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In this study, we developed an automatic system with integrated scanning hardware and machine learning-based software to perform differential cell count on bone marrow smears to assist diagnosis. The initial development of the artificial neural network was based on 3000 marrow smear samples retrospectively archived from Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine between June 2016 and December 2018. The preliminary field validating test of the system was based on 124 marrow smears newly collected from the Second Affiliated Hospital of Harbin Medical University between April 2019 and November 2019. The study was performed in parallel of machine automatic recognition with conventional manual differential count by pathologists using the microscope. We selected representative 600,000 marrow cell images as training set of the algorithm, followed by random captured 30,867 cell images for validation. In validation, the overall accuracy of automatic cell classification was 90.1% (95% CI, 89.8\u201390.5%). In a preliminary field validating test, the reliability coefficient (ICC) of cell series proportion between the two analysis methods were high (ICC\u2009\u2265\u20090.883, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and the results by the two analysis methods were consistent for granulocytes and erythrocytes. The system was effective in cell classification and differential cell count on marrow smears. It provides a useful digital tool in the screening and evaluation of various hematological disorders.<\/jats:p>","DOI":"10.1007\/s10916-020-01654-y","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T11:17:25Z","timestamp":1600082245000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Developing and Preliminary Validating an Automatic Cell Classification System for Bone Marrow Smears: a Pilot Study"],"prefix":"10.1007","volume":"44","author":[{"given":"Hong","family":"Jin","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0062-2796","authenticated-orcid":false,"given":"Xinyan","family":"Fu","sequence":"additional","affiliation":[]},{"given":"Xinyi","family":"Cao","sequence":"additional","affiliation":[]},{"given":"Mingxia","family":"Sun","sequence":"additional","affiliation":[]},{"given":"Xiaofen","family":"Wang","sequence":"additional","affiliation":[]},{"given":"Yuhong","family":"Zhong","sequence":"additional","affiliation":[]},{"given":"Suwen","family":"Yang","sequence":"additional","affiliation":[]},{"given":"Chao","family":"Qi","sequence":"additional","affiliation":[]},{"given":"Bo","family":"Peng","sequence":"additional","affiliation":[]},{"given":"Xin","family":"He","sequence":"additional","affiliation":[]},{"given":"Fei","family":"He","sequence":"additional","affiliation":[]},{"given":"Yongfang","family":"Jiang","sequence":"additional","affiliation":[]},{"given":"Haiyan","family":"Gao","sequence":"additional","affiliation":[]},{"given":"Shun","family":"Li","sequence":"additional","affiliation":[]},{"given":"Zhen","family":"Huang","sequence":"additional","affiliation":[]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[]},{"given":"Fengqi","family":"Fang","sequence":"additional","affiliation":[]},{"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,9,7]]},"reference":[{"key":"1654_CR1","unstructured":"Swerdlow S, Campo E, Harris N, Jaffe E, Pileri S, Thiele J, Arber D, Hasserjian R, Le Beau M (2017) WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, vol 421. revised 4th edn. 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The funder of Hangzhou Zhiwei was involved in data collection, interpretation of the data, writing, preparation and approval of the manuscript, and decision to submit the manuscript for publication. Xinyan Fu, Mingxia Sun, Xinyi Cao, Bo Peng, Shun Li, and Zhen Huang are employees of Hangzhou Zhi-wei Information andTechnology, Ltd. Qiang Li is CTO of Hangzhou Zhi-wei Information & Technology Ltd. and hold stock. Fengqi Fang was on the advisory board of Zhi-wei Information & Technology Ltd. All the authors declared that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the ethics committee of local hospitals (No. KY2018\u2013280). Since smears used in this retrospective study have been used in clinical examination, the informed consent of patients was exempted.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}}],"article-number":"184"}}