Hematopathologic Discrepancy between Submitted and Review Diagnoses
Kung-Chao Chang, Chen Chang, Shih-Wen Huang, Dan Jones. National Cheng Kung University and Hospital, Tainan, Taiwan; Quest Diagnostics Nichols Institute, Chantilly, VA
Background: Appropriate management of hematologic patients depends first upon correct diagnoses since therapeutic strategies may vary among different hematologic lesions. Extra-departmental personal consultation, thus, is important in reaching accurate diagnoses.
Design: We retrospectively analyzed 395 patients with 406 samples during the period from 2003 through 2011. Discrepancies between submitted and review diagnoses were categorized as major discrepancy, minor discrepancy or agreement based upon whether the divergence would alter management according to the guidelines recommended by National Comprehensive Cancer Network (NCCN).
Results: Major discrepancy accounted for 222 of 406 cases (54.7%), minor revision for 20 (4.9%) and agreements for 164 (40.4%) cases. The majority of cases (n = 116, 52.3%) in major discrepancy were non-diagnostic or ambiguous original reports, which was defined as the diagnosis was not specific enough to generate a treatment recommendation by NCCN guidelines. Other common categories included subtype differences among cancers (n = 52, 23.4%) and malignancy revised as benign conditions (n = 32, 14.4%). Accordingly, the benign mimickers for lymphomas were florid lymphoid hyperplasia with or without secondary changes, lymphocytic panniculitis, infectious mononucleosis, Kikuchi disease, EBV-associated lymphoid hyperplasia/reactivation, lupus lymphadenitis and stromal-rich hyaline vascular Castleman disease. Based on review diagnoses, there were 187 cases of B-cell and Hodgkin lymphoma and 72 cases of T- and NK-cell lymphoma. The common subtypes included diffuse large B-cell lymphoma (23%), marginal zone lymphoma (20%), follicular lymphoma (16%) and Hodgkin lymphoma (15%) for B-cell tumors, and anaplastic large cell lymphoma (22%), angioimmunoblastic T-cell lymphoma (21%), unspecified peripheral T-cell lymphoma (15%) and NK/T-cell lymphoma (15%) for T-cell tumors. Compared with the hospital-based lymphoma populations, the consultation lymphoma subtypes with a higher frequency were follicular lymphoma (16% vs. 7%, p=0.046), Hodgkin lymphoma (15% vs. 7%, p=0.032), and angioimmunoblastic lymphoma (21% vs. 6%, p=0.010), while the lymphoma subtypes with a lower frequency were diffuse large B-cell lymphoma (23% vs. 54%, p<0.001) and mycosis fungoides (6% vs. 19%, p=0.014).
Conclusions: Clinically meaningful diagnostic discrepancy occurs frequently in hematopathologic review. Familiarity with easily misinterpreted cases may help achieve the right diagnosis and benefit the patient care.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 184, Tuesday Morning