Metter G E, Nathwani B N, Burke J S, Winberg C D, Mann R B, Barcos M, Kjeldsberg C R, Whitcomb C C, Dixon D O, Miller T P
J Clin Oncol. 1985 Jan;3(1):25-38. doi: 10.1200/JCO.1985.3.1.25.
A collaborative study between the Repository Center for Lymphoma Clinical Studies and the members of the lymphoma pathology subcommittee of the major cooperative oncology groups was undertaken in an effort to ascertain the reproducibility and the interobserver agreement for the cytologic diagnosis of follicular lymphomas. A group of 105 patients with follicular lymphomas 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 these systems, follicular lymphomas are subclassified by estimation of the different cell populations without the actual counting of cells. With this method, great variability in diagnosis was noted. For example: (1) The consensus diagnosis was that of poorly differentiated lymphocytic lymphoma (PDL) in 39 cases, but among the individual pathologists the number of cases thus diagnosed ranged from 24 to 65; (2) In 40 cases, the consensus diagnosis was follicular lymphoma, mixed-cell type; however, all seven pathologists independently agreed on this subtype in only one case; (3) A major disagreement was noted in 39 cases (37%), in which both diagnostic extremes (small cleaved and large noncleaved) were expressed. In the second method, only precise counts of different cells were made, according to a modification of the method recommended by Berard. With this counting method, diagnoses were independently derived based on the counts provided by the seven pathologists for large cleaved, small noncleaved, and large noncleaved cells. The variability in the results was wide also with this second method. For example, the average number of large cells found by each pathologist was ascertained, and the ranges were determined. The average range was 28 cells, which was considered high. The same determinations were performed only for large noncleaved cells, and the range was found to be 15 cells, which was also considered high. When the diagnoses derived from counts of only large noncleaved cells were compared with the traditional, more subjective diagnoses, fairly close agreement was obtained. In summary, the great variability in diagnoses of follicular lymphomas among pathologists may be attributed to the difficulties inherent in accurate determination of cell size and of the precise percentages of different cells. Until solutions to these problems are developed, one can subclassify follicular lymphomas according to the Berard method or the estimation method.
淋巴瘤临床研究资源中心与主要合作肿瘤学组织的淋巴瘤病理小组委员会成员开展了一项合作研究，旨在确定滤泡性淋巴瘤细胞学诊断的可重复性及观察者间的一致性。105例滤泡性淋巴瘤患者由7名血液病理学家根据两种方法进行亚分类。在第一种方法中，病例根据Rappaport、Lukes和Collins以及工作分类系统进行亚分类。在这些系统中，滤泡性淋巴瘤通过估计不同细胞群体进行亚分类，而不实际计数细胞。采用这种方法时，诊断结果存在很大差异。例如：（1）39例病例的共识诊断为低分化淋巴细胞淋巴瘤（PDL），但在各个病理学家中，如此诊断的病例数从24例到65例不等；（2）40例病例的共识诊断为滤泡性淋巴瘤，混合细胞型；然而，所有7名病理学家仅在1例中独立达成这一亚型的诊断一致；（3）在39例病例（37%）中观察到主要分歧，其中两种极端诊断（小裂细胞型和大无裂细胞型）均有出现。在第二种方法中，根据Berard推荐方法的改良版，仅对不同细胞进行精确计数。采用这种计数方法，根据7名病理学家提供的大裂细胞、小无裂细胞和大无裂细胞计数独立得出诊断结果。第二种方法的结果差异也很大。例如，确定了每位病理学家发现的大细胞平均数，并确定了范围。平均范围为28个细胞，被认为较高。仅对大无裂细胞进行同样的测定，范围为15个细胞，也被认为较高。当将仅根据大无裂细胞计数得出的诊断结果与传统的、更主观的诊断结果进行比较时，获得了相当接近的一致性。总之，病理学家对滤泡性淋巴瘤诊断的巨大差异可能归因于准确确定细胞大小和不同细胞精确百分比所固有的困难。在找到解决这些问题的方法之前，可以根据Berard方法或估计方法对滤泡性淋巴瘤进行亚分类。
