Assessing dysplasia is one of the hardest parts of bone marrow cytomorphology. Dysplastic changes are often subtle, manifest in multiple forms, and spread across several cell lineages. Two experienced morphologists can look at the same slide and reach different conclusions.
This variability matters. Diagnosing myelodysplastic syndromes/neoplasms (MDS) is fundamentally based on cytomorphological and histopathological assessments. Under the WHO classification, a lineage counts as dysplastic when at least 10% of its cells show dysplastic features 1. Reaching that threshold reliably requires careful counting.
This diagnostic variability is well documented. In a blinded study, four cytomorphologists reviewed 50 MDS cases. While their agreement was good on a continuous scale, agreement fell sharply at the critical 10% cutoff, dropping to a kappa of only 0.19 for erythroid dysplasia 2. Earlier consensus work attempted to address this by defining a minimal set of reproducible morphological features 3.
To tackle, the International Consortium for Myelodysplastic Syndromes/Neoplasms has published recommendations for standardizing diagnostic reports in MDS 4. The primary goals were to assist in improving communication between pathologists and clinicians to ensure accurate clinical decisions, but also ensure that expert-written reports can be easily reinterpreted and reused in clinical trials, institutional databases and registries.
Cellbytes aligns directly with these reporting recommendations by providing structured data for every category of the Romanowsky-stained bone marrow aspirate recommended by the consortium: sample adequacy, cellularity, megakaryocytic density, and multilineage dysplasia.
Because every cell is counted and verifiable, the 10% threshold transforms from a subjective estimate into a transparent, measured value. Peripheral blood dysplasia and ring sideroblast assessment on iron stains are also currently in development. The result is a standardized output format that keeps data clean, readable, and ready for research.
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Footnotes
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Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia. 2022;36(7):1703–1719. doi:10.1038/s41375-022-01613-1 ↩
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Senent L, Arenillas L, Luño E, Ruiz JC, Sanz G, Florensa L. Reproducibility of the World Health Organization 2008 criteria for myelodysplastic syndromes. Haematologica. 2013;98(4):568–575. doi:10.3324/haematol.2012.071449 ↩
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Della Porta MG, Travaglino E, Boveri E, et al. Minimal morphological criteria for defining bone marrow dysplasia: a basis for clinical implementation of WHO classification of myelodysplastic syndromes. Leukemia. 2015;29(1):66–75. doi:10.1038/leu.2014.161 ↩
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Gisriel SD, Aakash F, Bennett JM, et al. Standardization of Bone Marrow Reporting for Myelodysplastic Syndromes/Neoplasms on Behalf of the International Consortium for Myelodysplastic Syndromes/Neoplasms. Arch Pathol Lab Med. 2025;149(10):968–976. doi:10.5858/arpa.2024-0322-RA ↩