Requirements for the Laboratory Work-up of Lymphoma

The American Society for Clinical Pathology (ASCP), the College of American Pathologists (CAP), and the American Society of Hematology (ASH) have convened an expert panel to develop an evidence-based guideline entitled “Requirements for Laboratory Workup of Lymphoma.” The draft recommendations were developed by the expert panel after a systematic review of more than 6,000 peer-reviewed titles with the aim of answering the overarching clinical question “What are the specimen requirements for accurate diagnosis for patients in whom lymphoma is being considered?” A list of disclosures and references included for data extraction is available for review.

All stakeholders—including pathologists, pathologist assistants, hematologists/oncologists, clinicians, laboratory personnel, quality managers in laboratories, hospitals or health systems, vendors, patient advocacy group representatives, and patients—are encouraged to provide feedback on the draft recommendations to ensure they are clinically sound, practical, and implementable.

During the open comment period, the expert panel will conduct a refresh of the literature search to include newer articles published since the initial literature search was conducted. The expert panel will consider all comments which will be used to finalize the recommendations along with the additional evidence from the literature refresh. The final recommendations will appear in the guideline manuscript.

Reviewing and commenting on the draft recommendations should take approximately 30+ minutes to complete. We thank you in advance for your participation.

Steven H. Kroft, MD, ASCP Co-chair
Cordelia E. Sever, MD, CAP Co-chair
Matthew Cheung, MD, ASH Co-chair


Definition:

Clinical care providers – are members of the clinical care team providing treatment to lymphoma patients which include physicians, oncologists, pathologists, radiologists, primary care physician.


Key Question: To what degree do specimen types allow for accurate primary diagnosis of indolent, aggressive and Hodgkin lymphoma?

SMALL VOLUME BIOPSY SPECIMENS
DRAFT Recommendation StatementClinical care providers should obtain core needle or excisional biopsy specimens over fine needle aspirate (FNA) alone in patients with high suspicion of lymphoma. Please indicate whether you agree or disagree with this recommendation.

DRAFT Recommendation Statement

Clinical care providers should obtain core needle or excisional biopsy specimens over fine needle aspirate (FNA) alone in patients with high suspicion of lymphoma.

 

Please indicate whether you agree or disagree with this recommendation.

DRAFT Recommendation StatementClinical care providers may use FNA with cell block and ancillary studies (e.g. immunohistochemistry (IHC), flow cytometry, fluorescence in situ hybridization) in the initial assessment for primary diagnosis in select patients with suspected lymphomas. Please indicate whether you agree or disagree with this recommendation.

DRAFT Recommendation Statement

Clinical care providers may use FNA with cell block and ancillary studies (e.g. immunohistochemistry (IHC), flow cytometry, fluorescence in situ hybridization) in the initial assessment for primary diagnosis in select patients with suspected lymphomas.

 

Please indicate whether you agree or disagree with this recommendation.
DRAFT Recommendation StatementClinical care providers should not use (FNA) cytomorphology alone without ancillary testing to achieve a definitive diagnosis of lymphoma.Note: Cytomorphology alone without ancillary studies has low sensitivity and low predictive value.Note: A defined subset of lymphoma requires architectural assessment and cannot be reliably diagnosed and subclassified by FNA. Please indicate whether you agree or disagree with this recommendation.

DRAFT Recommendation Statement

Clinical care providers should not use (FNA) cytomorphology alone without ancillary testing to achieve a definitive diagnosis of lymphoma.

Note: Cytomorphology alone without ancillary studies has low sensitivity and low predictive value.

Note: A defined subset of lymphoma requires architectural assessment and cannot be reliably diagnosed and subclassified by FNA.

 

Please indicate whether you agree or disagree with this recommendation.
DRAFT Recommendation StatementClinical care providers may obtain bone marrow biopsies for the primary diagnosis in select patients with suspected lymphomas.Note: For certain lymphoma types (e.g. splenic low grade lymphomas, lymphoplasmacytic lymphomas), bone marrow biopsy may be preferred over more invasive surgical methods. Please indicate whether you agree or disagree with this recommendation.

DRAFT Recommendation Statement

Clinical care providers may obtain bone marrow biopsies for the primary diagnosis in select patients with suspected lymphomas.

Note: For certain lymphoma types (e.g. splenic low grade lymphomas, lymphoplasmacytic lymphomas), bone marrow biopsy may be preferred over more invasive surgical methods.

 

Please indicate whether you agree or disagree with this recommendation.
 
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