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J Clin Oncol. 2017 Jun 20;35(18):2008-2017. doi: 10.1200/JCO.2016.71.2083. Epub 2017 May 1.

Impact of Expert Pathologic Review of Lymphoma Diagnosis: Study of Patients From the French Lymphopath Network.

Author information

1
Camille Laurent, Nadia Amara, Georges Delsol, and Pierre Brousset, Institut Universitaire du Cancer-Oncopole de Toulouse; Centre Hospitalier Universitaire (CHU) Toulouse; Camille Laurent, Georges Delsol, and Pierre Brousset, Institut National de la Santé et de la Recherche Médicale (INSERM), U.1037, Centre de Recherche en Cancerologie de Toulouse-Purpan, Laboratoire d'Excellence Toulouse Cancer; Thomas Filleron, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse, Toulouse; Marine Baron, Corinne Haioun, Christiane Copie-Bergman, and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Henri Mondor-Albert Chenevier; Corinne Haioun, Christiane Copie-Bergman, and Philippe Gaulard, INSERM U955, Université Paris-Est, Créteil; Mylène Dandoit, Marc Maynadié, and Laurent Martin, CHU de Dijon, Dijon; Marie Parrens, Beatrice Vergier, and Antoine de Mascarel, Hôpital du Haut Lévêque, CHU de Bordeaux, Bordeaux; Bettina Fabiani, AP-HP, Hôpital Saint-Antoine; Nicole Brousse and Thierry Jo Molina, AP-HP, Hôpital Necker; Josette Brière, AP-HP, Hôpital Saint Louis; Fréderic Charlotte, AP-HP, Hôpital Pitié Salpétrière; Diane Damotte, AP-HP, Hôpitaux Universitaires Paris Centre, Paris; Alexandra Traverse-Glehen and Françoise Berger, CHU Lyon-Sud; Catherine Chassagne-Clement, Centre Léon Bérard, Lyon; Marie-Christine Copin, Univ Lille, CHU Lille, Lille; Patrick Tas, CHU de Rennes, Rennes; Marie-Christine Rousselet, CHU d'Angers, Angers; Thérèse Rousset, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier; Luc Xerri, Aix-Marseille Univ, Institut Paoli-Calmettes, Marseille; Anne Moreau and Céline Bossard, Hôpital Hôtel Dieu, CHU de Nantes, Nantes; Antoine Martin, Hôpital Avicenne, Bobigny, Bobigny; Peggy Dartigues, Institut Gustave Roussy, Villejuif; Isabelle Soubeyran, Institut Bergonié, Bordeaux; Michel Peoch, CHU de Saint Etienne, Saint Etienne; Pierre Dechelotte, CHU de Clermont-Ferrand, Clermont-Ferrand; Jean-François Michiels, CHU de Nice, Nice; Flavie Arbion, CHU de Tours, Tours; Isabelle Quintin-Roué, CHU de Brest, Brest; Jean-Michel Picquenot, Centre Henri Becquerel, CHU de Rouen, Rouen; Martine Patey, CHU de Reims, Reims; Blandine Fabre, CHU de Grenoble, Grenoble; Henri Sevestre, CHU d'Amiens, Amiens; Cécile Le Naoures, CHU de Caen, Caen; Marie-Pierre Chenard-Neu, CHU de Strasbourg, Strasbourg; Claire Bastien, CHU de Nancy, Nancy; Sylvie Thiebault, CH de Mulhouse, Mulhouse; Manuela Delage, CHU de Limoges, Limoges; Gilles Salles, Hospices Civils de Lyon, CHU Lyon-Sud; Gilles Salles, INSERM1052, Centre National de la Recherche Scientifique 5286, Université Claude Bernard, Pierre Bénite, France; Tony Petrella, Pathology University of Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Canada.

Abstract

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.

PMID:
28459613
DOI:
10.1200/JCO.2016.71.2083
[Indexed for MEDLINE]

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