Impact of Expert Pathologic Review of Lymphoma Diagnosis: Study of Patients From the French Lymphopath Network
Purpose
To prospectively assess the clinical impact of expert review of lymphoma diagnosis in France. Materials and Methods
From January 2010 to December 2013, 42,145 samples from patients with newly diagnosed or suspected lymphomas were reviewed, according to the 2008 WHO classification, in real time by experts through the Lymphopath Network. Changes in diagnosis between referral and expert review were classified as major or minor according to their potential impact on patient care.
Results
The 42,145 reviewed samples comprised 36,920 newly diagnosed mature lymphomas, 321 precursor lymphoid neoplasms, 314 myeloid disorders, and 200 nonhematopoietic neoplasms, with 4,390 benign lesions. There were 4,352 cutaneous and 32,568 noncutaneous lymphomas. The most common mature noncutaneous lymphomas were diffuse large B-cell lymphomas (32.4%), follicular lymphomas (15.3%), classic Hodgkin lymphomas (13%), peripheral T-cell lymphomas (6.3%) of which angioimmunoblastic T-cell lymphomas (2.3%) were the most frequent, and mucosa-associated lymphoid tissue lymphomas (5.8%). A diagnostic change between referral and expert review occurred in 19.7% of patients, with an estimated impact on patient care for 17.4% of patients. This rate was significantly higher for patients sent with a provisional diagnosis seeking expert second opinion (37.8%) than for patients sent with a formal diagnosis (3.7%). The most frequent discrepancies were misclassifications in lymphoma subtype (41.3%), with 12.3% being misclassifications among small B-cell lymphoma entities. Fewer than 2% of changes were between benign and malignant lymphoid conditions. Minor changes (2.3%) mostly consisted of follicular lymphoma misgrading and diffuse large B-cell lymphoma subtype misclassification.
Conclusion
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.
在论坛上，我们总是强调病理会诊的重要性，从最近法国完成的一项临床研究来看，病理会诊的重要性怎么强调都不过分。这项研究一共纳入了四万多例淋巴瘤病人，有史以来规模最大。研究的主要目的原本是统计各种类型淋巴瘤在西方国家的发病率，为了确保结果准确无误，请了一些专家对原先的病理进行了会诊，结果有点出人意料，19.7%的诊断结论发生了改变，也就是说，原先的诊断结论是错误的。其中，如果最初的诊断是临时性的，即指病理报告中用的是不确定的词汇例如“考虑为”，“不除外”，“倾向于”，有37.8%经专家们复核后改变了诊断结论；如果最初的病理报告给出的是正式的结论，则误诊的比例是3.7%。最经常发生的误诊是病理分型错误（41.6%），其中12.3%是小B细胞淋巴瘤分型错误。良恶性判断错误的比例只有2%。总的来说，有17.4%的病人因为病理不准确的原因未能获得最佳的治疗。
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发表于 2017-5-26 09:57:42
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发表于 2017-5-26 10:09:56
