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Comparison of referring and tertiary cancer center physician's diagnoses in patients with leukemia
M DeLima1, M Albitar, S O'Brien
1Department of Hematology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Insights
Diagnosis concordance for hematological malignancies was analyzed. Major discrepancies in diagnoses, particularly for acute promyelocytic leukemia and hairy cell leukemia, were found in a significant number of referred patients.
Area of Science:
- Hematology
- Oncology
- Diagnostic Pathology
Background:
- Accurate diagnosis of hematological malignancies is crucial for effective treatment and prognosis.
- Referral to specialized cancer centers necessitates comparison of initial diagnoses with expert evaluations.
Purpose of the Study:
- To assess the diagnostic concordance rates for various hematological malignancies.
- To compare initial diagnoses from referring physicians with final diagnoses at a tertiary cancer center.
Main Methods:
- A cross-sectional study analyzed 409 patients referred to the M.D. Anderson Leukemia Service.
- Bone marrow examinations were performed by referring physicians and repeated at the institution.
- Morphologic review of slides was conducted for 100 cases.
Main Results:
- Overall diagnostic concordance was 73%, with 18% major and 9% minor discordances.
- High rates of major discordance were observed in acute myelogenous leukemia (29%), acute promyelocytic leukemia (43%), and hairy cell leukemia (57%).
- Concordance was 76% when comparing slides directly, and 75% for acute leukemias.
Conclusions:
- While most diagnoses agree, significant diagnostic discrepancies exist for several hematological malignancies.
- Major discordances impact treatment and prognosis, especially for treatable conditions like acute promyelocytic leukemia and hairy cell leukemia.
Purpose:
To analyze the rates of concordance in the diagnosis of various hematological malignancies among patients referred to a tertiary cancer center, comparing the referring diagnosis with the final diagnosis at the M.D. Anderson Cancer Center.
Patients And Methods:
This was a cross-sectional study analyzing the 409 patients referred to the M.D. Anderson Leukemia Service in 1995 in whom a bone marrow examination was performed by the referring physician and in whom this examination was repeated at our institution. We also analyzed 100 cases, including 84 of the 409 referred patients for whom the diagnostic outside bone marrow slide had been sent for review.
Results:
The overall concordance rate was 73%. In 18% discordances were present and considered of major importance (affecting treatment and/or prognosis) while in 9% there were minor discordances. Major discordance rates were 2% for chronic lymphocytic leukemic leukemia and 5% for chronic myelogenous leukemia, but 29% for acute myelogenous leukemia (79 patients), 43% for acute promyelocytic leukemia (7 patients), 19% for acute lymphocytic leukemia (42 patients), 57% for hairy cell leukemia (7 patients), and 23% for the myelodysplastic syndromes (75 patients). The concordance rate was 76% in the 100 cases in which bone marrow specimens permitted comparison of the morphologic diagnosis made by M.D. Anderson and the referring physician using the same slide, with a rate of 75% in the acute leukemias as finally diagnosed at our institution.
Conclusion:
Although in the majority of cases the referring physicians and the specialty service agreed on diagnosis, major discordance occurs in a significant number of cases, including highly treatable diseases such as acute promyelocystic leukemia and hairy cell leukemia.