Automatic Bone Marrow Cellularity Estimation in H&E Stained Whole Slide Images

Frederik Skou Nielsen, Mads Jozwiak Pedersen, Mathias Vassard Olsen, Morten Skaarup Larsen, Rasmus Røge, Alex Skovsbo Jørgensen

Research output: Contribution to journalJournal articleResearchpeer-review

2 Citations (Scopus)


Bone marrow cellularity is an important measure in diagnostic hematopathology. Currently, the gold standard for bone marrow cellularity estimation is manual inspection of hematoxylin and eosin stained whole slide images (H&E WSI) by hematopathologists. However, these assessments are subjective and subject to interobserver and intraobserver variability. This may be reduced by using a computer-assisted estimate of bone marrow cellularity. The aim of this study was to develop a fully automated algorithm to estimate bone marrow cellularity in H&E WSI stains using bone marrow segmentation. Data consisted of eight bone marrow H&E WSIs extracted from eight subjects. An algorithm was developed to estimate the bone marrow cellularity consisting of biopsy segmentation, tissue classification, and bone marrow segmentation. Segmentations of the red and yellow bone marrow (YBM) were used to estimate the bone marrow cellularity within the WSI H&E stains. The DICE coefficient between automatic tissue segmentations and ground truth segmentations conducted by an experienced hematopathologist were used for validation. Furthermore, the agreement between the automatic and two manual cellularity estimates was assessed using Bland–Altman plots and intraclass correlation coefficients (ICC). The validation of the bone marrow segmentation demonstrated an average DICE of 0.901 and 0.920 for the red and YBM, respectively. A mean cellularity estimate difference of −0.552 and − 7.816 was obtained between the automatic cellularity estimates and two manual cellularity estimates, respectively. An ICC of 0.980 (95%CI: 0.925–0.995, P-value: 5.51 × 10 −7) was obtained between the automatic and manual cellularity estimates based on manual annotations. The study demonstrated that it was possible to obtain bone marrow cellularity estimates with a good agreement with bone marrow cellularity estimates obtained from an experienced hematopathologist.

Original languageEnglish
JournalCytometry. Part A
Issue number10
Pages (from-to)1066-1074
Number of pages9
Publication statusPublished - Oct 2019


  • Bone marrow
  • Cellularity
  • Classification
  • Segmentation
  • WSI H&E stains


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