Histopathology view - integration of morphology with molecular diagnostics in a specialised integrated haematological malignancy diagnostic service

Abstract

The currently applicable WHO/ IARC (2017) classi?cation of tumours of Haematopoietic and lymphoid tissues incorporates distinctive entities that are de?ned on the basis of a combination of morphology, immunophenotype, genotype and clinical features. Correct diagnoses allow for appropriate tailored therapy to be selected from an ever-increasing set of therapeutic strategies. Simultaneously, the trend towards smaller biopsy sizes, greater number (and occasionally more complex) tests and sample types/ pathways makes it essential to incorporate integrated reporting within routine diagnostic practice (NICE, 2017). The implementation of integrated reporting within Greater Manchester through the Haematological Cancer Diagnostic Partnership (GM-HCDP) is highlighted within this talk. As a diagnostic strategy the importance of having access to the clinical/ radiological context and undertaking a detailed morphological assessment prior to requesting any molecular testing is stressed with some examples. There is a wide spectrum of molecular abnormalities (DNA, RNA and protein based, utilising a wide range of techniques, such as ?ow-cytometry, IHC, karyotyping/ FISH/ microarrays, PCR, NGS) that can be assessed in a range of diagnostic scenarios such as determining clonality, establishing lymphoma subtype, ascertaining prognostic information or for follow-up. The remainder of the talk is structured around diagnostic scenarios across the spectrum covering B- and T-cell lymphomas, where, in the appropriate context the various techniques are applied in an integrated manner to reach a de?nitive diagnosis or ascertain clinically important prognostic or predictive information. In summary, it is established that integrated reporting is essential to developing individualised treatment strategies for patients and that SIHMDS services need to demonstrate ?exibility and adaptability in order to continually widening the test repertoire to enable high-quality and timely reporting.