Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group

Abstract

SummaryAccurate clinical staging is crucial for adequate risk-adapted treatment in Hodgkin lymphoma (HL) to prevent patients from under-or over-treatment. Within the latest German Hodgkin Study Group trial generation, diagnostic findings such as histopathology, computerized tomography imaging and clinical risk factors were re-evaluated by expert panels. Here, we retrospectively analysed 5965 patients and identified 399 in who major discordant findings changed their first-line treatment allocation. Histopathology review did not confirm the initial diagnosis of HL in 87 patients. Treatment allocation was revised in 312 of the remaining 5878 patients: 176 were assigned to a higher and 128 to a lower risk group, respectively; the correct treatment group remained unclear in 8 patients. Cases of revised treatment allocation accounted for 9Á8%, 6Á0%, 0Á8%, and 14Á8% of patients initially assigned to the HD13, HD14, HD15 trials and stage IA lymphocyte-predominant HL project, respectively. Most revisions were due to wrong application of clinical stage (20Á5% of 312 patients with revised treatment group), histological subtype (9Á0%) or the risk factors ≥3 involved areas (46Á8%) or large mediastinal mass (9Á3%). In conclusion, centralized review by experienced experts changed risk-adapted first-line treatment in a relevant proportion of HL patients. Quality control measures clearly improve the accuracy of treatment and should be implemented in clinical practice.

Ultrasound‐guided core needle biopsies for workup of lymphadenopathy and lymphoma

“…Publications from single institutions show a conclusive result for the diagnosis of lymphoma by CNB specimens in 82–97% of the cases . The rate of misdetection of NHL leading to a change in treatment (3.2% of NHL diagnoses) was comparable to groups where the biopsy method was not assessed (2.1% for NHL and 2.2% for HL) . Yet the rate of undetected HL was unacceptably high, which emphasizes that for negative CNB results, excessive precaution, close follow‐up, and secondary biopsies are recommended.…”

Balancing risk and benefit in early-stage classical Hodgkin lymphoma

“…Exact initial staging and risk stratification are indispensable for a correct risk group allocation and treatment decision in HL. 7 The application of [ 18 F]fluorodeoxyglucose ([ 18 F]FDG)-PET in addition to a contrast-enhanced computed tomography (CT) scan revealed a higher disease stage in up to 25% of patients in retrospective analyses. 8,9 The higher sensitivity and specificity of PET/CT also allows omission of initial bone marrow biopsy in patients with inconspicuous bone marrow [ 18 F]FDG uptake.…”

Second Opinion Expert Pathology in Endometrial Cancer: Potential Clinical Implications

“…review has also been recommended for clinical trials of ovarian cancer. 14,19,20 The impact of potential diagnostic errors on endometrial cancer treatment has not been firmly established. The pathology report of endometrial carcinoma contains important information, which is fundamental for the assessment of patients' risk and treatment decisions.…”