABL Positive - classification</subject><subject>Leukemia, Myelogenous, Chronic, BCR-ABL Positive - metabolism</subject><subject>Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology</subject><subject>Leukemia, Myelomonocytic, Chronic - classification</subject><subject>Leukemia, Myelomonocytic, Chronic - metabolism</subject><subject>Leukemia, Myelomonocytic, Chronic - pathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>monoblast</subject><subject>Monocyte-Macrophage Precursor Cells - classification</subject><subject>Monocyte-Macrophage Precursor Cells - metabolism</subject><subject>Monocyte-Macrophage Precursor Cells - pathology</subject><subject>Monocytes</subject><subject>Myeloid leukemia</subject><subject>Myelomonocytic leukemia</subject><subject>Peripheral blood</subject><subject>promonocyte</subject><issn>1751-5521</issn><issn>1751-553X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LwzAYx4Mobk4vfgAJeBM689L0xdsY6iYDLwreQpqmW0bbdEnL6Lc3s9uO5pA8hF9-z5M_APcYTbFfz3pbbqaYEkwuwBjHDAeM0Z_Lc03wCNw4t0WIxSFKr8GIEpLGIY7GYDc3tTQ2F7VUUFSmXsONqkRrGtFuTGnW2rUO6hrKUjini157IvO1v23Kzm_W-FdG9q1yL3AGM1MrWAlrzR6eHD1cW9M10LVd3t-Cq0KUTt0dzwn4fnv9mi-C1ef7cj5bBZKymAQsTRKJmJBxKmmSKxEmWEiZ-H8SFAqWoyjJsgSRiKgwTTGOC4GkEAxFSEQ0pxPwOHj9hLtOuZZvTWdr35KTkMRhhCiLPPU0UNIa56wqeGO1H7_nGPFDuvyQLv9L18MPR2WXVSo_o6c4PYAHYK9L1f-j4suP1WKQ_gLtKIab</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Foucar, Kathryn</creator><creator>Hsi, Eric D.</creator><creator>Wang, Sa A.</creator><creator>Rogers, Heesun J.</creator><creator>Hasserjian, Robert P.</creator><creator>Bagg, Adam</creator><creator>George, Tracy I.</creator><creator>Bassett, Roland L.</creator><creator>Peterson, LoAnn C.</creator><creator>Morice, William G.</creator><creator>Arber, Daniel A.</creator><creator>Orazi, Attilio</creator><creator>Bueso‐Ramos, Carlos E.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><orcidid>https://orcid.org/0000-0001-5143-4835</orcidid><orcidid>https://orcid.org/0000-0001-8491-224X</orcidid><orcidid>https://orcid.org/0000-0001-5478-7847</orcidid><orcidid>https://orcid.org/0000-0001-8623-4067</orcidid></search><sort><creationdate>202008</creationdate><title>Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study</title><author>Foucar, Kathryn ; Hsi, Eric D. ; Wang, Sa A. ; Rogers, Heesun J. ; Hasserjian, Robert P. ; Bagg, Adam ; George, Tracy I. ; Bassett, Roland L. ; Peterson, LoAnn C. ; Morice, William G. ; Arber, Daniel A. ; Orazi, Attilio ; Bueso‐Ramos, Carlos E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3572-5988c05ac79c38dea481acc8132204a5d068bb80262e499117fa0caa5060a63d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>abnormal monocyte</topic><topic>Acute myeloid leukemia</topic><topic>Adult</topic><topic>Blast Crisis - classification</topic><topic>Blast Crisis - metabolism</topic><topic>Blast Crisis - pathology</topic><topic>Bone marrow</topic><topic>Bone Marrow - metabolism</topic><topic>Bone Marrow - pathology</topic><topic>Chronic myelomonocytic leukemia</topic><topic>Classification</topic><topic>concordance</topic><topic>Enumeration</topic><topic>Esterase</topic><topic>Female</topic><topic>Humans</topic><topic>Leukemia</topic><topic>Leukemia, Myelogenous, Chronic, BCR-ABL Positive - classification</topic><topic>Leukemia, Myelogenous, Chronic, BCR-ABL Positive - metabolism</topic><topic>Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology</topic><topic>Leukemia, Myelomonocytic, Chronic - classification</topic><topic>Leukemia, Myelomonocytic, Chronic - metabolism</topic><topic>Leukemia, Myelomonocytic, Chronic - pathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>monoblast</topic><topic>Monocyte-Macrophage Precursor Cells - classification</topic><topic>Monocyte-Macrophage Precursor Cells - metabolism</topic><topic>Monocyte-Macrophage Precursor Cells - pathology</topic><topic>Monocytes</topic><topic>Myeloid leukemia</topic><topic>Myelomonocytic leukemia</topic><topic>Peripheral blood</topic><topic>promonocyte</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Foucar, Kathryn</creatorcontrib><creatorcontrib>Hsi, Eric D.</creatorcontrib><creatorcontrib>Wang, Sa A.