title: Comparison of referring and tertiary cancer center physician's diagnoses in patients with leukemia.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hematology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: M
authors.initials: M
authors.lastname: DeLima
authors.forename: M
authors.initials: M
authors.lastname: Albitar
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: S
authors.initials: S
authors.lastname: Pierce
authors.forename: H
authors.initials: H
authors.lastname: Kantarjian
authors.forename: M
authors.initials: M
authors.lastname: Andreeff
authors.forename: L
authors.initials: L
authors.lastname: Fayad
authors.forename: M
authors.initials: M
authors.lastname: Keating
authors.forename: E
authors.initials: E
authors.lastname: Estey
mesh_terms: D001853:Bone Marrow / Q000473:pathology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007938:Leukemia / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D012017:Referral and Consultation