November 11, 2020
The College of American Pathologists (CAP) and the American Society for Clinical Pathology (ASCP) released a new evidence-based clinical practice guideline, “Laboratory Workup of Lymphoma in Adults” that focuses on the preanalytic phase of tissue handling and lymphoma diagnosis to help clinical teams improve patient care.
Recent estimates show that more than 75,000 new cases of non-Hodgkin lymphoma will be diagnosed this year in the U.S., with an additional 8,400 cases of Hodgkin lymphoma projected. Pathologists are challenged to diagnose lymphoma on samples of decreasing tissue volume, including those from fine needle aspirations and needle biopsies. Furthermore, advancements in lymphoma knowledge require clinical teams to perform a growing number of ancillary tests to differentiate specific lymphoma subtypes with complex diagnostic criteria to better optimize therapy for individual patients. This can lead to varied approaches depending on practice settings, and the new guideline provides direction and leadership to bridge the gaps.
“This guideline is an important steppingstone,” says Matthew Cheung, MD, co-chair of the guideline’s expert panel. “We can now detail areas in which well-designed prospective studies are essential to clarify the ideal specimen requirements required for modern ancillary testing techniques.”
“The overall weakness of the evidence base suggests many research opportunities to better inform the issue dealt with in the guideline,” adds Steven Kroft, MD, ASCP co-chair of the expert panel. “Many practices appear to have become standard of care without the generation of a robust evidence base.”
Developed following the standards endorsed by the National Academy of Medicine, and published jointly in the American Journal of Clinical Pathology and Archives of Pathology & Laboratory Medicine, the guideline is a collaborative effort by ASCP, the CAP, and the American Society of Hematology (ASH). Patient advocates were also included in the development of the guideline to provide non-clinical perspectives. The expert panel reviewed more than 6,000 articles from peer-reviewed literature to answer the overarching question, “What are the specimen requirements for accurate diagnosis for adult patients in whom lymphoma is suspected?”
“The lack of high-quality evidence for practices that are widely accepted was eye opening,” says Cordelia Sever, MD, FCAP, and CAP co-chair of the expert panel. “The predictive value of a set of diagnostic tests in lymphoma depends on the ultimate diagnosis, which introduces great complexity in the work up and diagnostic interpretation, unlike most other diagnostic test algorithms.”
The 13 evidence-based recommendations address the pre-analytic phase of testing, with an emphasis on specimen requirements, as well as ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive histology lymphomas. To learn more, find guideline details on cap.org or visit ajcp.com.
About the College of American Pathologists (CAP)
As the world’s largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, read the CAP Annual Report.
About the American Society for Clinical Pathology (ASCP)
Founded in 1922 in Chicago, ASCP unites more than 120,000 anatomic and clinical pathologists, residents and fellows, medical laboratory professionals and students to accelerate the advancement of laboratory medicine to better improve patient care through knowledge, collaboration and global community. ASCP’s mission is to provide excellence in education, certification, and advocacy on behalf of the patients, pathologists, and laboratory professionals across the globe. To learn more, visit www.ascp.org.