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1.
APMIS ; 123(9): 787-92, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26200697

RESUMO

We examined the learning effect of a workshop for Danish hematopathologists led by an international expert regarding histological subtyping of myeloproliferative neoplasms (MPN). Six hematopathologists evaluated 43 bone marrow (BM) biopsies according to the WHO description (2008), blinded to clinical data. All panelists then participated in the workshop. The case biopsies - mixed with 251 other MPN BM biopsies - were reviewed again. Consensus regarding the histological subtype was significantly improved; from 49% to 72% (Fleiss kappa value 0.302 pre-workshop, 0.474 post-workshop; p = 0.004). There was no significant effect on the isolated morphological characteristics. Agreement between cases with histological consensus and clinical diagnosis was 86% without significant change during workshop sessions. Our study demonstrates that experienced hematopathologists can significantly improve their diagnostic ability by a workshop led by an international expert; not by improving the evaluation of individual histological parameters but by weighting these in their conclusive diagnosis.


Assuntos
Neoplasias da Medula Óssea/patologia , Transtornos Mieloproliferativos/patologia , Adulto , Biópsia , Medula Óssea/patologia , Estudos de Casos e Controles , Humanos , Organização Mundial da Saúde , Adulto Jovem
2.
Am J Hematol ; 88(12): 1012-6, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23897670

RESUMO

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


Assuntos
Exame de Medula Óssea/normas , Ensaio de Proficiência Laboratorial , Transtornos Mieloproliferativos/classificação , Idoso , Medula Óssea/patologia , Exame de Medula Óssea/métodos , Consenso , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Mieloproliferativos/diagnóstico , Transtornos Mieloproliferativos/patologia , Variações Dependentes do Observador , Serviço Hospitalar de Patologia , Patologia Clínica , Distribuição Aleatória , Reprodutibilidade dos Testes , Método Simples-Cego , Suécia , Organização Mundial da Saúde
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