The morphologic classification of acute lymphoblastic leukemia in childhood: Observations on concordance using a simple scoring system

G. C. Childs, S. A. Stass, J. M. Bennett

    Research output: Contribution to journalArticlepeer-review

    Abstract

    The French-American-British (FAB) cooperative group proposed a simple scoring system in 1981 to improve concordance among researchers and clinicians for the subclassification of acute lymphoblastic leukemia (ALL) into subtypes L1 and L2. The authors subtyped 50 consecutively admitted patients with common ALL of childhood according to the FAB scoring system to assess concordance among a member of the FAB group (J.B.) and two pathologists (S.S and C.C.) who are not FAB members. The initial agreement of 66% was unsatisfactory to the authors prompting the critical evaluation of the major sources of disagreement. Concordance was improved greatly by the use of two technics that are logical extensions of the scoring system: performing 100-200 differential cell counts to determine the correct percentages in borderline cases, and using reference drawings that illustrate blasts with cytoplasmic contents of 15%, 20%, and 25% in determining the cell's nuclear cytoplasmic ratio. The authors believe that the criteria explicitly given greater weight by the FAB scoring system (nuclear cytoplasmic ratio and nucleoli) are the most subjective. By following the criteria carefully and resolving differences together at a multiheaded microscope, a concordance of 92% was achieved.
    Original languageEnglish
    Pages (from-to)503-506
    Number of pages3
    JournalAmerican journal of clinical pathology
    Volume86
    Issue number4
    Publication statusPublished - 1986

    Keywords

    • pathology: Bone Marrow
    • ultrastructure: Cell Nucleolus
    • Child
    • Humans
    • classification: Leukemia, Lymphoid

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