title: Integration of automated morphological features resolves a distinct group of atypical chronic lymphocytic leukemias with chromosomal aberrations.
abstract: Automated morphological assessment of peripheral blood slides has become an important modality facilitating characterization and quantification of cells in a uniform, fast and robust manner. In this study, we evaluated the morphological diversity in peripheral blood films of 94 chronic lymphocytic leukemia (CLL) patients using the DM1200 CellaVision automated microscopy system. Aberrant lymphocytes and smudge cells were enumerated and correlated with CLL immunophenotype, chromosomal aberrations and prognostic parameters. Herein, we show that the percentages of aberrant and smudge cells was highly variable between patients and did not correlate with each other. Increased aberrant lymphocytes and fewer smudge cells were associated with an atypical immunophenotype including low expression of CD23, higher levels of FMC7 and bright surface levels of CD20. High fraction of aberrant lymphocytes also was associated with trisomy 12. These cells were predominantly of small/medium size, sometimes with cleft nuclei. No correlation was noted between aberrant or smudge cells and clinical stage, CD38, ZA70 or time to first treatment. Taken together, automated morphological analysis of peripheral blood leukocytes emerged as a powerful and robust tool for the quantitative morphological stratification of CLL. Integration of the automated morphological features discriminates between different CLL phenotypes and distinct chromosomal aberrations.
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel,; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Herishanu
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Sigi
authors.initials: S
authors.lastname: Kay
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Erel
authors.initials: E
authors.lastname: Joffe
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel,; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ben-Ezra
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Baron
authors.affiliation: The Genetic Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rotman
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Rony
authors.initials: R
authors.lastname: Braunstein
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Nili
authors.initials: N
authors.lastname: Dezorella
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel,; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Naparstek
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Chava
authors.initials: C
authors.lastname: Perry
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Varda
authors.initials: V
authors.lastname: Deutsch
authors.affiliation: The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel,; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: bkatz@tasmc.health.gov.il.
authors.forename: Ben-Zion
authors.initials: BZ
authors.lastname: Katz
mesh_terms: D057205:Automation, Laboratory; D016022:Case-Control Studies; D048430:Cell Shape; D002869:Chromosome Aberrations; D003937:Diagnosis, Differential; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D007963:Leukocytes, Mononuclear / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology; D011379:Prognosis
keywords: Aberrant morphology; CLL; Chromosomal abnormalities; Peripheral blood