Objective      To determine the potential diagnostic value for myelodysplastic syndrome (MDS) by combining the following methods: bone marrow smear

biopsy

chromosome banding analysis

flow cytometry (FCM)

and fluorescence

in situ

hybridization (FISH)

namely MICM classification.       Methods      All MDS patients admitted in our hospital

from October 2010 to November 2013 were retrospectively analyzed

and those diagnosed as MDS according to the criteria formulated by WHO were enrolled in this study. Diagnostic compliance rate was analyzed by comparing the gold standard of diagnosis by WHO criteria with single test (bone marrow smear)

double test (bone marrow smear plus biopsy)

triple test (above 2 plus chromosome banding analysis)

test (above 3 plus FISH)

and quintuple test (above 4 plus FCM) respectively. The diagnostic value of MICM classification on subtype identification and prognosis assessment were also evaluated.       Results      Among the 248 patients with confirmed MDS

the diagnostic compliance rate was 79.44%

87.10%

88.71% and 93.15% respectively for double

triple

quadruple and quintuplet tests

and all of these were significantly higher than using bone marrow smear alone (59.27%

all

P

<

0.05). Quintuplet test also had significant value in the reticulin fibrosis and its severity

chromosomal karyotypes and its complexity

antigen expression and aberrant immunophenotype.       Conclusion      Our quintuplet test not only contributes to more precise and reliable diagnosis of MDS

but also benefits accurate identification of MDS subsets and prognosis assessment. So this combined diagnostic methods should be applied to routine clinical testing for MDS.