Abstract：
OBJECTIVE: Two new classifications of myeloid neoplasms have recently been published: the International Consensus Classification (ICC) and the 5th edition of the World Health Organization classification (WHO5). We sought to examine the real-world impact of dueling classifications on patient diagnoses.
METHODS: Our institutional pathology database was searched, and 237 specimens with a diagnosis of myeloid neoplasia were randomly selected. For each case, a classification based on the WHO5 and the ICC was assigned. The WHO5 and ICC diagnoses were compared to determine their degree of concordance.
RESULTS: After applying the WHO5 and ICC diagnostic criteria, 134 (56.5%) cases were classified as concordant, 63 (26.6%) cases had terminological differences, 37 (15.6%) cases had minor diagnostic discrepancies, and 3 (1.3%) cases had major diagnostic discrepancies. Cases with minor diagnostic discrepancies included 25 cases of myelodysplastic syndrome (MDS), 10 cases of acute myeloid leukemia (AML), and 2 cases of myeloid precursor lesions. Cases with major diagnostic discrepancies included 2 cases that were diagnosed as MDS, not otherwise specified (NOS), according to the ICC but classified as AML with NPM1 alteration and AML with RBM15::MRTFA according to the WHO5 and 1 case that was characterized as chronic myelomonocytic leukemia according to the ICC and as AML with NPM1 alteration according to the WHO5.
CONCLUSIONS: This study confirms that a majority of cases are classified similarly using the 2 systems. Given the overall similarity of the systems, future harmonization of the classifications should be pursued to avoid confusion and multiple diagnoses.
METHODS: Our institutional pathology database was searched, and 237 specimens with a diagnosis of myeloid neoplasia were randomly selected. For each case, a classification based on the WHO5 and the ICC was assigned. The WHO5 and ICC diagnoses were compared to determine their degree of concordance.
RESULTS: After applying the WHO5 and ICC diagnostic criteria, 134 (56.5%) cases were classified as concordant, 63 (26.6%) cases had terminological differences, 37 (15.6%) cases had minor diagnostic discrepancies, and 3 (1.3%) cases had major diagnostic discrepancies. Cases with minor diagnostic discrepancies included 25 cases of myelodysplastic syndrome (MDS), 10 cases of acute myeloid leukemia (AML), and 2 cases of myeloid precursor lesions. Cases with major diagnostic discrepancies included 2 cases that were diagnosed as MDS, not otherwise specified (NOS), according to the ICC but classified as AML with NPM1 alteration and AML with RBM15::MRTFA according to the WHO5 and 1 case that was characterized as chronic myelomonocytic leukemia according to the ICC and as AML with NPM1 alteration according to the WHO5.
CONCLUSIONS: This study confirms that a majority of cases are classified similarly using the 2 systems. Given the overall similarity of the systems, future harmonization of the classifications should be pursued to avoid confusion and multiple diagnoses.
摘要：
目的：最近发表了两种新的髓系肿瘤分类：国际共识分类（ICC）和第5版世界卫生组织分类（WHO5）。我们试图研究决斗分类对患者诊断的现实影响。
方法：搜索了我们的机构病理学数据库，随机选择237例诊断为髓样肿瘤的标本。对于每种情况，根据WHO5和ICC进行分类.比较WHO5和ICC诊断以确定它们的一致性程度。
结果：应用WHO5和ICC诊断标准后，134例(56.5%)被归类为一致，63例(26.6%)有术语差异，37例（15.6%）有轻微的诊断差异，3例(1.3%)有重大诊断差异。诊断差异较小的病例包括25例骨髓增生异常综合征（MDS），急性髓系白血病（AML）10例，2例髓样前体病变。诊断差异较大的病例包括2例确诊为MDS，未指定（NOS），根据ICC，但根据WHO5分类为具有NPM1改变的AML和具有RBM15的AML::MRTFA，根据ICC分类为慢性粒单核细胞白血病，根据WHO5分类为具有NPM1改变的AML。
结论：本研究证实，大多数病例使用两种系统进行了相似的分类。鉴于系统的整体相似性，未来应寻求分类的统一,以避免混淆和多重诊断.
方法：搜索了我们的机构病理学数据库，随机选择237例诊断为髓样肿瘤的标本。对于每种情况，根据WHO5和ICC进行分类.比较WHO5和ICC诊断以确定它们的一致性程度。
结果：应用WHO5和ICC诊断标准后，134例(56.5%)被归类为一致，63例(26.6%)有术语差异，37例（15.6%）有轻微的诊断差异，3例(1.3%)有重大诊断差异。诊断差异较小的病例包括25例骨髓增生异常综合征（MDS），急性髓系白血病（AML）10例，2例髓样前体病变。诊断差异较大的病例包括2例确诊为MDS，未指定（NOS），根据ICC，但根据WHO5分类为具有NPM1改变的AML和具有RBM15的AML::MRTFA，根据ICC分类为慢性粒单核细胞白血病，根据WHO5分类为具有NPM1改变的AML。
结论：本研究证实，大多数病例使用两种系统进行了相似的分类。鉴于系统的整体相似性，未来应寻求分类的统一,以避免混淆和多重诊断.
