TY - JOUR

T1 - World Health Organization-defined classification of myeloproliferative neoplasms

T2 - morphological reproducibility and clinical correlations--the Danish experience

AU - Madelung, Ann Brinch

AU - Bondo, Henrik

AU - Stamp, Inger

AU - Loevgreen, Preben

AU - Nielsen, Signe Ledou

AU - Falensteen, Anne

AU - Knudsen, Helle

AU - Ehinger, Mats

AU - Dahl-Sørensen, Rasmus

AU - Mortensen, Nana Brochmann

AU - Svendsen, Kira Dynnes

AU - Lange, Theis

AU - Ralfkiaer, Elisabeth

AU - Nielsen, Karsten

AU - Hasselbalch, Hans Carl

AU - Thiele, Jürgen

N1 - Copyright © 2013 Wiley Periodicals, Inc.

PY - 2013/12

Y1 - 2013/12

N2 - We examined inter- and intraobserver reproducibility and concordance between histological diagnosis and independently collected clinical findings in a large series of patients with the major subtypes of myeloproliferative neoplasms (MPNs) and controls. Seven hematopathologists reviewed 272 bone marrow biopsies including 43 controls. Diagnoses were determined according to the 2008 criteria of the World Health Organization (WHO). The participants were blinded to all clinical data except patient age. After initial evaluation all hematopathologists participated in a 3-day meeting with a leading clinician chaired by an expert hematopathologists. In cases with lack of consensus on fiber grading (n = 57), a new evaluation was performed. In cases with discordance on morphological diagnosis (n = 129), an additional nonblinded evaluation taking clinical data into consideration was carried out. For remaining cases with a lack of concordance between morphological diagnosis and clinical diagnosis (n = 33), a similar nonblinded evaluation was performed. Consensus on final histological diagnosis and concordance with clinical diagnosis were determined. Blinded histological evaluation resulted in a 53% consensus rate. After re-evaluation of fiber content, consensus was reached in 60% of cases. Adding clinical data increased the histological consensus to 83%. For cases with a histological consensus, we found a concordance of 71% with the clinician's diagnoses. This is the first study to present a larger cohort of MPN patients mimicking the diagnostic challenges that hematopathologists face in their daily practice. The results support the postulates of the WHO that both morphological and clinical findings are essential for a valid diagnosis

AB - We examined inter- and intraobserver reproducibility and concordance between histological diagnosis and independently collected clinical findings in a large series of patients with the major subtypes of myeloproliferative neoplasms (MPNs) and controls. Seven hematopathologists reviewed 272 bone marrow biopsies including 43 controls. Diagnoses were determined according to the 2008 criteria of the World Health Organization (WHO). The participants were blinded to all clinical data except patient age. After initial evaluation all hematopathologists participated in a 3-day meeting with a leading clinician chaired by an expert hematopathologists. In cases with lack of consensus on fiber grading (n = 57), a new evaluation was performed. In cases with discordance on morphological diagnosis (n = 129), an additional nonblinded evaluation taking clinical data into consideration was carried out. For remaining cases with a lack of concordance between morphological diagnosis and clinical diagnosis (n = 33), a similar nonblinded evaluation was performed. Consensus on final histological diagnosis and concordance with clinical diagnosis were determined. Blinded histological evaluation resulted in a 53% consensus rate. After re-evaluation of fiber content, consensus was reached in 60% of cases. Adding clinical data increased the histological consensus to 83%. For cases with a histological consensus, we found a concordance of 71% with the clinician's diagnoses. This is the first study to present a larger cohort of MPN patients mimicking the diagnostic challenges that hematopathologists face in their daily practice. The results support the postulates of the WHO that both morphological and clinical findings are essential for a valid diagnosis

KW - Aged

KW - Bone Marrow

KW - Bone Marrow Examination

KW - Consensus

KW - Denmark

KW - Female

KW - Humans

KW - Laboratory Proficiency Testing

KW - Male

KW - Middle Aged

KW - Myeloproliferative Disorders

KW - Observer Variation

KW - Pathology Department, Hospital

KW - Pathology, Clinical

KW - Random Allocation

KW - Reproducibility of Results

KW - Single-Blind Method

KW - Sweden

KW - World Health Organization

U2 - 10.1002/ajh.23554

DO - 10.1002/ajh.23554

M3 - Journal article

C2 - 23897670

VL - 88

SP - 1012

EP - 1016

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

IS - 12

ER -