Accuracy of Pathologic Diagnosis in Patients With Lymphoma and Survival: A Prospective Analysis From Botswana

Abstract

PURPOSE With intense HIV epidemics, southern African countries have a high burden of classic Hodgkin lymphoma (CHL) and non-Hodgkin lymphoma (NHL). However, suboptimal access to pathology resources limits subtype classification. We sought to assess the diagnostic accuracy of specimens classified as lymphoma and to determine association between discordant pathologic diagnosis and overall survival. METHODS Seventy patients with CHL or NHL and treated at three Botswana hospitals from 2010 to 2016 were analyzed. Local pathologic assessment relied primarily on morphology. All cases underwent secondary US hematopathology review, which is considered gold standard. RESULTS The median follow-up was 58 months. The overall reclassification rate was 20 of 70 cases (29%). All 20 CHL cases were correctly classified in Botswana, and mixed cellularity was the most common subtype, diagnosed in 11 (55%) cases. Of 47 confirmed NHL cases, diffuse large B-cell lymphoma was the final US diagnosis in 28 cases (60%), another aggressive B-cell NHL in nine (19%), an indolent B-cell NHL in six (13%), and T-cell NHL in four (9%). Common types of diagnostic discordance included NHL subtype reclassification (11 of 20, 55%) and CHL reclassified as NHL (7 of 20, 35%). Concordant versus discordant diagnosis after secondary review was associated with improved 5-year overall survival (60.1% v 26.3%, P = .0066). Discordant diagnosis was independently associated with increased risk of death (adjusted hazard ratio 2.733; 95% CI, 1.102 to 6.775; P = .0300) even after stratifying results by CHL versus NHL. CONCLUSION In this single prospective cohort, discordant pathologic diagnosis was associated with a nearly three-fold increased risk of death. Limited access to relatively basic diagnostic techniques impairs treatment decisions and leads to poor patient outcomes in low-resource countries.

HIV and Hodgkin Lymphoma Survival: A Prospective Study in Botswana

“…We also cannot exclude the possibility that our results could have been confounded by misdiagnoses, as external pathology review of HL and NHL cases in Botswana suggest. 26,27 In conclusion, in this cohort receiving longstanding ART, patients with HL living with HIV experienced comparable survival to their HIV-uninfected counterparts. Molecular genetic studies comparing HL cases are indicated to explore whether differences in HIV HL may confer a clinical benefit.…”

“…We also cannot exclude the possibility that our results could have been confounded by misdiagnoses, as external pathology review of HL and NHL cases in Botswana suggest. 26,27…”

Pediatric discordant lymphoma with classic Hodgkin lymphoma in cervical lymph nodes and high-grade B-cell non-Hodgkin lymphoma in bone marrow: a case report from Pakistan

“…We believe detailed diagnostic and therapeutic guidelines for pediatric DL cases would reduce the time to establish a diagnosis and, therefore, reduce the time taken to administer effective treatment for the patient. Establishing standardised treatment guidelines for pediatric lymphoma patients is especially important since according to recent literature, a discordant diagnosis was found to be associated with an approximate three-fold increased risk of death [ 12 ].…”