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Pathology reporting of bone marrow biopsy in myelofibrosis; application of the Delphi consensus process to the development of a standardised diagnostic report
  1. José M Raya1,
  2. Santiago Montes-Moreno2,
  3. Agustín Acevedo3,
  4. Antonio Ferrández4,
  5. Máximo Fraga5,
  6. Juan F García6,
  7. Mar García7,
  8. Empar Mayordomo-Aranda8,
  9. Javier Menárguez9,
  10. Carlos Besses10,
  11. Reyes Calzada11,
  12. María Rozman12
  1. 1Department of Hematopathology, Hospital Universitario de Canarias, Tenerife, Spain
  2. 2Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
  3. 3Department of Pathology, Hospital Universitario Quirón, Madrid, Spain
  4. 4Department of Pathology, Hospital Clínico de Valencia, Valencia, Spain
  5. 5Department of Pathology, Facultad de Medicina and Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  6. 6Department of Pathology, MD Anderson Cancer Center, Madrid, Spain
  7. 7Department of Pathology, Hospital del Mar, Barcelona, Spain
  8. 8Department of Pathology, Hospital de La Fe, Valencia, Spain
  9. 9Department of Pathology, Hospital Gregorio Marañón, Madrid, Spain
  10. 10Department of Hematology, Hospital del Mar, Barcelona, Spain
  11. 11Department of Novartis Oncology, Madrid, Spain
  12. 12Hematopathology Unit, Pathology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
  1. Correspondence to J M Raya, Department of Hematology, Hospital Universitario de Canarias, Ofra s/n, La Laguna, Tenerife 38320, Spain; jomaraya{at}


Aims The diagnosis of primary myelofibrosis (PMF) strongly relies on the bone marrow biopsy findings, but a report model has not been standardised. Our aim was to establish general recommendations for bone marrow evaluation and standardised reporting in a case suspicious of PMF.

Methods The Delphi method was employed to obtain expert consensus. An advisory panel of 10 leading members identifies a total of 37 haematopathology experts to participate. The first Delphi round included a questionnaire with three main groups of items: minimal clinical and laboratory data considered necessary before reporting, minimal descriptive aspects to record and main histological differential diagnosis. The final report content was based on consensus obtained after the second Delphi round.

Results The minimal data considered necessary were age, splenomegaly, haemoglobin, leucocyte and platelet counts, differential blood cell count, leucoerythroblastic blood picture, lactate dehydrogenase (LDH) level, BCR-ABL and JAK2 mutational status, reticulin stain and the internal control for the reticulin staining. The minimal descriptive aspects to report were cellularity, osteosclerosis, megakaryocytic morphology and localisation, dense megakaryocytic clusters, quantity of granulocytic precursors, grade of myelofibrosis in a scale of 4, and a proposed final diagnostic approach. The entities to be considered for differential diagnosis were mainly the other classical chronic myeloproliferative neoplasms.

Conclusions The Delphi method is a robust tool to determine essential information to be included in a pathology report. A standardised good-quality histopathological report form may help to homogenise PMF diagnosis. A close collaboration between the pathologist and the haematologist is desirable according to our survey.

  • Myelofibrosis
  • Bone marrow trephine
  • Reports
  • Hematopathology

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