Next-Generation Morphology (NGM) Enables Advanced Digital Analysis of Myelodysplastic Syndromes in Peripheral Blood Smears

A multilayer morphometric approach delivers high-resolution Full-Field imaging and quantitative insights into myelodysplasia using the Scopio Labs X100 digital system.

BACKGROUND

Morphological analysis remains largely manual, low in sensitivity, and constrained by technological limitations. A fundamental trade-off between field of view and resolution restricts high-magnification imaging (×100) to only 100–200 leukocytes, limiting analytical sensitivity to around 10⁻². Achieving high-resolution, large-scale (“big data”) imaging within practical time frames remains challenging with ~80% of practitioners continuing to rely on manual microscopy for peripheral blood smear (PBS) analysis. This study demonstrates a novel digital microscopy NGM approach that delivers an automated digital analysis, with sensitivity levels of at least 10−3 and 10−5 for WBCs, and RBCs respectively. The Scopio Labs X100 analyzer was used to test NGM performance for precise quantitative analysis of myelodysplasia in PBS 1 

METHODS

Stained PBS utilizing a May–Grunwald–Giemsa protocol were analyzed from 37 myelodysplastic syndrome (MDS) patients and 30 age-matched controls in a prospective study. A multilayer NGS approach was utilized Using a simple dimensionality reduction-based algorithm, a single grading scale without units (granulation index [GI]) was created from the parameters. RBCs were properly segmented, geometric-based features were extracted with image processing algorithms and the cell size and contours were quantified. The Revised IPSS-R using CBC parameters, cytogenetics, and blast percentage, together with demographic and laboratory data were analyzed using univariate and multivariate Cox regression, adjusted for age, gender, and morphometric variables, to identify independent predictors of MDS risk.

RESULTS

• Accuracy: 274,856 cells representing 1374 PBS smears were analyzed. More than 94% of WBCs belonging to the five major WBC classes were correctly classified by the system with accuracy highest for neutrophils (99.8%) and basophils (98.73%). Blasts were correctly identified 79.91% of the time. 
• Significant reduction in mean GI in MDS: Due to the high accuracy of AI-based neutrophil classification, neutrophils were evaluated automatically without human review. Mean GI was significantly reduced in MDS vs controls whereas the presence of hypogranulated neutrophils increased (49.6% vs 13.2%, p < 10⁻⁵). 
• Enhanced Detection Sensitivity for Blast Enumeration: A highly significant difference (p < 10−9) in the detection of blasts was noted in 1000 WBC counts per sample. 
• Detection of RBC morphometry: At least 152,310 RBCs were analyzed per PBS. Macrocytosis was significantly higher in MDS samples (p < 0.0002) and a significantly higher proportion of deformed RBCs p < 10⁻⁵ were found versus age-matched controls  

CONCLUSION

Using the Scopio Labs X100 digital system NGM overcomes traditional microscopy limitations, offering high-resolution, large-field imaging for sensitive digital morphometry of PBS. This technology can enhance the detection and quantitative characterization of hematological abnormalities, with objective, quantitative morphometry supporting risk stratification. This NGM approach contributes to the understanding of MDS physiology, and may support early detection of dysplasia in PBS as well as allowing Opportunities for remote diagnostics and research into hematologic dysplasia.

AI-Artificial Intelligence; PSS- R Revised International Prognostic Scoring System; MDS- Myelodysplastic Syndrome; NGM Next Generation Morphology; PBS -Peripheral Blood Smear; RBC Red Blood Cell; WBC- White Blood Cell.

Reference:
Katz BZ, Moshe Y, Bensity D, Luttwak E, Brazilai M, Oster HS, Pozdnyakova O, Mittelman M, Avivi I. Next-generation morphology, a novel multilayer morphometric digital analysis, reveals both the basic topology and new trends of myelodysplasia of peripheral blood specimens. Br J Haematol. 2025 Aug 29. doi: 10.1111/bjh.70110.
Disclaimer: Full-Field Peripheral Blood Smear Application is CE-marked and FDA-cleared, and is commercially available across the U.S., UK and Europe and other territories.