Hematopathologic discrepancies between referral and review diagnoses: a gap between general pathologists and hematopathologists

Abstract

The World Health Organization (WHO) lymphoma classification has been widely adopted by hematopathologists. However, its practical application by general pathologists is largely unknown. Using a hematopathology consultation program in Taiwan, we reviewed 406 cases. Diagnostic discrepancies were scored based upon whether the divergence would alter disease management according to National Comprehensive Cancer Network guidelines. Major discrepancies accounted for 55% (222/406), minor discrepancies for 5% (20/406) and agreement for 40% (164/406) cases. The more common groups in major discrepancies were non-diagnostic/ambiguous referral reports (116/222, 52%), tumor type revisions (52/222, 23%) and changes from malignant to benign lesions (32/222, 14%). In a total of 259 cases of lymphoma, the concordance rates were 41% (77/187) and 33% (24/72) for B-cell and T/natural killer (NK)-cell lymphomas, respectively. It appears that the WHO approach has made lymphoma classification rather poorly reproducible at least in countries where extensive use of an ancillary technique is not employed by general pathologists.

Discrepancies in Lymphoma Diagnosis Over the Years: A 13-Year Experience in a Tertiary Center

“…Some of the most important reasons for this are probably the recent initiation of widespread use of immunohistochemistry (IHC), deficiencies in selection of the right IHC staining panels, evaluation and implementation in primary centers, and the lack of an official training system for hematopathology in Turkey. The study that is most similar to ours in terms of selection of cases, by Matasar et al in 2006, reported a major revision rate of 18.6% [6], and Chang et al reported a rate of 55% [9]. In our study, we found revision rates that could change clinical management (groups A and C) as 44.2% in the first period and 31.5% in the second.…”

“…However, lymphomas still remain a diagnostic challenge among general pathologists. The literature on this topic reveals that widely varying agreement values have been reported recently [6,7,8,9,10]. These studies encompassed short periods and/or assessed relatively small numbers of cases.…”

Non‐Hodgkin lymphoma in Southern Africa: review of 487 cases from The International Non‐Hodgkin Lymphoma Classification Project

“…Lymphoma pathology in Africa faces multiple challenges, the most prominent being the lack of infrastructure and resources to perform the necessary studies to characterize lymphomas, as well as shortage of qualified personnel (Cainelli et al , ; Wiggill et al , ). Studies from other developing countries indicate that a lack of appropriate subspecialty training and technology are the main obstacles to correct diagnosis in the complicated and expanding field of lymphoma pathology (Laurini et al , ; Chang et al , ). Moreover, SAF had a relatively high frequency of unclassifiable HG B‐NHL due to poor quality of the tissue, which precluded a more precise diagnosis.…”

Non-Hodgkin lymphoma in the developing world: review of 4539 cases from the International Non-Hodgkin Lymphoma Classification Project

“…In resource-poor countries, pathologists often lack training and experience in hematopathology, as well as the technology to perform the necessary ancillary studies. 14,15 Moreover, the developing regions had a higher number of unclassifiable cases, which mainly reflects problems associated with specimen handling and tissue processing that result in poor-quality slides. 12 Our findings suggest that training in hematopathology, as well as technical improvements, are needed in the developing world to decrease the number of misdiagnosed cases.…”