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Evaluation of Testing of Acute Leukemia Samples: Survey Result From the College of American Pathologists
Tracy I George, Joseph A Tworek, Nicole E Thomas
1From the Department of Pathology, University of New Mexico, Albuquerque (Dr George); the Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, Michigan (Dr Tworek); Laboratory and Pathology Quality Center (Mses Thomas and Fatheree) and Statistics Department (Ms Souers), College of American Pathologists, Northfield, Illinois; Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville (Dr Nakhleh); and Department of Pathology, Stanford University, Stanford, California (Dr Arber).
Insights
Physicians routinely use flow cytometry and karyotyping for acute leukemia (AL) diagnosis. However, significant variations exist in other genetic, immunohistochemistry, and cytochemistry testing practices.
Area of Science:
- Hematology
- Oncology
- Clinical Pathology
Background:
- Acute leukemia (AL) classification and prognosis are complex.
- Current diagnostic testing practices for AL are not well-defined.
Purpose of the Study:
- To survey physicians on their current test ordering practices for acute leukemia diagnosis.
- To establish a baseline understanding of AL diagnostic testing prior to guideline development.
Main Methods:
- A survey was designed by an expert panel from the College of American Pathologists (CAP).
- Members of professional hematology societies were asked to describe their AL diagnostic test ordering practices.
- Two hundred ninety-four responses were received and analyzed.
Main Results:
- Flow cytometry and karyotype analysis are routinely performed for both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).
- Fluorescence in situ hybridization (FISH) studies are also commonly used.
- Significant variation exists in the utilization of other molecular studies, immunohistochemistry, and cytochemistry.
Conclusions:
- Flow cytometry and karyotyping are standard diagnostic tests for acute leukemia.
- There is considerable heterogeneity in the application of other genetic and specialized testing modalities in AL diagnosis.
- Further standardization of AL diagnostic testing may be warranted.
Context:
- The classification and prognosis determination in acute leukemia (AL) are complex and it is unclear what testing is being performed in practice.
Objective:
- To survey physicians describing their current practice of test ordering in the diagnosis of AL.
Design:
- In anticipation of a guideline by the College of American Pathologists (CAP) and the American Society for Hematology on laboratory testing needed for the initial workup of AL, a baseline survey was designed by an expert panel from CAP. Members of professional societies were asked to describe their current practice of test ordering.
Results:
- Two hundred ninety-four responses were received with 258 respondents analyzed after the first qualifying survey question regarding initial diagnosis of AL. One hundred seventy-six of 249 respondents (70.7%) were board-certified hematopathologists. Flow cytometry and karyotype analysis were routinely performed for acute myeloid leukemia (AML) (99.1% [232 of 234] and 96.2% [225 of 234], respectively) and acute lymphoblastic leukemia (ALL) (98.3% [229 of 233] and 96.6% [225 of 233], respectively). In addition, fluorescence in situ hybridization studies were routinely performed by 81.2% (190 of 234) of respondents for AML and 85.0% (198 of 233) of respondents for ALL; other molecular studies were performed by 78.2% (183) for AML and 54.9% (128) for ALL; immunohistochemistry by 44.9% (105) for AML and 47.6% (111) for ALL; and cytochemistry by 24.8% (58) for AML and 14.2% (33) for ALL.
Conclusions:
- While flow cytometry and karyotyping are routinely reported as being performed for the diagnosis of AL, there is marked variation in the reporting of testing patterns for other genetic studies, immunohistochemistry, and cytochemistry.
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