Accuracy of Pathologic Diagnosis in Patients With Lymphoma and Survival: A Prospective Analysis From Botswana.
Accuracy of Pathologic Diagnosis in Patients With Lymphoma and Survival: A Prospective Analysis From Botswana.
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DOI：
10.1200/go.21.00209
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发表时间：
2021-09
影响因子：
4.5
通讯作者：
Sohani AR
中科院分区：
文献类型：
--
作者：
Chipidza FE;Kayembe MKA;Nkele I;Efstathiou JA;Chabner BA;Abramson J;Dryden-Peterson SL;Sohani AR
随着艾滋病毒的严重流行，南部非洲国家的典型霍奇金淋巴瘤(CHL)和非霍奇金淋巴瘤(NHL)负担很重。然而，对病理学资源的次优访问限制了亚型分类。我们试图评估被归类为淋巴瘤的标本的诊断准确性，并确定不一致的病理诊断与总存活率之间的关联。分析了2010至2016年间在博茨瓦纳三家医院接受治疗的70名CHL或NHL患者。局部病理评估主要依赖于病理形态。所有病例都接受了二次美国血液病理学检查，这被认为是金标准。中位随访时间为58个月。总的再分型率为29%(20/70)。在博茨瓦纳，所有20例CHL都被正确地分类，混合细胞型是最常见的亚型，诊断为11例(55%)。在47例确诊的NHL中，28例(60%)为弥漫性大B细胞淋巴瘤，9例(19%)为另一种侵袭性B细胞NHL，6例(13%)为惰性B细胞NHL，4例(9%)为T细胞NHL。诊断不一致的常见类型包括NHL亚型重新分类(11/20，55%)和CHL重新分类为NHL(7/20，35%)。二次复查后诊断符合与不一致与改善5年总存活率有关(60.1%vs26.3%，P=0.0066)。诊断不一致与死亡风险增加独立相关(调整后的风险比为2.733；95%可信区间为1.102至6.775；P=.0300)，即使在慢性淋巴细胞性白血病与非霍奇金淋巴瘤的分层结果后也是如此。在这个单一的前瞻性队列中，不一致的病理诊断与死亡风险增加近三倍相关。在资源匮乏的国家，获得相对基本的诊断技术的机会有限会损害治疗决策，并导致患者预后不佳。
With intense HIV epidemics, southern African countries have a high burden of classic Hodgkin lymphoma (CHL) and non-Hodgkin lymphoma (NHL). However, suboptimal access to pathology resources limits subtype classification. We sought to assess the diagnostic accuracy of specimens classified as lymphoma and to determine association between discordant pathologic diagnosis and overall survival. Seventy patients with CHL or NHL and treated at three Botswana hospitals from 2010 to 2016 were analyzed. Local pathologic assessment relied primarily on morphology. All cases underwent secondary US hematopathology review, which is considered gold standard. The median follow-up was 58 months. The overall reclassification rate was 20 of 70 cases (29%). All 20 CHL cases were correctly classified in Botswana, and mixed cellularity was the most common subtype, diagnosed in 11 (55%) cases. Of 47 confirmed NHL cases, diffuse large B-cell lymphoma was the final US diagnosis in 28 cases (60%), another aggressive B-cell NHL in nine (19%), an indolent B-cell NHL in six (13%), and T-cell NHL in four (9%). Common types of diagnostic discordance included NHL subtype reclassification (11 of 20, 55%) and CHL reclassified as NHL (7 of 20, 35%). Concordant versus discordant diagnosis after secondary review was associated with improved 5-year overall survival (60.1% v 26.3%, P = .0066). Discordant diagnosis was independently associated with increased risk of death (adjusted hazard ratio 2.733; 95% CI, 1.102 to 6.775; P = .0300) even after stratifying results by CHL versus NHL. In this single prospective cohort, discordant pathologic diagnosis was associated with a nearly three-fold increased risk of death. Limited access to relatively basic diagnostic techniques impairs treatment decisions and leads to poor patient outcomes in low-resource countries.