Camille Laurent, Nadia Amara, Georges Delsol, and Pierre Brousset, Institut Universitaire du Cancer-Oncopole de Toulouse; Centre Hospitalier Universitaire (CHU) Toulouse; Camille Laurent, Georges Delsol, and Pierre Brousset, Institut National de la Santé et de la Recherche Médicale (INSERM), U.1037, Centre de Recherche en Cancerologie de Toulouse-Purpan, Laboratoire d'Excellence Toulouse Cancer; Thomas Filleron, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse, Toulouse; Marine Baron, Corinne Haioun, Christiane Copie-Bergman, and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Henri Mondor-Albert Chenevier; Corinne Haioun, Christiane Copie-Bergman, and Philippe Gaulard, INSERM U955, Université Paris-Est, Créteil; Mylène Dandoit, Marc Maynadié, and Laurent Martin, CHU de Dijon, Dijon; Marie Parrens, Beatrice Vergier, and Antoine de Mascarel, Hôpital du Haut Lévêque, CHU de Bordeaux, Bordeaux; Bettina Fabiani, AP-HP, Hôpital Saint-Antoine; Nicole Brousse and Thierry Jo Molina, AP-HP, Hôpital Necker; Josette Brière, AP-HP, Hôpital Saint Louis; Fréderic Charlotte, AP-HP, Hôpital Pitié Salpétrière; Diane Damotte, AP-HP, Hôpitaux Universitaires Paris Centre, Paris; Alexandra Traverse-Glehen and Françoise Berger, CHU Lyon-Sud; Catherine Chassagne-Clement, Centre Léon Bérard, Lyon; Marie-Christine Copin, Univ Lille, CHU Lille, Lille; Patrick Tas, CHU de Rennes, Rennes; Marie-Christine Rousselet, CHU d'Angers, Angers; Thérèse Rousset, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier; Luc Xerri, Aix-Marseille Univ, Institut Paoli-Calmettes, Marseille; Anne Moreau and Céline Bossard, Hôpital Hôtel Dieu, CHU de Nantes, Nantes; Antoine Martin, Hôpital Avicenne, Bobigny, Bobigny; Peggy Dartigues, Institut Gustave Roussy, Villejuif; Isabelle Soubeyran, Institut Bergonié, Bordeaux; Michel Peoch, CHU de Saint Etienne, Saint Etienne; Pierre Dechelotte, CHU de Clermont-Ferrand, Clermont-Ferrand; Jean-François Michiels, CHU de Nice, Nice; Flavie Arbion, CHU de Tours, Tours; Isabelle Quintin-Roué, CHU de Brest, Brest; Jean-Michel Picquenot, Centre Henri Becquerel, CHU de Rouen, Rouen; Martine Patey, CHU de Reims, Reims; Blandine Fabre, CHU de Grenoble, Grenoble; Henri Sevestre, CHU d'Amiens, Amiens; Cécile Le Naoures, CHU de Caen, Caen; Marie-Pierre Chenard-Neu, CHU de Strasbourg, Strasbourg; Claire Bastien, CHU de Nancy, Nancy; Sylvie Thiebault, CH de Mulhouse, Mulhouse; Manuela Delage, CHU de Limoges, Limoges; Gilles Salles, Hospices Civils de Lyon, CHU Lyon-Sud; Gilles Salles, INSERM1052, Centre National de la Recherche Scientifique 5286, Université Claude Bernard, Pierre Bénite, France; Tony Petrella, Pathology University of Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Canada.
J Clin Oncol. 2017 Jun 20;35(18):2008-2017. doi: 10.1200/JCO.2016.71.2083. Epub 2017 May 1.
Purpose To prospectively assess the clinical impact of expert review of lymphoma diagnosis in France. Materials and Methods From January 2010 to December 2013, 42,145 samples from patients with newly diagnosed or suspected lymphomas were reviewed, according to the 2008 WHO classification, in real time by experts through the Lymphopath Network. Changes in diagnosis between referral and expert review were classified as major or minor according to their potential impact on patient care. Results The 42,145 reviewed samples comprised 36,920 newly diagnosed mature lymphomas, 321 precursor lymphoid neoplasms, 314 myeloid disorders, and 200 nonhematopoietic neoplasms, with 4,390 benign lesions. There were 4,352 cutaneous and 32,568 noncutaneous lymphomas. The most common mature noncutaneous lymphomas were diffuse large B-cell lymphomas (32.4%), follicular lymphomas (15.3%), classic Hodgkin lymphomas (13%), peripheral T-cell lymphomas (6.3%) of which angioimmunoblastic T-cell lymphomas (2.3%) were the most frequent, and mucosa-associated lymphoid tissue lymphomas (5.8%). A diagnostic change between referral and expert review occurred in 19.7% of patients, with an estimated impact on patient care for 17.4% of patients. This rate was significantly higher for patients sent with a provisional diagnosis seeking expert second opinion (37.8%) than for patients sent with a formal diagnosis (3.7%). The most frequent discrepancies were misclassifications in lymphoma subtype (41.3%), with 12.3% being misclassifications among small B-cell lymphoma entities. Fewer than 2% of changes were between benign and malignant lymphoid conditions. Minor changes (2.3%) mostly consisted of follicular lymphoma misgrading and diffuse large B-cell lymphoma subtype misclassification. Conclusion To our knowledge, this study provides the largest ever description of the distribution of lymphoma entities in a western country and highlights how expert review significantly contributes to a precise lymphoma diagnosis and optimal clinical management in a proportion of patients.
目的 前瞻性评估法国专家对淋巴瘤诊断的临床影响。
材料与方法 2010 年 1 月至 2013 年 12 月，根据 2008 年 WHO 分类，通过淋巴病理学网络实时对 42145 例新诊断或疑似淋巴瘤患者的样本进行专家审查。根据其对患者治疗的潜在影响，将转诊和专家审查之间的诊断变化分为主要变化或次要变化。
结果 42145 例审查样本包括 36920 例新诊断的成熟淋巴瘤、321 例前体淋巴肿瘤、314 例髓系疾病和 200 例非造血系统肿瘤，其中良性病变 4390 例。有 4352 例皮肤和 32568 例非皮肤淋巴瘤。最常见的非皮肤成熟淋巴瘤为弥漫性大 B 细胞淋巴瘤（32.4%）、滤泡性淋巴瘤（15.3%）、经典霍奇金淋巴瘤（13%）、外周 T 细胞淋巴瘤（6.3%），其中血管免疫母细胞 T 细胞淋巴瘤（2.3%）最常见，黏膜相关淋巴组织淋巴瘤（5.8%）。转诊和专家审查之间发生诊断变化的患者占 19.7%，估计对 17.4%的患者治疗有影响。与正式诊断相比，寻求专家二次意见的患者（37.8%）的诊断差异发生率明显更高。最常见的差异是淋巴瘤亚型分类错误（41.3%），其中小 B 细胞淋巴瘤实体分类错误占 12.3%。良性和恶性淋巴组织疾病之间的变化少于 2%。次要变化（2.3%）主要包括滤泡性淋巴瘤降级和弥漫性大 B 细胞淋巴瘤亚型分类错误。
结论 据我们所知，这项研究提供了西方国家淋巴瘤实体分布的最大描述，并强调了专家审查如何显著有助于在一部分患者中实现更精确的淋巴瘤诊断和最佳临床管理。
