儿童急性淋巴细胞白血病骨髓细胞形态学检查多中心综合比较及评价

摘要

目的：比较中国儿童白血病协作组（CCLG）成员医院儿童急性淋巴细胞白血病（ALL）骨髓细胞形态学诊断综合水平，评价并规范细胞形态学检验方法、专业术语使用，同时提高检验人员骨髓细胞形态识别能力。方法随机抽取CCLG成员医院入组的ALL患儿110例，由成员医院提供上述患儿的初诊、治疗第15天、第33天以及第12周骨髓细胞涂片，共440份。将所有骨髓细胞涂片随机发放给2名专职从事骨髓细胞形态检验的中级职称技术人员进行复检，复检报告由血液专业临床医师与原始检验报告进行比对、分析，并提供书面意见。结果在取材情况及骨髓增生程度方面，共有427份（97．0％）骨髓细胞涂片的复检报告与原始报告判断基本吻合，有13份（3．0％）骨髓细胞涂片的复检报告判断骨髓稀释，故未描述增生程度，而原始报告判断骨髓取材良好，并描述骨髓增生减低。在染色程度方面，共有428份（97．3％）骨髓细胞涂片的复检报告与原始报告判断相符，有12份（2．7％）涂片的复检报告描述涂片染色偏浅或偏深，而原始报告均描述染色良好。原始报告及复检报告在描述骨髓像特点时均存在术语使用不规范，中、英文混用，使用不规范的缩略语或英文缩写等现象。在检验结论方面，除13份骨髓细胞涂片取材情况存在异议，造成检验结论不一致外，其余427份（97．0％）复检报告与原始报告基本吻合。结论多中心儿童ALL骨髓细胞涂片进行比对分析，对提高CCLG成员医院骨髓细胞形态学诊断总体水平有重要的作用和意义。同时为建立规范的细胞形态学检验模式，统一专业术语，提高检验报告互认程度也是一次必要的尝试和探索。%Objective Through the cooperation Chinese Children′s Leukemia Group (CCLG)members,to compare the diagnosis comprehensive level of bone marrow cell morphology in child with acute lymphocytic leukemia (ALL)in these hospitals,in order to assess and standardize the cell morphology determination method,unify terminology,improve the identification ability of bone marrow cell morphology.Methods A total of 1 10 children with ALL were enrolled randomly from the hospitals of CCLG.These hospitals provided the bone marrow smear of every child with newly diagnosed,treatment for 15th d,33rd d and 12 weeks,respectively.Totally,there were 440 samples.These smears were randomly issued to 2 inspectors to reexamine.The review reports and original reports were compared and analyzed by another hematologist.Results Out of these 440 bone marrow smears,the consistent judgment was described in both review reports and original reports in 427 cases(97.0%).Of the other 13 cases (3.0%),the review reports showed the dilution of bone marrow aspiration without the description of bone marrow hyperplasia grade,but the original reports showed good aspiration of bone marrow with bone marrow hypoplasia.Good staining of bone marrow smear was described in both review reports and original reports in 428 cases (97.3%).Light or deep staining was showed in the other 12 cases (2.7%),but in the original reports,they showed good staining.In the procedure of describing the character of bone marrow,both the review and original reports were showed no standard terms with Sino-English language mixing,without standard Chinese and English abbreviation.The conclusions of bone marrow smear in the review and original reports were consistent in 427 cases(97.0%),except for the other 13 cases with objection in the aspiration of bone marrow between the 2 reports.Conclusions The comparison analysis of bone marrow smear in children with ALL in multicenter is a very important attempt and exploration to improve the diagnosis level of bone marrow cell morphology,establishes a standardized cell morphology determination pattern,unify terminology,and improve the report recognition degree.