The Scotland and Newcastle epidemiological study of Hodgkin's disease: impact of histopathological review and EBV status on incidence estimates

Abstract

Aims: The epidemiological and pathological features of Hodgkin lymphoma (HL) are complex. The Epstein-Barr virus (EBV) is consistently associated with a proportion of cases, and these cases are thought to represent a distinct aetiological subgroup of HL. The aim of the present analysis was to determine the age and sex specific incidence of EBV associated and non-associated HL, analysed separately, using data derived from a population based study-the Scotland and Newcastle epidemiological study of Hodgkin's disease (SNEHD). This study also provided a unique opportunity to evaluate accuracy in the current diagnosis and classification of HL. Methods: SNEHD analysed consecutive cases of HL diagnosed in the study area between 1993 and 1997. Diagnostic biopsy material was retrieved, EBV status of tumours was determined, and histological review was performed. Results: In total, 622 cases were eligible for the study, and EBV studies and histopathological review were performed on biopsy material from 537 and 549 cases, respectively. Accuracy in the overall diagnosis of HL and classification of nodular sclerosis HL was good, but diagnosis of HL in the elderly and classification of other subtypes was less reliable. One third of classic HL cases were EBV associated, and age specific incidence curves for EBV associated and non-associated cases were distinct. Conclusions: Comparison of age specific incidence curves for EBV associated and non-associated HL supports the hypothesis that these are two distinct aetiological entities. Accuracy in the diagnosis of HL is generally good, but certain subgroups of cases continue to present diagnostic difficulties.H odgkin lymphoma (HL) is a heterogeneous condition that most probably comprises more than one aetiological entity.1 Recent data suggest that the Epstein-Barr virus (EBV) is associated with approximately one third of cases in developed countries, and this association is believed to be causal. [2][3][4] Data describing the association between EBV and HL have mostly been derived from studies examining archival samples and reporting the proportion of positive samples within subgroups of cases.3-5 It is clear from these studies that EBV is more often associated with mixed cellularity HL (MCHL) than nodular sclerosis HL (NSHL), and that HL in children and older adults is more likely to be EBV associated than is HL in young adults. [5][6][7][8] The only population based studies that have classified cases according to EBV status have been small or restricted by age or sex. 9-12The epidemiology of HL is complex, and further understanding of the aetiology of this heterogeneous condition will only be gained by performing epidemiological studies with separate analyses of EBV associated and non-associated cases, because these are thought to represent two distinct aetiological entities. Therefore, we set up the Scotland and Newcastle epidemiological study of Hodgkin's disease (SNEHD), a population based, case-control study of adult HL (then referred to as Hodgkin's disease). Our main aim wa...

Clinicopathological Profile of Hodgkin Lymphoma in Tertiary Care Hospital

“…This is in concurrence with the study by Sudipta Chakrabarti et al [4], Jarrett et al [5] and Bidyut Krishna et al [6]. This study is discordance with the study conducted by Neelam Siddiqui et al [7], which showed unimodal distribution.…”

Epstein–Barr virus and Hodgkin’s lymphoma in Cairo, Egypt

“…-Europe [8,13,[31][32][33][34][35][36][37][38][39][40][41]; between 27% of cases in Sweden [41] and 56% of cases in Italy [13] were positive, with a higher rate in two reports: 79% in Switzerland [31] and 91% in Greece [8] -USA [12,[42][43][44]: between 25% and 65% of cases were positive -Australia [8]: a high frequency of positive cases (69%).…”

Senile Epstein-Barr Virus-Associated B-Cell Lymphoproliferative Disorders: a Mini Review

“…These patients also exhibited a reduced survival in comparison to EBV-negative patients 8 . Recently, Ganhdi et al 3 and Jarrett et al [9][10][11] indicated that the decline in EBV-specific cellular immunity that occurs with age may contribute to the development of EBV-positive CHL in older patients. These conclusions also reinforce the recognition of senile EBV + B cell LPDs as a continuous spectrum of EBV + CHL.…”