title: Comparison of referring and final pathology for patients with non-Hodgkin's lymphoma in the National Comprehensive Cancer Network.
abstract: OBJECTIVE
  Before the implementation of the WHO lymphoma classification system, disagreement about pathologic diagnosis was common. We sought to estimate the impact of expert review in the modern era by comparing final pathologic diagnoses at five comprehensive cancer centers with diagnoses assigned at referring centers.
  
  
  METHODS
  Patients in the National Comprehensive Cancer Network (NCCN) non-Hodgkin's lymphoma (NHL) database with a documented pathologic diagnosis before presentation and a final pathologic diagnosis of any of five common B-cell NHLs were eligible. After central review of discordant cases, we estimated the rate of pathologic concordance, then investigated the etiology of discordance as well its potential impact on prognosis and treatment.
  
  
  RESULTS
  The overall pathologic discordance rate was 6% (43 of 731 patients; 95% CI, 4% to 8%). For the majority of cases in which the referring diagnosis was apparently final, no additional studies were conducted at the NCCN center, and the change in diagnosis reflected a different interpretation of existing data. Concordance was highest for diffuse large B-cell lymphoma (95%) and follicular lymphoma (FL; grades 1, 2, and not otherwise specified, 95%) and lowest for grade 3 FL (88%). Of the 43 pathologically discordant cases, 81% (35 patients) might have experienced a change in treatment as a result of the pathologic reclassification.
  
  
  CONCLUSIONS
  In the era of the WHO lymphoma classification system, the majority of common B-cell NHLs diagnosed in the community were unchanged by second opinion review by an expert hematopathologist. However, for one patient in 20, there was a discordance in diagnosis that could have altered therapy.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. ann_lacasce@dfci.harvard.edu
authors.forename: Ann S
authors.initials: AS
authors.lastname: LaCasce
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Kho
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Niland
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
authors.forename: Maria Alma
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Myron S
authors.initials: MS
authors.lastname: Czuczman
authors.forename: Michael M
authors.initials: MM
authors.lastname: Millenson
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks