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Updated: Jul 22, 2026
Automated Quantification of Hematopoietic Cell – Stromal Cell Interactions in Histological Images of Undecalcified Bone
Published on: April 8, 2015
Diagnosis and quantification of bone marrow fibrosis are significantly biased by the pre-staining processing of bone
G Buesche1, A Georgii, H-H Kreipe
1Department of Pathology, Medizinische Hochschule Hannover, Germany. guntram.buesche@arcor.de
Aims:
Marrow fibrosis (MF) is an unfavourable, often lethal complication of haematological neoplasms. Although biopsy technique and staining procedure are standardized, the prestaining processing of bone marrow biopsies (BMBs) varies markedly without any existing data on its significance for the diagnosis of MF.
Methods And Results:
In this study on 712 BMBs from 296 patients with chronic idiopathic myelofibrosis (CIMF), chronic myeloid leukaemia (CML), or healthy bone marrow, MF was a characteristic complication of CML and CIMF. However, diagnosis and quantification of MF and detection of its prognostic significance were significantly biased by fixation, decalcification, embedding, marrow tissue shrinkage during biopsy processing and the thickness of marrow sections (P < 0.000005). The relevance of these influences was explained by their effect on the marrow volume to which the fibre content was related, whereas the stainability of fibres was not affected. Semiquantitative grading of fibrosis and measurements of fibre density could not be adjusted to various methods of processing of bone marrow biopsies (P < 0.003).
Conclusions:
Evaluations of MF and its prognostic significance should consider the bias due to the prestaining processing of BMBs and the necessity of an adjustment to the thickness of tissue sections and the degree of marrow tissue shrinkage.
Insights
Pre-staining processing significantly impacts bone marrow fibrosis diagnosis. Adjustments for tissue shrinkage and section thickness are crucial for accurate marrow fibrosis evaluation in hematological neoplasms.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Marrow fibrosis (MF) is a critical complication of hematological neoplasms.
- Standardized biopsy and staining exist, but pre-staining processing methods for bone marrow biopsies (BMBs) vary.
- The impact of these processing variations on MF diagnosis is largely unknown.
Purpose of the Study:
- To investigate the influence of pre-staining processing variables on the diagnosis and quantification of marrow fibrosis.
- To assess the impact of these variables on the prognostic significance of MF.
Main Methods:
- Analysis of 712 BMBs from 296 patients with chronic idiopathic myelofibrosis (CIMF), chronic myeloid leukemia (CML), or healthy controls.
- Evaluation of MF characteristics, quantification, and prognostic relevance.
- Statistical analysis to identify biases introduced by fixation, decalcification, embedding, tissue shrinkage, and section thickness.
Main Results:
- MF is a common feature in CML and CIMF.
- Fixation, decalcification, embedding, tissue shrinkage, and section thickness significantly biased MF diagnosis, quantification, and prognostic assessment (P < 0.000005).
- These factors affected the calculated fiber density by altering marrow volume, not fiber stainability. Adjustments for grading and density measurements were not feasible across different processing methods (P < 0.003).
Conclusions:
- Pre-staining processing introduces significant bias in MF evaluation.
- Adjustments for tissue section thickness and marrow tissue shrinkage are necessary for accurate MF assessment.
- Consideration of processing variability is essential for reliable MF diagnosis and prognostic interpretation.
