血液病理学家在淋巴瘤分类方面的观察者间差异。
Interobserver variation in classifying lymphomas among hematopathologists.
作者信息
Pongpruttipan Tawatchai, Sukpanichnant Sanya, Assanasen Thamathorn, Bhoopat Lertlakana, Kayasut Kanita, Kanoksil Wasana, Wannakrairot Pongsak
机构信息
Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
出版信息
Diagn Pathol. 2014 Aug 22;9:162. doi: 10.1186/s13000-014-0162-3.
BACKGROUND
Lymphomas are common malignancies that have various subtypes with many overlapping histologic, immunophenotypic and genetic features. Therefore, discordance in classifying lymphoma among pathologists may be encountered. But this issue is not well characterized. We conducted the present study to demonstrate discordances among Thai hematopathologists as well as to highlight common arguing points for classifying lymphomas.
METHODS
The 117 lymphoma cases were randomly retrieved and individually reviewed by 7 hematopathologists, members of the "Thai Hematopathologist Group," without knowing the original diagnoses. The consensus diagnoses were given from a discussion by all members. In each case, the diagnosis from each participant was compared with the consensus diagnosis and classified into 4 categories as follow: 1) concordance, 2) minor discordance, 3) major discordance and 4) serious discordance.
RESULTS
There were approximately 11% discordances between original and consensus diagnoses. The average discordances among all pathologists according to minor, major and serious discordances were 10%, 3.5% and 0.3%, respectively. Diffuse large B-cell lymphoma had the least discordance (7%). Small biopsies had been found to increase discordances in some lymphoma subtypes.
CONCLUSIONS
The present study reveals some degrees of interobserver variation in classifying of lymphoma by using the 2008 WHO classification among hematopathologists. Some types of lymphomas on small biopsies were found to have a significant higher discordance rate. This study also described some common diagnostic discordances regarded as potential pitfalls in classifying lymphomas.
VIRTUAL SLIDES
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_162.
背景
淋巴瘤是常见的恶性肿瘤，有多种亚型，在组织学、免疫表型和基因特征方面存在许多重叠。因此，病理学家在淋巴瘤分类上可能存在不一致。但这个问题尚未得到充分描述。我们开展本研究以证明泰国血液病理学家之间的不一致情况，并突出淋巴瘤分类中常见的争议点。
方法
随机抽取117例淋巴瘤病例，由“泰国血液病理学家小组”的7名血液病理学家在不知道原始诊断的情况下进行单独审查。所有成员通过讨论给出共识诊断。在每个病例中，将每位参与者的诊断与共识诊断进行比较，并分为以下4类：1）一致；2）轻微不一致；3）严重不一致；4）极严重不一致。
结果
原始诊断与共识诊断之间约有11%的不一致。根据轻微、严重和极严重不一致情况，所有病理学家之间的平均不一致率分别为10%、3.5%和0.3%。弥漫性大B细胞淋巴瘤的不一致率最低（7%）。已发现小活检标本会增加某些淋巴瘤亚型的不一致率。
结论
本研究揭示了血液病理学家使用2008年世界卫生组织分类法对淋巴瘤进行分类时存在一定程度的观察者间差异。发现小活检标本的某些类型淋巴瘤的不一致率显著更高。本研究还描述了一些常见的诊断不一致情况，这些情况被视为淋巴瘤分类中的潜在陷阱。
虚拟切片
本文的虚拟切片可在此处找到：http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_162 。
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