An Academic Center's Experience with Lymphoma Diagnosis: Rate of Revision and Impact on Patient Care
Joslin M Bowen, Ana M Perry, Lynnette Smith, Kim Klinetobe, Martin Bast, Julie M Vose, Kai Fu, Timothy C Greiner, Wing-Chung Chan, Dennis D Weisenburger, Patricia Aoun. University of Nebraska Medical Center, Omaha, NE
Background: At many institutions, a second review of referred patients' diagnostic pathology material is mandatory. However, few studies have examined the value of this review for hematologic malignancies. Therefore, we compared the diagnoses on biopsies from patients referred to an academic medical center for consultation to determine the rate and therapeutic impact of revised diagnoses resulting from the second review.
Design: We reviewed 1016 cases from 963 patients referred for lymphoma during 2009-2010. Cases were analyzed using the chi-square test to compare agreement of the diagnoses by sample characteristics. P-values < 0.05 were considered significant. The revised diagnoses were then reviewed by an oncologist to determine whether changes in therapy would result from the change in diagnosis. Diagnostic changes were grouped as either major (resulting in a change in therapy) or minor (having no impact on therapy). Cases were also divided by the type of biopsy specimen and whether additional ancillary tests were performed to arrive at the revised diagnosis.
Results: Of the 1016 cases, 142 were originally diagnosed at other academic medical centers and 874 at non-academic centers. Overall, there was no change in the diagnosis in 867 (85.3%) cases. However, in 149 (14.7%) cases, secondary review resulted in a revised diagnosis, including 11/142 (7.8%) cases from academic centers and 138/874 (15.8%) from non-academic centers. The highest rate of revised diagnoses were for follicular, aggressive B-cell, T-cell, and nodular lymphocyte predominant Hodgkin lymphomas. Revised diagnoses were more frequent on excisional biopsies than on other small biopsy types (18% vs. 10%, p = 0.0003). Cases requiring additional testing also had a higher rate of diagnostic change (20% vs. 9%, p < 0.0001). The revised diagnosis was considered major (resulting in a change in therapy) in 131/1016 (12.9%) cases.
Conclusions: Mandatory review of pathology material prior to the treatment of patients for lymphoma will identify a significant number of misclassified cases for which the revised diagnosis results in a major change in therapy.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 203, Monday Morning