Reproducibility of Diagnosis Assessment in ELN Low-Risk Registry
This research aims to assess the reproducibility of diagnosis in low-risk ELN registry cases by reviewing selected slides from various countries. The methodology involves a panel of experts and trainee physicians, with results compared to original findings. Detailed morphologic characteristics are examined, with discrepancies calculated using a test image. Essential data sets are prepared for review, focusing on key parameters for accurate diagnosis.
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Presentation Transcript
Morphology substudy ELN low risk Registry Aims - assess the reproducibility of diagnosis Methods - review of random selected slides from all participating countries - reviewer panel includes both experts as well as physicians in training - description of results and correlation with original findings - calculation of degree of discrepancy using -test
Methods in detail - Random selection of a total of 100 cases from all countries taking into account the amount of included patients (for example more from France as compared to Germany -> already done by Alex Smith -2 marrow slides (preferably also iron staining) and 1 blood film from each selected case should be sent to D sseldorf, where the morphology review will take place -> action by country coordinators
Methods in detail Preparation of minimal required data set of selected cases necessary for review, to be sent to D sseldorf: - ID, (Country, Hospital: only available to Alex Smith) - age at diagnosis - Hb, WBC, Platelets, Defferential count, LDH, Bilirubin, Coombs test - cytogenetic finding at diagnosis: necessary for WHO classification - no original morphology report -> to be done by Alex Smith
Morphology assessment in detail Description of Morphologic characeristics, to be filled in a file during the morphology meeting I) Peripheral blood - % of blasts - % of monocytes - signs of Dysplasia - Anisometry of platelts? - Macroplatelets? - Pseudopelger? - Hypogranulation? - cytoplasma anomalies of erythrocytes?
Morphology assessment in detail Description of Morphologic characeristics, to be filled in a file during the morphology meeting II) Marrow 1) Erythropoiesis - % of erythropoiesis - Clear signs of dysplasia? - Nuclear abnormalities? - Cytoplasma abnormalities? - Ring sideroblasts? (%) 2) Megakaryopoiesis - Assessment of 25 megakaryocytes - Clear signs of dysplasia? (>10%) - Micromegakaryocytes ? - Mononuclear megakaryocytes? - Megas with spreaded nuclei?
Morphology assessment in detail Description of Morphologic characeristics 3) Granulopoiesis - Clear signs of dysplasia? (>10%) - Pseudopelger? - Hypogranulation? - % Medullary blast (if Erythropoiesis >50%, count blasts in the non-erythropoietic cells) 4) Other items - Cellularity (Hypo vs. Normo vs. Hyper) - Plasma cells increased? - Lymphoid cells increased? - Iron load? - Other stainings available?
Morphology assessment in detail Diagnostic categories RCUD (bicytopenia) RC RA RN MDS unclass RCUD with pancytopenia RCUD/RCMD with blasts in blood RCUD without dysplasia but with clonal marker RCMD MDS with del(5q) RARS-T RAEB I RAEB II, RAEB-T, AML, CMML I, CMMLII, ICUS No MDS at all
Methods to analyse the results 1) Within the panel - Discussion of cases during meeting - Report on interobserver variation within experts - Report on possible discrepancies between experts and non-experts - description of staining techniques and quality of slides - comparison of methods to read the slides - correlation of WHO types with hematologic and cytogenetic findings 2) Panel vs. Original reports - Send list of WHO results of the morphology panel to Alex Smith - Comparison of original reports with the results of the panel by k-test (and/or other tests to be done my Alex Smith) to describe amount of discrepancies 3) Final report on - Validation and reliability of the cases included into the ELN low risk R
Methods to analyse the results 3) Final report on - Validation and reliability of the cases included into the ELN low risk Registry to be done within the panel and Alex Smith
Morphology Panel Chairs: Proposed Experts Argiris Symenoidis, Greece Jaroslaw Cermak, Czech Rep. Anna Porwit, Sweden Teresa Valespie?, Spain Proposed non-experts Louise deSwart, Netherlands Judith Neukirchen, Germany By David Bowen, UK Others Ulrich Germing and Marius MacKenzie
