Memorias del Instituto de Investigaciones en Ciencias de la Salud
versão On-line ISSN 1812-9528
FIGUEREDO THIEL, SJ. Levels of concordance in the clinical and pathological diagnosis of hematological diseases. Mem. Inst. Investig. Cienc. Salud [online]. 2007, vol.5, n.2, pp.11-16. ISSN 1812-9528.
In the hemopathological diagnosis, clinical findings (patient physical examination, laboratory, radiology and others) are correlated to the quanti-qualitative morphological exam of blood and hematopoietic cells in peripheral blood smears and bone marrow aspirates. In the case of clinical presumptions, the anatomopathological results, considered accurate, have to be considered for the final diagnosis. This cross-sectional study describes and analyzes the diagnostic concordance between the hematological-clinical and the anatomopathological findings in 370 patients from the greatest medical centers of Paraguay. with 679 cytohystological and anatomopathological studies were systematically analyzed with special especial techniques of the Hematopathology Section of the Health Sciences Research Institute from 1997 to 2002. The concordance, evaluated by the Kappa index, could be divide in three groups: Group 1: good concordance (11% of cases) in chronic myeloproliferative syndromes (KI:0.40-0.60)). Group 2: regular concordance (47%) in chronic lymphoproliferative syndromes (IK=0.22), acute lymphoblastic leukemias (IK:0.20) and myeloid leukemias (IK=0.20). Group 3: low concordance (42%) in bone marrow aplasias (IK=0.14), reactive hyperplasias (IK=0.5) and myelodysplasias (IK=0.4). We demonstrated the necessity of anatomopathological studies complemented with special techniques to achieve an accurate diagnosis and dete4rmine the stage, prognosis and sub-classify hematological pathologies.
Palavras-chave : Enzymatic cytochemistry techniques; bone marrow biopsy; hematopathology.