White blood cell evaluation in haematological malignancies using a web‐based digital microscopy platform

Abstract

Introduction Digital microscopy systems are beginning to replace traditional light microscopes for morphologic analysis of blood films, but these are geographically restricted to individual computers and technically limited by manufacturer's constraints. We explored the use of a scanner‐agnostic web‐based artificial intelligence (AI) system to assess the accuracy of white blood cell (WBC) differentials and blast identification in haematological malignancies. Methods Digitized images of 20 normal and 124 abnormal peripheral blood films were uploaded to the web‐based platform (Techcyte©) and WBC differentials performed using the online AI software. Digital images were viewed for accuracy and manual cell reassignment was performed where necessary. Results were correlated to the ‘gold standard’ of manual microscopy for each WBC class, and sensitivity and specificity of blast identification were calculated. Results The AI digital differential was very strongly correlated to microscopy (r > .8) for most normal cell types and did not require any manual reassignment. The AI digital differential was less reliable for abnormal blood films (r = .50‐.87), but could be greatly improved by manual assessment of digital images for most cell types (r > .95) with the exception of immature granulocytes (r = .62). For blast identification, initial AI digital differentials showed 96% sensitivity and 25% specificity, which was improved to 99% and 84%, respectively, after manual digital review. Conclusions The Techcyte platform allowed remote viewing and manual analysis of digitized slides that was comparable to microscopy. The AI software produced adequate WBC differentials for normal films and had high sensitivity for blast identification in malignant films.

Digital assessment of peripheral blood and bone marrow aspirate smears

“…These full‐field analyzers allow for remote analysis of PB smears and improved diagnostic turnaround time 33 . Web‐based scanner‐agnostic systems are also being developed to provide accurate WBC differentials across instruments 34 . Together, these improvements over current instrumentation for digital PB smear analysis will enhance diagnostic performance and will likely become integrated in the clinical laboratory over the next decade.…”

A comparative evaluation of three consecutive artificial intelligence algorithms released by Techcyte for identification of blasts and white blood cells in abnormal peripheral blood films

“…This was a prototype developed in 2014 and the results of this analysis were extensively reported. 4 When the online AI software was updated in 2020, the same images were processed using the new algorithm (AI2), and the process again repeated with the current version of the software released on Oct 21, 2022 (AI3). The AI differentials were individually correlated to those obtained by manual microscopy (gold standard) for each WBC class, and results compared to determine the superior AI version.…”

“…3 We have previously reported on the accuracy of peripheral WBC differential and blast identification in abnormal blood films by the Techcyte online AI system. 4 The aim of the current study was to perform a comparison of the three AI protocols released over time (2019 to 2022) to assess for improvement in cell identification.…”

Is the interaction of technology useful in laboratory haematology diagnostics?

“…Very experienced operators are needed, because the morphology is complex and also because, otherwise, there is a high degree of variability between observers. Digital microscopy is increasingly used in diagnostic laboratories, even though the devices have a large footprint, are relatively expensive, and have limited slip parameters that must be adhered to generate accurate differentials [10] [11]. Flow cytometry gives the maximum guarantee of results by using specific markers in the recognition of abnormal cells or abnormal phenotypes.…”

“…Digital microscopy is increasingly used in diagnostic laboratories, even though the devices have a large footprint, are relatively expensive, and have limited slip parameters that must be adhered to generate accurate differentials [10] [11].…”