Yorkshire regional lymphoma histopathology panel: Analysis of five years' experience

Abstract

Five years' experience of operating a Regional Lymphoma Histopathology Panel is described. During this period, approximately 1400 cases were registered of which nearly 1200 were confirmed as malignant lymphoma. Complete concordance of diagnosis was achieved between submitting pathologists and the Panel in two-thirds of cases of Hodgkin's disease and just over half of non-Hodgkin's lymphoma. Most discrepancies in diagnosis were found to be of clinical importance in terms of prognosis and/or therapeutic management of patients. In approximately two-thirds of such instances disagreement arose because of wrong assignment of tumour grade within the main lymphoma class but in one-third of cases the main class of lymphoma was wrongly designated. Panel members experienced similar diagnostic problems as submitting pathologists although to a lesser extent. The existence of the panel has not reduced the proportion of cases causing diagnostic difficulty for submitting pathologists or panel members during the 5 year study period. The principal cause of death was ascertained from death certificates and autopsy findings in nearly half the cases dying during the study period. In approximately half of these infection (largely pulmonary) played a major role while most of the remainder died of various cardiovascular, pulmonary or renal disorders. There was no specific pattern relating to the main lymphoma class. It is concluded that whilst the panel fulfils a useful function in resolving diagnostic difficulties and standardizing lymphoma diagnosis its role is restricted somewhat by the limitations imposed by conventional morphological assessments.

Treatment and survival of lymphoid malignancy in the north-west of England: a population-based study

“…(Bird et al, 1984). The results of these studies are similar to our findings of 47% reclassification and 25% major revision.…”

The clinical impact of expert pathological review on lymphoma management: a regional experience

“…A number of published regional lymphoma review series have identified discrepancy rates of between 24% and 48% (Bird et al, 1984;Dick et al, 1987;Youngson et al, 1995). More recently, a comparative review of lymphomas submitted to a San Francisco community hospital identified a 11% discrepancy rate (Siebert et al, 2001).…”

“…A total of 53 consultant pathologists in 16 district general hospitals serving a population of 2AE9 million people participate in the review scheme. The review provides a primary diagnostic service where the diagnosis is unknown and a central pathological review of lymphomas where the primary diagnosis was made at the district general hospital by the general histopathologist.For the purposes of diagnostic standardization, the AWLP initially adopted the Revised European-American classification of Lymphoid neoplasms (REAL, Harris et al, 1994) and subsequently the World Health Organization (WHO) classification (Jaffe et al, 2001).When lymphoma pathology is reviewed by specialist haematopathologists, discrepancy rates of 24-48% between submitted and review diagnoses have been described (Bird et al, 1984;Dick et al, 1987;Youngson et al, 1995). A previous study by the AWLP identified a discrepancy rate of 20% in the 412 pathological specimens submitted for specialist review between January 1998 and January 2000 (Dojcinov & Attanoos, 2001).…”

“…When lymphoma pathology is reviewed by specialist haematopathologists, discrepancy rates of 24-48% between submitted and review diagnoses have been described (Bird et al, 1984;Dick et al, 1987;Youngson et al, 1995). A previous study by the AWLP identified a discrepancy rate of 20% in the 412 pathological specimens submitted for specialist review between January 1998 and January 2000 (Dojcinov & Attanoos, 2001).…”

DNA content and prognosis of non-Hodgkin's lymphoma

“…The classification of non-Hodgkin's lymphomas (NHL) using conventional morphology has resulted in poor reproducibility reflecting the inherently subjective nature of morphological assessments (Bird, et al, 1984). This has lead to a search for more objective methods for classifying NHL and predicting their behaviour.…”