Integration of the Ki-67 proliferation index into the Ogata score improves its diagnostic sensitivity for low-grade myelodysplastic syndromes

Stefan G C Mestrum*, Eline M P Cremers, Norbert C J de Wit, Roosmarie J M Drent, Frans C S Ramaekers, Anton H N Hopman, Math P G Leers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Although flow cytometric detection of myelodysplastic syndrome (MDS) with the Ogata score has a high specificity, its sensitivity for low-grade MDS is low. Additional markers are needed to improve its diagnostic reliability. Therefore, we investigated the diagnostic performance of the Ki-67 proliferation index in bone marrow (BM) cell populations for detection of MDS.

METHODS: BM aspirates from 50 MDS patients and 20 non-clonal cytopenic controls were analyzed with flow cytometry to determine the Ogata score and the Ki-67 proliferation indices in different cell populations.

RESULTS: Ki-67 proliferation indices alone could be used to detect MDS with a sensitivity of up to 80 % and specificity of up to 70 %. Combining the Ogata score with the Ki-67 proliferation index of erythroid cells significantly improved its sensitivity for detection of MDS from 66 % to 90 %, while maintaining a specificity of 100 %. Particularly, the sensitivity for detection of low-grade MDS improved from 56 % to 91 %.

CONCLUSIONS: This is the first study using Ki-67 proliferation indices to detect MDS and shows their particularly high diagnostic sensitivity for detection of low-grade MDS. Integration of the Ki-67 proliferation index of erythroid cells into the Ogata score significantly improved its sensitivity without loss of the high specificity.

Original languageEnglish
Article number106789
Number of pages8
JournalLeukemia Research
Publication statusPublished - Feb 2022


  • Aged
  • Aged, 80 and over
  • Biomarkers/analysis
  • Bone Marrow Cells/metabolism
  • Cell Proliferation
  • Erythroid Cells/metabolism
  • Female
  • Granulocytes/metabolism
  • Humans
  • Ki-67 Antigen/analysis
  • Male
  • Middle Aged
  • Mitotic Index
  • Monocytes/metabolism
  • Myelodysplastic Syndromes/diagnosis
  • ROC Curve
  • Severity of Illness Index
  • Flow cytometry
  • MDS
  • Ki-67
  • Proliferation
  • Ogata score

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