Originally published as JCO Early Release 10.1200/JCO.2008.16.4061 on September 2 2008

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Comparison of Referring and Final Pathology for Patients With Non-Hodgkin's Lymphoma in the National Comprehensive Cancer Network

Ann S. LaCasce, Michelle E. Kho, Jonathan W. Friedberg, Joyce C. Niland, Gregory A. Abel, Maria Alma Rodriguez, Myron S. Czuczman, Michael M. Millenson, Andrew D. Zelenetz, Jane C. Weeks

From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Lymphoma Clinical Research, Wilmot Cancer Center, Rochester; Department of Medicine, Lymphoma/Myeloma Service, Roswell Park Cancer Institute, Buffalo; Division of Hematologic Oncology, Lymphoma Service, Memorial Sloan-Kettering Cancer Center, Sloan-Kettering Institute, New York, NY; Department of Information Sciences, City of Hope National Medical Center, Duarte, CA; Division of Cancer Medicine Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA

Corresponding author: Ann S. LaCasce, MD, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA, 02115; e-mail: ann_lacasce{at}dfci.harvard.edu

Purpose Before the implementation of the WHO lymphoma classification system, disagreement about pathologic diagnosis was common. We sought to estimate the impact of expert review in the modern era by comparing final pathologic diagnoses at five comprehensive cancer centers with diagnoses assigned at referring centers.

Patients and Methods Patients in the National Comprehensive Cancer Network (NCCN) non-Hodgkin's lymphoma (NHL) database with a documented pathologic diagnosis before presentation and a final pathologic diagnosis of any of five common B-cell NHLs were eligible. After central review of discordant cases, we estimated the rate of pathologic concordance, then investigated the etiology of discordance as well its potential impact on prognosis and treatment.

Results The overall pathologic discordance rate was 6% (43 of 731 patients; 95% CI, 4% to 8%). For the majority of cases in which the referring diagnosis was apparently final, no additional studies were conducted at the NCCN center, and the change in diagnosis reflected a different interpretation of existing data. Concordance was highest for diffuse large B-cell lymphoma (95%) and follicular lymphoma (FL; grades 1, 2, and not otherwise specified, 95%) and lowest for grade 3 FL (88%). Of the 43 pathologically discordant cases, 81% (35 patients) might have experienced a change in treatment as a result of the pathologic reclassification.

Conclusion In the era of the WHO lymphoma classification system, the majority of common B-cell NHLs diagnosed in the community were unchanged by second opinion review by an expert hematopathologist. However, for one patient in 20, there was a discordance in diagnosis that could have altered therapy.

published online ahead of print at www.jco.org on September 2, 2008.

Supported by the National Comprehensive Cancer Network. M.E.K. is funded by a Canadian Institutes of Health Research Fellowship Award from the Clinical Research Initiative. J.W.F. is supported in part by a career development award from the National Cancer Institute (Grant No. CA-102216).

Presented in part at the Annual Meeting of the American Society of Hematology, 2005, abstract 2816: Potential Impact of Pathologic Review on Therapy in Non-Hodgkin's Lymphoma (NHL): Analysis from the National Comprehensive Cancer Network (NCCN) NHL Outcomes Project.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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