title: Mature B-cell lymphoma/leukemia in children and adolescents: intergroup pathologist consensus with the revised European-American Lymphoma Classification.
abstract: BACKGROUND
  The Revised European-American Lymphoma (R.E.A.L.) Classification criteria were evaluated in the international protocol FAB LMB 96 Treatment of Mature B-cell Lymphoma/Leukemia: A SFOP LMB 96/CCG-5961/UKCCSG NHL 9600 Cooperative Study. This includes B-lineage lymphomas: Burkitt's lymphoma (including ALL-L3); high-grade B-cell lymphoma, Burkitt-like; diffuse large B-cell lymphoma (excluding anaplastic large cell Ki-1 lymphoma).
  
  
  METHODS
  Cases were independently reviewed by eight hematopathologists from the three cooperative national groups (two SFOP, two CCG, four UKCCSG), without prior discussion of classification criteria or guidelines for case rejection. Consensus diagnosis was determined by each national cooperative group, and final consensus diagnosis established when at least two national consensus diagnoses were in agreement, or following group agreement at a multiheaded microscope.
  
  
  RESULTS
  Two hundred eight cases were reviewed, with final consensus diagnosis established in two hundred three. The percent agreement of each group's national consensus diagnosis with final consensus diagnosis was 86%, 86% and 71%. The percent agreement of the group's national consensus diagnosis with final consensus diagnosis for Burkitt's and diffuse large B-cell lymphoma were 88% and 80%, respectively, but only 42% for Burkitt-like lymphoma.
  
  
  CONCLUSIONS
  International panel review of mature B-cell lymphoma/leukemia in children and adolescents highlighted difficulties in subclassification, particularly with Burkitt-like, which is a 'provisional entity' in the R.E.A.L. Classification. The absence of previous discussion of classification and guidelines for case rejection may in part explain the discrepancy between pathologists. These results underline that morphology may need to be complemented by other studies, such as molecular genetic and cytogenetics, to discriminate between the mature B-cell lymphomas.
authors.affiliation: Children's Cancer Group (CCG), Operations Center, Arcadia, California, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Lones
authors.forename: A
authors.initials: A
authors.lastname: Auperin
authors.forename: M
authors.initials: M
authors.lastname: Raphael
authors.forename: K
authors.initials: K
authors.lastname: McCarthy
authors.forename: S L
authors.initials: SL
authors.lastname: Perkins
authors.forename: K A
authors.initials: KA
authors.lastname: MacLennan
authors.forename: A
authors.initials: A
authors.lastname: Ramsay
authors.forename: A
authors.initials: A
authors.lastname: Wotherspoon
authors.forename: M
authors.initials: M
authors.lastname: Gerrard
authors.forename: M S
authors.initials: MS
authors.lastname: Cairo
authors.forename: C
authors.initials: C
authors.lastname: Patte
mesh_terms: D000293:Adolescent; D002051:Burkitt Lymphoma / Q000145:classification / Q000473:pathology; D002648:Child; D003245:Consensus Statements as Topic; D006801:Humans; D015448:Leukemia, B-Cell / Q000145:classification* / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000145:classification* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000145:classification / Q000473:pathology