CAP Issues New Guidelines for Reports on Bone Marrow Testing

The College of American Pathologists has released new practice guidelines for the reporting by laboratories of clinical findings from bone marrow samples. CAP's intent is to create a standardized format and template for the reporting of the results of bone marrow tests. Such testing can be used to diagnose leukemia, lymphoma, multiple myeloma and a variety of infections, as well as determine whether forms of cancer are metastasizing to the bone marrow or other parts of the body.

"Diseases emerging from bone marrow analyses—such as blood cancers—can be difficult to distinguish from a wide variety of noncancer causes, and often additional testing and data integration is required beyond morphologic evaluation of the bone marrow," said Cordelia E. Sever, M.D., a hematopathologist at Presbyterian Hospital in Albuquerque and one of the primary authors of the new guidelines, in a statement.

CAP noted in a report recently published in the Archives of Pathology & Laboratory Medicine that a diagnosis of leukemia can range from a single sentence to paragraphs of analysis. "The significant variability in reporting of bone marrow specimens may result in incomplete information or misleading information that is ill-defined and difficult to find in the report," it said.

Altogether, CAP issued nine different guideline statements:

• Laboratories should adopt synoptic reporting as a component of bone marrow pathology reports for clearly defined neoplasia.
• When reporting on peripheral blood specimens for bone marrow synoptic reports, laboratories should report clinically and diagnostically pertinent elements.
• When reporting bone marrow aspirate results, laboratories should report clinically and diagnostically pertinent elements in the synoptic section. These may include the evidence-based parameters.
• When reporting bone marrow core biopsy results, laboratories should report clinically or diagnostically pertinent elements in the synoptic section. These key elements may include the evidence-based parameters.
• If relevant ancillary testing studies are performed on the primary sample, laboratories should report the results, general methodology, performance site, and interpretation site or have the data readily available.
• Laboratories should include in the synoptic section of the report data groups for diagnosis, supporting studies, and ancillary data that are critical for diagnosis. Key morphologic descriptors should be included and may be in the diagnosis line if critical or if a component of the disease classification. The diagnosis (or diagnosis group) should head the synoptic section when possible.
• Laboratories should consider the integrity of electronic data transmission for formatting and data presentation of synoptic reports.
• Laboratories should include clinical and laboratory data required for a definitive diagnosis in the synoptic section, along with its source(s), if applicable.
• No recommendation was made regarding the inclusion of coding terms in a synoptic report because coding terms are distinct from scientific terms and vary considerably among health authorities, payers, and different countries.

"Combining the essential data elements will help pathologists and laboratories produce clear, complete, and consistent synoptic reports that address the most relevant diagnostic and prognostic information," Sever said.

Takeaway: The College of American Pathologists has issued guidelines intended to clarify the reporting of bone marrow samples in order to better improve cancer diagnoses.