COMPARISON OF REFERRING AND TERTIARY CANCER CENTER PHYSICIANS DIAGNOSES IN PATIENTS WITH LEUKEMIA

PURPOSE: To analyze the rates of concordance in the diagnosis of vario us hematological malignancies among patients referred to a tertiary ca ncer center, comparing the referring diagnosis with the final diagnosi s at the M.D. Anderson Cancer Center. PATIENTS AND METHODS: This was a cross-sectional study analyzing the 409 patients referred to the M.D. Anderson Leukemia Service in 1995 in whom a bone marrow examination w as performed by the referring physician and in whom this examination w as repeated al our institution. We also analyzed 100 cases, including 84 of the 409 referred patients for whom the diagnostic outside bone m arrow slide had been sent for review. RESULTS: The overall concordance rate was 73%. In 18% discordances were present and considered of majo r importance (affecting treatment and/or prognosis) while in 9% there were minor discordances. Major discordance rates were 2% for chronic l ymphocytic leukemic leukemia and 5% for chronic myelogenous leukemia, but 29% for acute myelogenous leukemia (79 patients), 43% for acute pr omyelocytic leukemia (7 patients), 19% for acute lymphocytic leukemia (42 patients), 57% for hairy cell leukemia (7 patients), and 23% for t he myelodysplastic syndromes (75 patients). The concordance rate was 7 6% in the 100 cases in which bone marrow specimens permitted compariso n of the morphologic diagnosis made by M.D. Anderson and the referring physician using the same slide, with a rate of 75% in the acute leuke mias as finally diagnosed at our institution. CONCLUSION: Although in the majority of cases the referring physicians and the specialty servi ce agreed on diagnosis, major discordance occurs in a significant numb er of cases, including highly treatable diseases such as acute promyel ocystic leukemia and hairy cell leukemia.