Hematopathologic discrepancies between referral and review diagnoses: a gap between general pathologists and...

Area of Science:

• Hematopathology
• Oncology
• Diagnostic Pathology

Background:

• The World Health Organization (WHO) lymphoma classification is a standard in hematopathology.
• Its practical application and reproducibility among general pathologists remain under-evaluated.

Purpose of the Study:

• To assess the reproducibility of the WHO lymphoma classification in a real-world setting.
• To identify common sources of diagnostic discrepancies in lymphoma classification.

Main Methods:

• Retrospective review of 406 cases via a hematopathology consultation program in Taiwan.
• Diagnostic discrepancies were categorized based on potential impact on disease management using National Comprehensive Cancer Network guidelines.

Main Results:

• Major diagnostic discrepancies occurred in 55% of cases, with common issues including ambiguous referrals, tumor type revisions, and malignant-to-benign misclassifications.
• Concordance rates for B-cell and T/natural killer (NK)-cell lymphomas were 41% and 33%, respectively.
• Poor reproducibility was observed, especially in settings without widespread ancillary technique use.

Conclusions:

• The current WHO lymphoma classification system demonstrates limited reproducibility among general pathologists.
• Diagnostic discrepancies significantly impact patient management, highlighting a need for improved training and standardization.
• The findings underscore challenges in applying complex classifications without extensive ancillary support.