Impact of Expert Pathologic Review on Lymphoma Diagnoses

Key Points

  • Expert review of lymphoma diagnoses in French patients resulted in a change in diagnosis in 19.7% of patients.
  • For 17.4% of patients, the change had an impact on patient care.

As reported in the Journal of Clinical Oncology by Laurent et al, expert review of lymphoma diagnoses in French patients resulted in a change in diagnosis in 19.4% of cases of noncutaneous disease.

Study Details

In the study, 42,145 samples from patients with newly diagnosed or suspected lymphomas were reviewed according to 2008 World Health Organization classification by experts in the French Lymphopath Network between January 2010 and December 2013. The network provides a diagnosis within a mean of 8 days of sample receipt. Changes in diagnosis between referral and expert review were defined as major or minor based on the potential impact on patient care.

Spectrum of Diagnoses

On expert review, the samples consisted of 36,920 newly diagnosed mature lymphomas, 321 precursor lymphoid neoplasms, 314 myeloid disorders, and 200 nonhematopoietic neoplasms, with 4,390 benign lesions. Overall, there were 4,352 cutaneous and 32,568 noncutaneous lymphomas, with the most common mature noncutaneous lymphomas being diffuse large B-cell lymphomas (32.4%), follicular lymphomas (15.3%), classic Hodgkin lymphomas (13%), peripheral T-cell lymphomas (6.3%; 2.3% angioimmunoblastic T-cell lymphomas), and mucosa-associated lymphoid tissue lymphomas (5.8%).

Changes in Diagnosis With Expert Review

Expert review resulted in a change in diagnosis in 19.7% of patients, with the change considered to have an impact on patient care in 17.4% of cases. The diagnosis discrepancy rate was markedly higher for patients with a provisional diagnosis for whom an expert second opinion was sought (37.8%) than for patients who had received a formal diagnosis (3.7%). The most common discrepancies involved misclassification of lymphoma subtype (41.3%), including misclassifications among small B-cell lymphomas in 12.3%. Changes between diagnoses of benign vs malignant disease occurred in 1.5% of cases. Minor changes occurred for 2.3% of patients and primarily consisted of those affecting grading of follicular lymphoma and diffuse large B-cell lymphoma subtypes.

The investigators concluded: “To our knowledge, this study provides the largest ever description of the distribution of lymphoma entities in a western country and highlights how expert review significantly contributes to a precise lymphoma diagnosis and optimal clinical management in a proportion of patients.”

The study was supported by grants from the Institut National du Cancer, the Institut Universitaire de France, and the Institut Carnot CALYM.

Camille Laurent, MD, PhD, of L’Institut Universitaire du Cancer de Toulouse-Oncopole, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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