The correlation of bone marrow aspiration and biopsy examinations in patients with myelodysplastic syndrome

Introductıon: Myelodysplastic syndrome (MDS) is an acquired hematopoietic clonal malignant disease with heterogeneous clinical course characterized by dysplastic and infective production of stem cells . Even though the bone marrow formation may be either normocellular or hypercellular; dysplasia is observed in the erythroid, myeloid and/or megakaryocytic series, This condition implies a high risk of conversion to acute myeloid leukemia (AML). The diagnosis of MDS is based on the morphological evaluation of bone marrow aspiration. Dysplastic formation of more than the 10 per cent of the evaluated cell-lineages which are provided via bone marrow aspiration and the ruling out the other possible underlying causes of dysplasia supports the diagnosis. Moreover, blast monitoring in bone marrow aspiration is also important in risk assessment and selection of the treatment plan of the disease. In our clinic, bone marrow aspiration performed with the diagnosis of MDS is evaluated by the hematology specialists in the outpatient clinic conditions and a pre-diagnosis is made and after the pathological evaluation treatment plan of the patient is initiated (unless the preliminary evaluation shows excessively high blast numbers and emergent intervention necessities). However, the exact diagnosis of the disease is based on the results of pathological evaluations. Patients and Methods: Patient dataset is obtained by scanning patient files and electronic records in the Informatics and Computational Management Softwares of the Institution (Nucleus) and documented patient notes Department of Hematology Archives, Hacettepe University, Department of Internal Medicine. Patients older than 18 years old who were diagnosed and defined with MDS ICD 10 code (D46) in Hacettepe University Hematology Department were included to the study. Patients who were entered into the system with the MDS ICD 10 code(D46) but whose bone marrow pathology results did not support the diagnosis of MDS and whose clinical data were insufficient for analysis were excluded from the study. In the study, gender, age, underlying disease and comorbidities, types of chemotherapy received by patients, bone marrow transplantation status, date of diagnosis and time of last visit, vital status, hemoglobin values, leukocyte, neutrophil, platelet counts at the time of diagnosis, cytogenetic evaluation and aspiration and dysplasia level, blast, ring sideroblast was collected. This study is conducted as a retrospective observational study covering the period between 01.01.2001 and 01.01.2020 and the information of MDS patients who were entered in the hospital nucleus system with the diagnosis of D46 was collected after obtaining the ethical committee approval. Patient files and electronic records were used without any special requests for the study. The results and the demographic characteristics of the patients were analyzed using IBM SPSS software v25.0. The general characteristics of the patient group were calculated separately. Chi-square test was used to compare the rates and odds ratios and 95% confidence intervals were calculated. Results: In this study, 130 patients over 18 years of age which are diagnosed with MDS in the Department of Hematology, Hacettepe University Faculty of Medicine between 2001-2020 were evaluated. The study showed that estimated overall survival of a patient which is diagnosed with MDS is between 57-106 months with 95% confidence interval. In addition, the most common coexistent condition is hypertension, and the second is DM. Hematologists' evaluation accuracy is not significantly different the pathologists' in the evaluation of erythroid dysplasia and bone marrow cellularity, but it is inadequate to recognize/evaluate other dysplastic series. Discussion: Hematologists' evaluation accuracy is not significantly different the pathologists' in the evaluation of erythroid dysplasia and bone marrow cellularity, but it is inadequate to recognize/evaluate other dysplastic series (myeloid and megakaryocytic cell-lineages). A statistically significant difference was observed between pathologists and hematologists in the blast assessment.