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Combined Pathology-Driven Algorithmic Testing and Integrated Reporting for Bone Marrow Examination.

Lauren N Pearson1, Jill M Miller1, John H Lunde1

  • 1From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired.

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Pathology-driven algorithmic testing (PDAT) with integrated synoptic reporting significantly improves World Health Organization diagnoses for hematologic neoplasms and optimizes test utilization, with clinicians preferring this approach.

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Area of Science:

  • Hematopathology
  • Oncology Diagnostics
  • Clinical Pathology

Background:

  • The College of American Pathologists recommends synoptic reporting for bone marrow examinations in hematologic neoplasms.
  • Current diagnostic pathways may lead to suboptimal test utilization and diagnostic accuracy.
  • Pathology-driven algorithmic testing (PDAT) with integrated reporting offers a structured approach.

Purpose of the Study:

  • To evaluate the impact of PDAT with integrated reporting on bone marrow examination.
  • Assess changes in test utilization, diagnostic accuracy (World Health Organization classification), and clinician satisfaction.
  • Compare outcomes 1 year after implementation against previous practices.

Main Methods:

  • Retrospective review of hematopathology reports, integrated synoptic reports, and ancillary test results over 12 months.
  • Comparison of initial versus final diagnoses.
  • Analysis of test utilization data and clinician satisfaction via anonymous surveys.

Main Results:

  • Integrated reporting achieved a World Health Organization diagnosis in 94% of cases, compared to 64% with traditional reports alone.
  • Unnecessary testing decreased from 45% to 0.7%, with fewer omissions of essential tests.
  • Clinicians expressed a preference for PDAT, valuing the accessibility of prognostic information in integrated reports.

Conclusions:

  • PDAT with integrated reporting enhances diagnostic accuracy for hematologic neoplasms and improves test utilization.
  • Clinician preference supports PDAT over traditional clinician-ordered testing.
  • This study demonstrates the positive impact of synoptic reporting on modifying hematologic diagnoses.