The need for specialist review of pathology in paediatric cancer

Abstract

Summary A retrospective histopathological review of 2104 cases of solid tumour was carried out to assess the variability in diagnosis of childhood cancer. Cases were subject to three independent, concurrent opinions from a national panel of specialist pathologists. The conformity between them was analysed using the percentage of agreement and the kappa statistic (ic), a measure of the level of agreement beyond that which could occur by chance alone, and weighted kappa (wic), which demonstrates the degree of variation between opinions. The major groupings of the Birch-Marsden classification were used within which tumours were assigned for kappa analysis according to the clinical significance of the differential diagnoses. The mean agreement for all tumours together was 90%; 1C=0.82, wKi=0.82. Retinoblastoma achieved the highest kappa value (1.0) and lymphoma the lowest (0.66). Of the cases, 16.5% had their original diagnoses amended and the panel confirmed the original diagnosis of paediatric pathologists in 89% of cases compared with 78% for general pathologists. The varying levels of agreement between experts confirm the difficulty of diagnosis in some tumour types, suggesting justification for specialist review in most diagnoses. Specialist training in paediatric pathology is also recommended.

Where should paediatric surgery be performed? Commentary Commentary Commentary

“…There is clear evidence in anaesthesia that anaesthetists doing small numbers of neonatal procedures had significantly worse results 213 16-18The same seems to be true in the fields of oncology,26 27radiology,37 pathology,38 and intensive care 39-4143 …”

“…Better results for diagnosis and treatment of certain high risk or rare childhood disorders can be achieved by concentrating expertise; this has been shown for radiology,37 pathology,38paediatric intensive care,39-42 and neonatal intensive care 43. In many ways the debate these other specialties have regarding centralisation is remarkably similar; Murdoch and Bihari state that “Paediatric intensive care, to function well, must be associated with a full range of on-site paediatric specialties—cardiology, renal, neurology and surgery.”40 The forthcoming Troop report is expected to highlight the benefits of carefully planned paediatric intensive care provision, with centralisation of very high intensity level care.…”

Seasonal differences in the onset of the EBV-positive and -negative forms of paediatric Hodgkin's lymphoma

“…Patient data (age, date of diagnosis, sex, histological subtype, ethnic group and social class (based on father's occupation)) were extracted from medical notes by the West Midlands Regional Children's Tumour Registry (WMRCTR). Histological subtype was classified according to the Rye system (Lukes et al, 1966) and based upon expert histology as reported elsewhere (Parkes et al, 1997). Epstein -Barr virus status was determined by immunohistochemistry for LMP1 expression as previously described (Murray et al, 1992).…”

Incidence of childhood CNS tumours

“…The West Midlands Regional Children's Tumour Research Group (WMRCTRG) is also a specialist childhood cancer registry, holding population-based data from 1957 onwards on all children resident or treated in the West Midlands, one of the largest Health Authorities in England and Wales. Routine histopathological review has been carried out on over 2000 cases of solid tumour (Parkes et al, 1997), including over 80% of the CNS tumours in the Register.…”