Herrera Alex F, Crosby-Thompson 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
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer. 2014 Jul 1;120(13):1993-9. doi: 10.1002/cncr.28676. Epub 2014 Apr 4.
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.
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.
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.
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.
T细胞淋巴瘤（TCLs）在美国并不常见。TCL的准确诊断具有挑战性，需要形态学解释、免疫表型分析和分子技术。作者比较了转诊中心的病理诊断与专家血液病理学审查的诊断结果，以确定一致性率，并描述二次病理诊断审查对TCL的实用性。
如果国家综合癌症网络非霍奇金淋巴瘤数据库中的患者有外周TCL（未另行指定，PTCL-NOS）、血管免疫母细胞性TCL（AITL）、间变性淋巴瘤激酶（ALK）阳性和ALK阴性间变性大细胞淋巴瘤（ALCL），且之前在转诊机构检查过组织标本，则符合条件。使用可用的病理和诊断测试报告以及医疗服务提供者的病程记录评估病理一致性。检查不一致的病因及其对治疗的潜在影响。
在131名符合条件的患者中，57名（44%）结果一致，占最终诊断转诊的89名患者的64%。32名患者（24%）结果不一致，占最终诊断转诊患者的36%。PTCL-NOS、AITL、ALK阴性ALCL和ALK阳性ALCL患者的不一致率分别为19%、33%、34%和6%。在14名患者中（占不一致结果的44%），病理重新分类可能导致不同的治疗策略。42名患者（32%）因临时诊断而被转诊进行分类。
在一大群转诊至国家综合癌症网络中心的TCL患者中，转诊机构最终诊断一致的可能性较低。由于当前和未来的治疗针对TCL亚组，这些数据表明疑似TCL的患者将受益于专家血液病理学家的评估。