</creatorcontrib><creatorcontrib>Rogers, Heesun J.</creatorcontrib><creatorcontrib>Hasserjian, Robert P.</creatorcontrib><creatorcontrib>Bagg, Adam</creatorcontrib><creatorcontrib>George, Tracy I.</creatorcontrib><creatorcontrib>Bassett, Roland L.</creatorcontrib><creatorcontrib>Peterson, LoAnn C.</creatorcontrib><creatorcontrib>Morice, William G.</creatorcontrib><creatorcontrib>Arber, Daniel A.</creatorcontrib><creatorcontrib>Orazi, Attilio</creatorcontrib><creatorcontrib>Bueso‐Ramos, Carlos E.</creatorcontrib><creatorcontrib>Bone Marrow Pathology Group</creatorcontrib><creatorcontrib>for the Bone Marrow Pathology Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>International journal of laboratory hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Foucar, Kathryn</au><au>Hsi, Eric D.</au><au>Wang, Sa A.</au><au>Rogers, Heesun J.</au><au>Hasserjian, Robert P.</au><au>Bagg, Adam</au><au>George, Tracy I.</au><au>Bassett, Roland L.</au><au>Peterson, LoAnn C.</au><au>Morice, William G.</au><au>Arber, Daniel A.</au><au>Orazi, Attilio</au><au>Bueso‐Ramos, Carlos E.</au><aucorp>Bone Marrow Pathology Group</aucorp><aucorp>for the Bone Marrow Pathology Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study</atitle><jtitle>International journal of laboratory hematology</jtitle><addtitle>Int J Lab Hematol</addtitle><date>2020-08</date><risdate>2020</risdate><volume>42</volume><issue>4</issue><spage>418</spage><epage>422</epage><pages>418-422</pages><issn>1751-5521</issn><eissn>1751-553X</eissn><abstract>Enumeration of blasts and promonocytes is essential for World Health Organization (WHO) classification of myelomonocytic neoplasms. The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to assess concordances between experienced hematopathologists in classifying cells as blasts, promonocytes, and monocytes according to WHO criteria. Each of 11 hematopathologists assessed glass slides from 20 patients [12 with chronic myelomonocytic leukemia (CMML) and 8 with acute myeloid leukemia (AML)] including blood and BM aspirate smears, and limited nonspecific esterase (NSE) stains. All cases were blindly reviewed. Fleiss’ extension of Cohen's kappa for multiple raters was used on these variables, separately for peripheral blood (PB) and bone marrow (BM). Spearman's rank correlation was used to assess correlations between each pair of hematopathologists for each measurement. For the classification based on the sum of blasts and promonocytes in the BM, Fleiss’ kappa was estimated as 0.744. For PB, categorizing patients according to the sum of blasts and promonocytes, Fleiss’ kappa was estimated as 0.949. Distinction of abnormal monocytes from normal monocytes in PB did not achieve a good concordance and showed strong evidence of differences between hematopathologists (P < .0001). The hematopathologists achieved a good concordance rate of 74% in CMML vs AML classification and a high k rate, confirming that criteria for defining the blasts equivalents (blasts plus promonocytes) could be applied consistently. Identification of monocyte subtypes (abnormal vs normal) was not concordant. 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| subjects | abnormal monocyte Acute myeloid leukemia Adult Blast Crisis - classification Blast Crisis - metabolism Blast Crisis - pathology Bone marrow Bone Marrow - metabolism Bone Marrow - pathology Chronic myelomonocytic leukemia Classification concordance Enumeration Esterase Female Humans Leukemia Leukemia, Myelogenous, Chronic, BCR-ABL Positive - classification Leukemia, Myelogenous, Chronic, BCR-ABL Positive - metabolism Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology Leukemia, Myelomonocytic, Chronic - classification Leukemia, Myelomonocytic, Chronic - metabolism Leukemia, Myelomonocytic, Chronic - pathology Male Middle Aged monoblast Monocyte-Macrophage Precursor Cells - classification Monocyte-Macrophage Precursor Cells - metabolism Monocyte-Macrophage Precursor Cells - pathology Monocytes Myeloid leukemia Myelomonocytic leukemia Peripheral blood promonocyte |
| title | Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study |
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