Pathology reporting of bone marrow biopsy in myelofibrosis; application of the Delphi consensus process to the development of a standardised diagnostic report.
OBJECTIVE
The diagnosis of primary myelofibrosis (PMF) strongly relies on the bone marrow biopsy findings, but a report model has not been standardised. Our aim was to establish general recommendations for bone marrow evaluation and standardised reporting in a case suspicious of PMF.


METHODS
The Delphi method was employed to obtain expert consensus. An advisory panel of 10 leading members identifies a total of 37 haematopathology experts to participate. The first Delphi round included a questionnaire with three main groups of items: minimal clinical and laboratory data considered necessary before reporting, minimal descriptive aspects to record and main histological differential diagnosis. The final report content was based on consensus obtained after the second Delphi round.


RESULTS
The minimal data considered necessary were age, splenomegaly, haemoglobin, leucocyte and platelet counts, differential blood cell count, leucoerythroblastic blood picture, lactate dehydrogenase (LDH) level, BCR-ABL and JAK2 mutational status, reticulin stain and the internal control for the reticulin staining. The minimal descriptive aspects to report were cellularity, osteosclerosis, megakaryocytic morphology and localisation, dense megakaryocytic clusters, quantity of granulocytic precursors, grade of myelofibrosis in a scale of 4, and a proposed final diagnostic approach. The entities to be considered for differential diagnosis were mainly the other classical chronic myeloproliferative neoplasms.


CONCLUSIONS
The Delphi method is a robust tool to determine essential information to be included in a pathology report. A standardised good-quality histopathological report form may help to homogenise PMF diagnosis. A close collaboration between the pathologist and the haematologist is desirable according to our survey.
Department of Hematopathology, Hospital Universitario de Canarias, Tenerife, Spain.
José M
JM
Raya
Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Santiago
S
Montes-Moreno
Department of Pathology, Hospital Universitario Quirón, Madrid, Spain.
Agustín
A
Acevedo
Department of Pathology, Hospital Clínico de Valencia, Valencia, Spain.
Antonio
A
Ferrández
Department of Pathology, Facultad de Medicina and Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Máximo
M
Fraga
Department of Pathology, MD Anderson Cancer Center, Madrid, Spain.
Juan F
JF
García
Department of Pathology, Hospital del Mar, Barcelona, Spain.
Mar
M
García
Department of Pathology, Hospital de La Fe, Valencia, Spain.
Empar
E
Mayordomo-Aranda
Department of Pathology, Hospital Gregorio Marañón, Madrid, Spain.
Javier
J
Menárguez
Department of Hematology, Hospital del Mar, Barcelona, Spain.
Carlos
C
Besses
Department of Novartis Oncology, Madrid, Spain.
Reyes
R
Calzada
Hematopathology Unit, Pathology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain.
María
M
Rozman
D001706:Biopsy / Q000592:standards*; D001856:Bone Marrow Examination / Q000592:standards*; D032921:Consensus; D003697:Delphi Technique; D003937:Diagnosis, Differential; D006801:Humans; D008499:Medical Records / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D055728:Primary Myelofibrosis / Q000473:pathology*; D011379:Prognosis; D011795:Surveys and Questionnaires
Bone marrow trephine; Hematopathology; Myelofibrosis; Reports