Expert second-opinion pathology review of lymphoma in the era of the World Health Organization classification
Open Access
- 17 March 2011
- journal article
- review article
- Published by Elsevier BV in Annals Of Oncology
- Vol. 23 (1), 159-166
- https://doi.org/10.1093/annonc/mdr029
Abstract
Background: The World Health Organization (WHO) classification of hematologic malignancies, published in 2000, was designed to improve diagnostic accuracy by incorporating the latest in scientific understanding. The impact of the WHO classification on the frequency of diagnostic discrepancy in lymphoma is unknown. Methods: We reviewed all second-opinion pathology of lymphoma at our National Cancer Institute-designated Comprehensive Cancer Center (NCI-CCC) from January to June 2001 and from January to June 2006. Discrepancies between submitted and second-opinion diagnoses were scored based upon an a priori grading schema. Results: Major diagnostic revision was rendered in 65 of 365 cases (17.8%) in 2001 and 58 of 354 (16.4%) in 2006 (P = NS). Including cases reviewed and revised beforehand at another NCI-CCC, rates of major diagnostic revision were 21.4% and 18.6%, respectively (P = NS). Discrepancy rates varied by diagnosis, from Hodgkin lymphoma (10%) to Burkitt's lymphoma (75%). No association was seen for age, gender, race/ethnicity, biopsy type, or nature of referring center. Conclusions: Clinically meaningful diagnostic revision occurs frequently with expert pathology review for a diagnosis of lymphoma. Despite the WHO classification, rates of diagnostic revision at our institution in 2001 and 2006 did not differ significantly. Given the potential harm from misdiagnosis, expert hematopathology review should be considered the standard of care.This publication has 13 references indexed in Scilit:
- Use of the WHO lymphoma classification in a population-based epidemiological studyAnnals Of Oncology, 2004
- The clinical impact of expert pathological review on lymphoma management: a regional experienceBritish Journal of Haematology, 2003
- Clinical Significance of Performing Immunohistochemistry on Cases With a Previous Diagnosis of Cancer Coming to a National Comprehensive Cancer Center for Treatment or Second OpinionThe American Journal of Surgical Pathology, 2002
- Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registryCancer, 2001
- Lymphoma classification – from controversy to consensus: The R.E.A.L. and WHO Classification of lymphoid neoplasmsAnnals Of Oncology, 2000
- The World Health Organization Classification of Hematological Malignancies Report of the Clinical Advisory Committee Meeting, Airlie House, Virginia, November 1997Laboratory Investigation, 2000
- Mandatory second opinion surgical pathology at a large referral hospitalCancer, 1999
- Classification of non-Hodgkin's lymphomas. Reproducibility of major classification systemsCancer, 1985
- National cancer institute sponsored study of classifications of non-hodgkin's lymphomas. Summary and description of a working formulation for clinical usageCancer, 1982
- Prognostic Value of the Kiel Classification of Malignant Non-hodgkin's LymphomasTumori Journal, 1979