Haematological malignancies; the rationale for integrated Haematopathology services, key elements of organisation and wider contribution to patient care.

Robin Martin Ireland (1)

1 Haematological Medicine

Abstract The National Institute of Clinical Excellence (NICE) defined the process of care for haematological malignancies in Improving Outcomes Guidance for Haematological Oncology 2003. The most challenging recommendation has been the requirement to develop integrated laboratory services for accurate diagnosis. This is an area of NICE guidance that has not been fully achieved. The unified concept of haematological malignancy is recent and based on an understanding of the cellular pathology of the bone marrow and immune systems. Historical UK pathology practice has previously resulted in the separation of laboratory haematology from histopathology and of liquid and tissue specimens. Proposals for re-integration and centralisation with specialist-led, centralised diagnostic and reporting services challenge the fragmented historical model. Accuracy and certainty of diagnosis remains problematic, particularly applying to lymphomas, with evidence that accuracy of diagnosis is slowly improving but still only approaches 85%. There is a potentially significant human and financial cost of diagnostic errors. No nationwide, validated and comparable epidemiology/population based data exist for accurate and complete ascertainment of new cases of haematological cancers, service planning or clinical outcomes monitoring. This article examines the original rationale behind the NICE guidance and outlines the key components and processes of an integrated diagnostic service.

Mots clés: Medicine

Robin Martin Ireland. Haematological malignancies; the rationale for integrated Haematopathology services, key elements of organisation and wider contribution to patient care.. Histopathology, 2011, 58 (1), pp.145. ⟨10.1111/j.1365-2559.2010.03697.x⟩. ⟨hal-00610746⟩