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Comparison of referring and final pathology for patients with T‐cell lymphoma in the National Comprehensive Cancer Network
Author(s) -
Herrera Alex F.,
CrosbyThompson Allison,
Friedberg Jonathan W.,
Abel Gregory A.,
Czuczman Myron S.,
Gordon Leo I.,
Kaminski Mark S.,
Millenson Michael M.,
Nademanee Auayporn P.,
Niland Joyce C.,
Rodig Scott J.,
Rodriguez Maria A.,
Zelenetz Andrew D.,
LaCasce Ann S.
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28676
Subject(s) - medicine , anaplastic large cell lymphoma , concordance , hematopathology , anaplastic lymphoma kinase , lymphoma , medical diagnosis , not otherwise specified , cancer , immunophenotyping , pathology , biopsy , cohort , oncology , immunology , lung cancer , cytogenetics , biochemistry , chemistry , flow cytometry , malignant pleural effusion , chromosome , gene
BACKGROUND T‐cell lymphomas (TCLs) are uncommon in the United States. The accurate diagnosis of TCL is challenging and requires morphologic interpretation, immunophenotyping, and molecular techniques. The authors compared pathologic diagnoses at referring centers with diagnoses from expert hematopathology review to determine concordance rates and to characterize the usefulness of second‐opinion pathology review for TCL. METHODS Patients in the National Comprehensive Cancer Network non‐Hodgkin lymphoma database with peripheral TCL, not otherwise specified (PTCL‐NOS), angioimmunoblastic TCL (AITL), and anaplastic lymphoma kinase (ALK)‐positive and ALK‐negative anaplastic large cell lymphoma (ALCL) were eligible if they had prior tissue specimens examined at a referring institution. Pathologic concordance was evaluated using available pathology and diagnostic testing reports and provider progress notes. The etiology of discordance and the potential impact on treatment were examined. RESULTS Among 131 eligible patients, 57 (44%) had concordant results, totaling 64% of the 89 patients who were referred with a final diagnosis. Thirty‐two patients (24%) had discordant results, representing 36% of those who were referred with a final diagnosis. The rates of discordance among patients with of PTCL‐NOS, AITL, ALK‐negative ALCL, and ALK‐positive ALCL were 19%, 33%, 34%, and 6%, respectively. In 14 patients (44% of discordant results), pathologic reclassification could have resulted in a different therapeutic strategy. Forty‐two patients (32%) were referred for classification with a provisional diagnosis. CONCLUSIONS In a large cohort of patients with TCL who were referred to National Comprehensive Cancer Network centers, the likelihood of a concordant final diagnosis at a referring institution was low. As current and future therapies target TCL subsets, these data suggest that patients with suspected TCLs would benefit from evaluation by an expert hematopathologist. Cancer 2014;120:1993–1999 . © 2014 American Cancer Society .