World Health Organization-defined classification of myeloproliferative neoplasms: morphological reproducibility and clinical correlations--the Danish experience

Ann Brinch Madelung; Henrik Bondo; Inger Stamp; Preben Loevgreen; Signe Ledou Nielsen; Anne Falensteen; Helle Knudsen; Mats Ehinger; Rasmus Dahl-Sørensen; Nana Brochmann Mortensen; Kira Dynnes Svendsen; Theis Lange; Elisabeth Ralfkiaer; Karsten Nielsen; Hans Carl Hasselbalch; Jürgen Thiele

doi:10.1002/ajh.23554

World Health Organization-defined classification of myeloproliferative neoplasms: morphological reproducibility and clinical correlations--the Danish experience

Ann Brinch Madelung, Henrik Bondo, Inger Stamp, Preben Loevgreen, Signe Ledou Nielsen, Anne Falensteen, Helle Knudsen, Mats Ehinger, Rasmus Dahl-Sørensen, Nana Brochmann Mortensen, Kira Dynnes Svendsen, Theis Lange, Elisabeth Ralfkiaer, Karsten Nielsen, Hans Carl Hasselbalch, Jürgen Thiele

39 Citations (Scopus)

Abstract

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

Original language	English
Journal	American Journal of Hematology
Volume	88
Issue number	12
Pages (from-to)	1012-1016
Number of pages	5
ISSN	0361-8609
DOIs	https://doi.org/10.1002/ajh.23554
Publication status	Published - Dec 2013

Keywords

Aged
Bone Marrow
Bone Marrow Examination
Consensus
Denmark
Female
Humans
Laboratory Proficiency Testing
Male
Middle Aged
Myeloproliferative Disorders
Observer Variation
Pathology Department, Hospital
Pathology, Clinical
Random Allocation
Reproducibility of Results
Single-Blind Method
Sweden
World Health Organization

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Madelung, A. B., Bondo, H., Stamp, I., Loevgreen, P., Nielsen, S. L., Falensteen, A., Knudsen, H., Ehinger, M., Dahl-Sørensen, R., Mortensen, N. B., Svendsen, K. D., Lange, T., Ralfkiaer, E., Nielsen, K., Hasselbalch, H. C., & Thiele, J. (2013). World Health Organization-defined classification of myeloproliferative neoplasms: morphological reproducibility and clinical correlations--the Danish experience. American Journal of Hematology, 88(12), 1012-1016. https://doi.org/10.1002/ajh.23554

World Health Organization-defined classification of myeloproliferative neoplasms : morphological reproducibility and clinical correlations--the Danish experience. / Madelung, Ann Brinch; Bondo, Henrik; Stamp, Inger et al.

In: American Journal of Hematology, Vol. 88, No. 12, 12.2013, p. 1012-1016.

Research output: Contribution to journal › Journal article › Research › peer-review

Madelung, AB, Bondo, H, Stamp, I, Loevgreen, P, Nielsen, SL, Falensteen, A, Knudsen, H, Ehinger, M, Dahl-Sørensen, R, Mortensen, NB, Svendsen, KD, Lange, T, Ralfkiaer, E, Nielsen, K, Hasselbalch, HC & Thiele, J 2013, 'World Health Organization-defined classification of myeloproliferative neoplasms: morphological reproducibility and clinical correlations--the Danish experience', American Journal of Hematology, vol. 88, no. 12, pp. 1012-1016. https://doi.org/10.1002/ajh.23554

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abstract = "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",

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author = "Madelung, {Ann Brinch} and Henrik Bondo and Inger Stamp and Preben Loevgreen and Nielsen, {Signe Ledou} and Anne Falensteen and Helle Knudsen and Mats Ehinger and Rasmus Dahl-S{\o}rensen and Mortensen, {Nana Brochmann} and Svendsen, {Kira Dynnes} and Theis Lange and Elisabeth Ralfkiaer and Karsten Nielsen and Hasselbalch, {Hans Carl} and J{\"u}rgen Thiele",

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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

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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

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KW - Pathology, Clinical

KW - Random Allocation

KW - Reproducibility of Results

KW - Single-Blind Method

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KW - World Health Organization

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DO - 10.1002/ajh.23554

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EP - 1016

JO - American Journal of Hematology

JF - American Journal of Hematology

IS - 12

ER -

World Health Organization-defined classification of myeloproliferative neoplasms: morphological reproducibility and clinical correlations--the Danish experience

Abstract

Keywords

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