Nathwani B N, Metter G E, Miller T P, Burke J S, Mann R B, Barcos M, Kjeldsberg C R, Dixon D O, Winberg C D, Whitcomb C C
Blood. 1986 Oct;68(4):837-45.
The members of the Pathology Panel for Lymphoma Clinical Studies undertook a collaborative study with the hope of resolving some of the controversies regarding the criteria and methods for the subclassification of follicular lymphomas (FLs). A group of 105 patients with FL were subclassified by seven hematopathologists according to two methods. In the first method, cases were subclassified according to the Rappaport, Lukes and Collins, and Working Formulation systems. In each of these systems, FLs are subclassified by estimation of the different cell populations, without actual counting of cells. In the second method, precise counts of different cells were made according to the standard and modified Berard methods. With this counting method, diagnoses were independently derived, based on counts provided by the seven pathologists, for large cleaved (LC), small noncleaved (SNC), and large noncleaved (LNC) cells. To ascertain what method and which criteria are most useful in predicting survival, we made clinicopathologic correlations. When the subjective (first method) diagnoses were rendered, and when the consensus diagnoses of the seven pathologists were used, there were no significant differences in survival among patients with the different subtypes. On the other hand, when we used the counting method of Berard (second method) and the cut-off points for the cell counts suggested by him for the subclassification, we were able to divide the patient population into prognostic subgroups. Because the cut-off points proposed by Berard are not derived objectively, we made statistical comparisons of survival curves to determine cut-off points (and thus to establish objective criteria). We found that the patient population could be separated into at least two prognostic groups, for SNC and/or LNC and for SNC + LNC + LC cells. The cut-off points which we derived differed with cell type, however. Until the usefulness of these new cut-off points is established, we recommend that the cut-off points and the counting method of Berard be used for the subclassification of FL. Because the choice of treatment for the different subtypes of FL is totally dependent on the histologic diagnosis, and because of the variability among the diagnoses of pathologists, treatment planning is difficult.
淋巴瘤临床研究病理小组的成员进行了一项合作研究，希望解决一些关于滤泡性淋巴瘤（FL）亚型分类标准和方法的争议。105例FL患者由7名血液病理学家根据两种方法进行亚型分类。第一种方法中，病例根据Rappaport、Lukes和Collins以及工作分类系统进行亚型分类。在这些系统中的每一个中，FL通过估计不同细胞群体进行亚型分类，而不实际计数细胞。第二种方法中，根据标准和改良的Berard方法对不同细胞进行精确计数。采用这种计数方法，根据7名病理学家提供的计数，独立得出大裂细胞（LC）、小无裂细胞（SNC）和大无裂细胞（LNC）的诊断。为了确定哪种方法和哪些标准在预测生存方面最有用，我们进行了临床病理相关性分析。当做出主观（第一种方法）诊断时，以及当使用7名病理学家的共识诊断时，不同亚型患者的生存率没有显著差异。另一方面，当我们使用Berard的计数方法（第二种方法）以及他建议的细胞计数切点进行亚型分类时，我们能够将患者群体分为预后亚组。由于Berard提出的切点不是客观得出的，我们对生存曲线进行了统计比较以确定切点（从而建立客观标准）。我们发现患者群体可以至少分为两个预后组，分别针对SNC和/或LNC以及SNC + LNC + LC细胞。然而，我们得出的切点因细胞类型而异。在确定这些新切点的有用性之前，我们建议使用Berard的切点和计数方法对FL进行亚型分类。由于FL不同亚型的治疗选择完全取决于组织学诊断，并且由于病理学家诊断之间的变异性，治疗计划很困难。
