title: Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group.
abstract: Accurate clinical staging is crucial for adequate risk-adapted treatment in Hodgkin lymphoma (HL) to prevent patients from under- or over-treatment. Within the latest German Hodgkin Study Group trial generation, diagnostic findings such as histopathology, computerized tomography imaging and clinical risk factors were re-evaluated by expert panels. Here, we retrospectively analysed 5965 patients and identified 399 in who major discordant findings changed their first-line treatment allocation. Histopathology review did not confirm the initial diagnosis of HL in 87 patients. Treatment allocation was revised in 312 of the remaining 5878 patients: 176 were assigned to a higher and 128 to a lower risk group, respectively; the correct treatment group remained unclear in 8 patients. Cases of revised treatment allocation accounted for 9·8%, 6·0%, 0·8%, and 14·8% of patients initially assigned to the HD13, HD14, HD15 trials and stage IA lymphocyte-predominant HL project, respectively. Most revisions were due to wrong application of clinical stage (20·5% of 312 patients with revised treatment group), histological subtype (9·0%) or the risk factors ≥3 involved areas (46·8%) or large mediastinal mass (9·3%). In conclusion, centralized review by experienced experts changed risk-adapted first-line treatment in a relevant proportion of HL patients. Quality control measures clearly improve the accuracy of treatment and should be implemented in clinical practice.
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Paul J
authors: PJ
authors: Bröckelmann
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Helen
authors: H
authors: Goergen
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Michael
authors: M
authors: Fuchs
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department of Radiation Oncology, University Hospital Münster, Münster, Germany.
authors: Jan
authors: J
authors: Kriz
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany.
authors: Robert
authors: R
authors: Semrau
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany.
authors: Christian
authors: C
authors: Baues
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Carsten
authors: C
authors: Kobe
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Karolin
authors: K
authors: Behringer
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Dennis A
authors: DA
authors: Eichenauer
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Bastian
authors: B
authors: von Tresckow
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department III of Internal Medicine, Krankenhaus Düren, Düren, Germany.
authors: Beate
authors: B
authors: Klimm
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department II of Internal Medicine, University Hospital of Frankfurt, Frankfurt, Germany.
authors: Teresa
authors: T
authors: Halbsguth
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Diana
authors: D
authors: Wongso
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Annette
authors: A
authors: Plütschow
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Heinz
authors: H
authors: Haverkamp
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Markus
authors: M
authors: Dietlein
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Department of Radiation Oncology, University Hospital Münster, Münster, Germany.
authors: Hans T
authors: HT
authors: Eich
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.|Pathodiagnostik Berlin, Berlin, Germany.
authors: Harald
authors: H
authors: Stein
authors: German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Volker
authors: V
authors: Diehl
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Peter
authors: P
authors: Borchmann
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Hodgkin Study Group (GHSG), Cologne, Germany.
authors: Andreas
authors: A
authors: Engert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D002986:Clinical Trials as Topic; D003951:Diagnostic Errors; D003952:Diagnostic Imaging; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging; D015588:Observer Variation; D018579:Patient Selection; D011786:Quality Control; D012189:Retrospective Studies; D020379:Risk Adjustment; D012985:Software Design; D055815:Young Adult
keywords: Hodgkin lymphoma; accuracy; quality control; risk-adapted therapy; staging