Audit of bone marrow biopsy reports submitted to a myelodysplastic syndrome registry

Abstract

Background: Reviewing a diagnosis of myelodysplastic syndrome (MDS) is challenging due to variability in morphological description and report content. Improved concordance in diagnosis may be achieved by adhering to morphological requirements based upon WHO classification criteria,1 and by following structured reporting guidelines. Aim: We reviewed bone marrow biopsy reports submitted to a pilot Myelodysplastic Syndromes Registry (MDSLink) to confirm accuracy of diagnoses based on morphological description, according to WHO 2016 criteria.1 We also audited report content according to the RCPA Bone Marrow Specimen Structured Reporting Protocol.2 Results: Out of 59 bone marrow biopsy reports reviewed, four (∼7%) cases did not describe morphological features consistent with the stated diagnoses based on WHO diagnostic criteria. Quantitative assessment of reported dysplasia (>/<10%) was infrequently provided, with qualitative terms more commonly used. Fifty-three reports complied with RCPA structured reporting guidelines, but six (∼11%) omitted details regarding trephine length, iron stores or presence and proportion of ring sideroblasts. WHO disease subtype was provided in all cases, but ICD-O code was rarely included (∼8%). Discussion: Reporting of morphological features in MDS according to WHO criteria in a structured format based on published guidelines allows objective confirmation and standardisation of MDS diagnoses, and identifies areas for improvement. 1.Swerdlow SH, Campo E, Harris NL, et al., editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised 4th ed, 2016. Lyon: IARC, 2017.2.Royal College of Pathologists of Australasia (RCPA). Bone Marrow Specimen (Aspirate and Trephine Biopsy) Structured Reporting Protocol (1st Edition 2014). Sydney: RCPA, 2014. https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Cancer-Protocols