Impact of Expert Pathologic Review of Lymphoma Diagnosis: Study of Patients From the French Lymphopath Network

Camille Laurent , Marine Baron , Nadia Amara , Corinne Haioun , Mylene Dandoit , Marc Maynadie , Marie Parrens , Beatrice Vergier , Christiane Copie-Bergman , Bettina Fabiani , Alexandra Traverse-Glehen , Nicole Brousse , Marie-Christine Copin , Patrick Tas , Tony Petrella , Marie-Christine Rousselet , Josette Briere , Frederic Charlotte , Catherine Chassagne-Clement , Therese Rousset , Luc Xerri , Anne Moreau , Antoine Martin , Diane Damotte , Peggy Dartigues , Isabelle Soubeyran , Michel Peoch , Pierre Dechelotte , Jean-Francois Michiels , Antoine De Mascarel , Francoise Berger , Celine Bossard , Flavie Arbion , Isabelle Quintin-Roue , Jean-Michel Picquenot , Martine Patey , Blandine Fabre , Henri Sevestre (1) , Cecile Le Naoures , Marie-Pierre Chenard-Neu , Claire Bastien , Sylvie Thiebault , Laurent Martin , Manuela Delage , Thomas Filleron , Gilles Salles , Thierry Jo Molina , Georges Delsol , Pierre Brousset , Philippe Gaulard

1 LPCM - Laboratoire de Physiologie Cellulaire et Moléculaire - UR UPJV 4667

PurposeTo prospectively assess the clinical impact of expert review of lymphoma diagnosis in France.Materials and MethodsFrom January 2010 to December 2013, 42,145 samples from patients with newly diagnosed or suspected lymphomas were reviewed, according to the 2008 WHO classification, in real time by experts through the Lymphopath Network. Changes in diagnosis between referral and expert review were classified as major or minor according to their potential impact on patient care.ResultsThe 42,145 reviewed samples comprised 36,920 newly diagnosed mature lymphomas, 321 precursor lymphoid neoplasms, 314 myeloid disorders, and 200 nonhematopoietic neoplasms, with 4,390 benign lesions. There were 4,352 cutaneous and 32,568 noncutaneous lymphomas. The most common mature noncutaneous lymphomas were diffuse large B-cell lymphomas (32.4%), follicular lymphomas (15.3%), classic Hodgkin lymphomas (13%), peripheral T-cell lymphomas (6.3%) of which angioimmunoblastic T-cell lymphomas (2.3%) were the most frequent, and mucosa-associated lymphoid tissue lymphomas (5.8%). A diagnostic change between referral and expert review occurred in 19.7% of patients, with an estimated impact on patient care for 17.4% of patients. This rate was significantly higher for patients sent with a provisional diagnosis seeking expert second opinion (37.8%) than for patients sent with a formal diagnosis (3.7%). The most frequent discrepancies were misclassifications in lymphoma subtype (41.3%), with 12.3% being misclassifications among small B-cell lymphoma entities. Fewer than 2% of changes were between benign and malignant lymphoid conditions. Minor changes (2.3%) mostly consisted of follicular lymphoma misgrading and diffuse large B-cell lymphoma subtype misclassification.ConclusionTo our knowledge, this study provides the largest ever description of the distribution of lymphoma entities in a western country and highlights how expert review significantly contributes to a precise lymphoma diagnosis and optimal clinical management in a proportion of patients.

Domaines: Sciences du Vivant [q-bio]

Camille Laurent, Marine Baron, Nadia Amara, Corinne Haioun, Mylene Dandoit, et al.. Impact of Expert Pathologic Review of Lymphoma Diagnosis: Study of Patients From the French Lymphopath Network. Journal of Clinical Oncology, 2017, 35 (18), pp.2008+. ⟨10.1200/JCO.2016.71.2083⟩. ⟨hal-03607766⟩