随着经验和发现导致新的临床病理实体和技术的增加,淋巴瘤的诊断工作继续迅速发展。最佳的临床效果,高效,对患者安全的经济有效的诊断方法可能难以捉摸,在社区和学术实践中。研究表明,两种情况下的实践都存在差异。
为测试的前分析阶段制定基于证据的指南,重点关注淋巴瘤诊断评估的标本要求。
美国临床病理学会,美国病理学家学院,美国血液学会召集了一个淋巴瘤实验室检查专家小组,以制定循证建议。小组对文献进行了系统的审查,以解决关键问题。使用建议评估的等级,发展,和评估方法,建议是根据现有证据得出的,证据的强度,以及建议评估分级中定义的关键判断,发展,和评估证据到决策框架。
建立了13个指南声明,以优化标本选择,辅助诊断测试,并进行适当的随访,以安全,准确地诊断惰性和侵袭性淋巴瘤。
淋巴瘤的初步诊断和分类可以通过各种标本来实现。建议的应用可以指导标本适宜性的决定,诊断能力,并正确使用辅助测试。患者人群中的疾病患病率,辅助测试的可用性,和诊断目标应该被纳入适合每个实践环境的算法。
The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery led to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings.
To develop an evidence-based
guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma.
The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were derived based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework.
Thirteen
guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma.
Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions on specimen suitability, diagnostic capabilities, and correct use of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.