Пятилетний опыт работы референс-центра ФГБУ «НМИЦ гематологии» Минздрава России по дифференциальной диагностике опухолей гемопоэтической и лимфоидной тканей

In the framework of the federal project “Cancer Management” in accordance with the Decree of the Ministry of Health of the Russian Federation in 2020, at the pathology department of the National Research Center for Hematology, a reference center was established for immunohistochemical (IHC) and pathomorphological studies in adult patients with hematopathology. The present paper analyzes the activities of this reference center in the period from 2020 to 2024. Within that time, it conducted 24,101 studies using histological, histochemical, and IHC methods of analyzing biopsy/surgical specimens with antemortem pathology protocols and pathomorphological reports. The next step was to provide an expert comparison between the referral pathomorphological diagnosis received from different healthcare institutions and the pathomorphological diagnosis determined at the reference center. In addition to that, the analysis was focused on 825 histoscans received by the National Research Center for Hematology upon requests from the Federal Telemedicine Service (TMS). In the period of 2020–2024, there appeared to be a considerable increase in the number of senders of biopsy/surgical specimens (from 51 to 80) in the Russian Federation and in-life protocols (from 1939 to 3877, the maximum of 9413 was in 2021). The comparison of the referral diagnosis with the diagnosis based on the studies at the reference center yielded an average difference of 30 %. A total of 14,434 lymphoid tumors were diagnosed including 63 % of B-cell, 12 % of T-cell, and 19 % of Hodgkin lymphomas, among which the nodular variant accounted for 10 %. In 6 % of cases, for this or that reason,the nosology verification did not seem possible. In 75 % of primary skin lymphomas, mycosis fungoides was identified with half of cases (48–52 %) diagnosed as non-neoplastic dermatosis/dermatitis on the basis of skin biopsy analysis with lymphoma suspicion. The comparison of the referral diagnosis based on histoscans by TMS request with the diagnosis of the reference center revealed only modest similarity of 27–45 %. Therefore, the reference center model of the Ministry of Health of the Russian Federation specializing in different fields of oncopathology, and hematopathology in particular, proved its effectiveness and urgency throughout 2020–2024. Accordingly, there is a crucial need for support and development of reference centers for pathomorphological and IHC methods of studies, while legal and finance issues accumulated over 5 years still remain to be resolved.