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Diagnostic Criteria and Laboratory Investigation of Haematological Malignancies

Current practice at the Haematological Malignancies Diagnostic Service at Leeds

There are over 50 subtypes of haematological malignancy currently recognised, displaying a wide range of clinical presentation, degree of malignancy and responsiveness to treatment. The World Health Organisation Classification of Tumours of the Haematopoietic and Lymphoid Tissues, published in 2001, [Jaffe ES, Harris NL, Stein H, Vardiman JW. Tumours of Haematopoietic and Lymphoid Tissues IARC Press Lyon 2001] is the latest in a long line of classifications of haematological malignancy. As a direct descendant of the REAL (Revised European and American Lymphoma) classification introduced in the mid-1990's it adopts a similar approach to define entities based on combinations of morphology, immunophenotype, genetic abnormalities and clinical features. This differs from the predominately morphological approach seen in previous classifications (FAB and Kiel).

Reproduced below is the standard operating procedure for the laboratory diagnosis of leukaemia and lymphoma used in HMDS. The individual diagnostic criteria have been chosen with the aim of ensuring high levels of diagnostic accuracy and reproducibility. In most cases this is achieved by ensuring the consistency of results across a range of independent diagnostic techniques. In a number of cases more stringent diagnostic criteria are used than those set out in the WHO classification. Emphasis has also been placed on the use of cellular prognostic factors that are likely to make an increasing impact on routine clinical practice.

The use of terminology and diagnostic criteria is subject to internal audit within the laboratory.

Version History

June 2005 (current revision): minor protocol amendments and updates.

October 2004: further revision to incorporate the reporting of prognostic factors.

March 2003: extensive revision of the previous SOP, undertaken in response to the publication of the WHO classification. Broadly followed the diagnostic categories set out therein, with the exception of a few entities where the diagnostic criteria were felt to be too imprecise or showed significant overlap with other entities.

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