Multidisciplinary Guidance Document Focuses on Specimen Requirements for Diagnosis of Lymphoma
Medical practitioners are challenged to diagnose lymphoma on samples of decreasing tissue volume, including fine needle aspirations and needle biopsies. At the same time, increasingly complex diagnostic criteria require more ancillary tests to differentiate specific subtypes of lymphoma for optimal therapy.
With a focus on the pathology aspects of diagnosing lymphoma, the American Society for Clinical Pathology (ASCP), the College of American Pathologists (CAP), and the American Society of Hematology (ASH) are collaborating to develop an evidence-based clinical practice guideline for the workup of lymphoma. An interdisciplinary panel of experts representing these organizations is developing the guideline. The expert panel includes clinical oncologists, pathologists, and patient representatives.
The draft recommendations summary for the “ASCP/CAP/ASH Requirements for Laboratory Workup of Lymphoma Guideline” is now available for public comment from September 27, 2018, through October 24, 2018.
According to Steven H. Kroft, MD, ASCP Co-Chair, “Diagnosis and classification of lymphoma has become a highly complex, multi-modality process that requires rigorous attention to and quality assurance of pre-analytical, analytical, and post-analytical details. At the same time, clinical practice has evolved to favor the least invasive possible procedures to secure diagnoses. Thus, pathologists are being asked to do more and more with less and less. However, little guidance exists regarding the appropriate handling, testing, and reporting of lymphoma specimens. This guideline will assist pathologists and clinicians in making good decisions about the workup of lymphoma, so as to best serve our patients and enable optimal outcomes.”
All stakeholders, including pathologists, pathologists’ 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 these draft recommendations.
“It is our hope that an open comment period draws input from diverse practice settings beyond the diversity represented in the expert panel,” says Cordelia E. Sever, MD, CAP Co-Chair. “This input usually provides information on common practice, as well as particular practice settings that were not obvious in the drafting stage of the guideline. Incorporating the feedback will strengthen the final guideline and make it universally applicable.”
The panel has drafted 14 evidence-based recommendations, primarily addressing the pre-analytic phase of testing, with an emphasis on specimen requirements. Specimens to investigate suspected lymphoma require special handling, the expert panel notes, and these handling decisions are best planned in advance in consultation with the pathologist or per agreed-upon institutional protocols.
The expert panel reviewed over 6,000 articles in peer-reviewed literature, 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 primary goal of this guideline would be to provide evidence-based recommendations for the pre-analytic phase of testing with a focus on specimen requirements,” shares Matthew Cheung, MD, ASH Co-Chair. “A secondary goal would be to provide evidence-based guidance on which ancillary testing and clinical parameters would contribute to diagnostic certainty in circumstances, in particular when additional sampling is not possible or associated with risk to patient safety. Optimal answers to key questions would guide users toward appropriate tissue sampling for common scenarios and inform which circumstances should prompt a tissue handling consultation prior to collection of the sample.”
Following the open comment period, the guideline authors will consider all feedback to finalize the recommendations. The final recommendations will be available in the guideline manuscript and will be available at no cost. To read and comment on the draft guidelines, click here.