Chronic myelogenous leukemia diagnostic study of choice: Difference between revisions

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=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].


OR
* There is no single diagnostic study of choice for the diagnosis of [[chronic myelogenous leukemia]].


The following result of [gold standard test] is confirmatory of [disease name]:
* Chronic myelogenous leukemia is primarily diagnosed based on the clinical presentation, supported by the typical findings in the blood and bone marrow, and then confirmed by the determination of one of the following
* [Result 1]
** the Philadelphia chromosome
* [Result 2]
** the BCR-ABL1 fusion gene
** the BCR-ABL1 fusion mRNA
* Using one of the folowing techniques:


OR
** Conventional cytogenetics
** Fluorescence in situ hybridization (FISH) analysis
** Reverse transcription polymerase chain reaction (RT-PCR)


[Name of the investigation] must be performed when:
===== Diagnostic results =====
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
The following finding(s) on performing PCR is confirmatory for [chronic myelogenous leukemia]].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].  


OR
** the Philadelphia chromosome
 
** the BCR-ABL1 fusion gene
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
** the BCR-ABL1 fusion mRNA
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
The peripheral blood studies must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* The patient presented with signs of anemia, lecopenia and thrombocytopenia as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
Peripheral blood studies may show :


OR
Characteristic complete blood count (CBC) features are as follows:<ref name="pmid8289491">{{cite journal |vauthors=Melo JV, Myint H, Galton DA, Goldman JM |title=P190BCR-ABL chronic myeloid leukaemia: the missing link with chronic myelomonocytic leukaemia? |journal=Leukemia |volume=8 |issue=1 |pages=208–11 |date=January 1994 |pmid=8289491 |doi= |url=}}</ref>
* Absolute leukocytosis (median of 100,000/µL) with a left shift and classic “myelocyte bulge” (more myelocytes than the more mature metamyelocytes seen on the blood smear)
* blasts usually number <2%;
* Absolute basophilia, in 90% of cases
* Monocytosis is often seen, but generally not an increased monocyte percentage
* Absolute monocytosis is more prominent in the unusual cases with a p190 BCR-ABL
* Platelet count is usually normal or elevated;
* Thrombocytopenia suggests an alternative diagnosis or the presence of advanced stage, rather than chronic phase, disease.


The various investigations must be performed in the following order:
The various investigations must be performed in the following order:
* [Initial investigation]
* Peripheral blood studies
* [2nd investigation]
* Bone marrow biopsy


=== Name of Diagnostic Criteria ===
=== Name of Diagnostic Criteria ===

Revision as of 17:56, 26 October 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2]

Overview

Diagnostic Study of Choice

Study of choice

  • Chronic myelogenous leukemia is primarily diagnosed based on the clinical presentation, supported by the typical findings in the blood and bone marrow, and then confirmed by the determination of one of the following
    • the Philadelphia chromosome
    • the BCR-ABL1 fusion gene
    • the BCR-ABL1 fusion mRNA
  • Using one of the folowing techniques:
    • Conventional cytogenetics
    • Fluorescence in situ hybridization (FISH) analysis
    • Reverse transcription polymerase chain reaction (RT-PCR)
Diagnostic results

The following finding(s) on performing PCR is confirmatory for [chronic myelogenous leukemia]].

    • the Philadelphia chromosome
    • the BCR-ABL1 fusion gene
    • the BCR-ABL1 fusion mRNA
Sequence of Diagnostic Studies

The peripheral blood studies must be performed when:

  • The patient presented with signs of anemia, lecopenia and thrombocytopenia as the first step of diagnosis.

Peripheral blood studies may show :

Characteristic complete blood count (CBC) features are as follows:[1]

  • Absolute leukocytosis (median of 100,000/µL) with a left shift and classic “myelocyte bulge” (more myelocytes than the more mature metamyelocytes seen on the blood smear)
  • blasts usually number <2%;
  • Absolute basophilia, in 90% of cases
  • Monocytosis is often seen, but generally not an increased monocyte percentage
  • Absolute monocytosis is more prominent in the unusual cases with a p190 BCR-ABL
  • Platelet count is usually normal or elevated;
  • Thrombocytopenia suggests an alternative diagnosis or the presence of advanced stage, rather than chronic phase, disease.

The various investigations must be performed in the following order:

  • Peripheral blood studies
  • Bone marrow biopsy

Name of Diagnostic Criteria

It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:

  • Criteria 1
  • Criteria 2
  • Criteria 3

OR

IF there are clear, established diagnostic criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

IF there are no established diagnostic criteria

There are no established criteria for the diagnosis of [disease name].

References

  1. ↑ Melo JV, Myint H, Galton DA, Goldman JM (January 1994). "P190BCR-ABL chronic myeloid leukaemia: the missing link with chronic myelomonocytic leukaemia?". Leukemia. 8 (1): 208–11. PMID 8289491.

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