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Image morphometry of acute leukemias. Comparison between lymphoid and myeloid subtypes
Logasundaram Rajesh1, Sanjib Kumar Pattari, Gurjeewan Garewal
1Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Image morphometry shows potential in distinguishing acute lymphoblastic leukemia (ALL-L2) from acute myeloid leukemia (AML-M1 and AML-M2) subtypes. Specific nuclear features like average optical density and pixel grey value variance were significant between ALL-L2 and AML-M2 blasts.
Area of Science:
- Hematology
- Medical Imaging
- Computational Pathology
Background:
- Distinguishing between acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) subtypes is critical for effective treatment.
- Morphological classification of leukemia blasts can be challenging, necessitating advanced diagnostic tools.
Purpose of the Study:
- To evaluate the utility of image morphometry in differentiating ALL-L2 blasts from AML-M1 and AML-M2 blasts.
- To identify specific morphometric parameters that can aid in leukemia subtyping.
Main Methods:
- Analysis of May-Grünwald-Giemsa stained bone marrow smears from 10 cases each of ALL-L2, AML-M1, and AML-M2.
- Quantitative analysis of at least 100 blast cells per case using an image cytometer.
- Measurement of nuclear features including area, roundness, optical density, and grey value variance.
Main Results:
- Considerable overlap in most morphometric variables was observed between the three leukemia subtypes.
- Nuclear 'roundness' showed statistical significance between AML-M1 and ALL-L2, but lacked sufficient power for reliable differentiation.
- 'Average optical density' and 'pixel grey value variance' demonstrated statistical significance with full power for differentiating ALL-L2 from AML-M2 blasts.
Conclusions:
- Image morphometry, particularly specific nuclear features, shows promise as an adjunct tool for differentiating lymphoid and myeloid leukemia subtypes.
- Further research with larger sample sizes may refine the role of image morphometry in leukemia diagnostics.
Objective:
To determine if image morphometry has any role in distinguishing blasts of acute lymphoblastic leukemia (ALL-L2) from those of acute myeloid leukemia (AML-M1) and (AML-M2).
Study Design:
Ten cases each of ALL-L2, AML-M1 and AML-M2 diagnosed according to the French-American-British criteria were studied. In all cases May-Grünwald-Giemsa-stained bone marrow aspiration smears were obtained. At least 100 blast cells from each case were subjected to analysis randomly with an image cytometer using Leica Quantimet 600 software (Cambridge, U.K.). The area, convex area, length, width, perimeter, convex perimeter, roundness, total optical density, average optical density and pixel grey value variance of the nuclei were measured by random selection of cells using a 40:1 objective (1 pixel = 0.446 micron).
Results:
Mann Whitney's nonparametric test showed that there was considerable overlap of morphometric variables between the 3 subtypes. Though statistical significance was found in "roundness" between blasts of AML-M1 and ALL-L2, power analyses (sample size of 100 blasts of each subtype) did not show sufficient power for this variable. However, between blasts of ALL-L2 and AML-M2, "average optical density" and "pixel grey value variance" were statistically significant with full power using power analyses.
Conclusion:
Image morphometry may be helpful in differentiating blasts from lymphoid and myeloid leukemic subtypes.
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