Diagnostic accuracy of a defined immunophenotypic and molecular genetic approach for peripheral T/NK-cell lymphomas: A North American PTCL study group project

Eric D. Hsi, Jonathan Said, William R. Macon, Scott J. Rodig, Sarah L. Ondrejka, Randy D. Gascoyne, Elizabeth A. Morgan, David M. Dorfman, Matthew J. Maurer, Ahmet Dogan

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

The diagnosis of peripheral T-cell and NK-cell lymphomas (PTNKCL) is difficult with few standards for required ancillary studies. We evaluated a series of PTNKCLs using a tiered approach to immunohistochemistry and molecular genetic characterization to document diagnostic accuracy and clinical relevance. Seven hematopathologists reviewed 374 cases that included PTNKCL and non-PTNKCL cases to mimic diagnostic practice. Cases received tier 0, 1, and 2 diagnoses by 3 independent pathologists, on the basis of hematoxylin and eosin stains and progressive immunohistochemistry panels. A tier 2b diagnosis was rendered when gene rearrangement data were available, and a final consensus diagnosis was rendered after discussion of each case. Across all 374 cases, consensus agreement was 92.5%. For PTNKCLs, World Health Organization subclassification was possible in 16.5%, 37.1%, 82.8%, and 85.9% of individual reviewer diagnoses at tier 0, 1, 2, and 2b, respectively. Gene rearrangement contributed to a change in diagnosis in 51 of 647 (8%) individual reviews. Following this algorithm may provide prognostic information on the basis of individual marker expression in common PTNKCL types (CD4 in peripheral T-cell lymphoma, not otherwise specified and PD-1 in angioimmunoblastic T-cell lymphoma). This evidence-based approach to the diagnosis of PTNKCL informs practicing pathologists, clinical trial designers, and policy-makers regarding required ancillary studies.

Original languageEnglish (US)
Pages (from-to)768-775
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume38
Issue number6
DOIs
StatePublished - Jan 1 2014

Keywords

  • Accuracy
  • Diagnosis
  • Evidence-based medicine
  • Guidelines
  • Pathology
  • Peripheral T-cell lymphoma

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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    Hsi, E. D., Said, J., Macon, W. R., Rodig, S. J., Ondrejka, S. L., Gascoyne, R. D., Morgan, E. A., Dorfman, D. M., Maurer, M. J., & Dogan, A. (2014). Diagnostic accuracy of a defined immunophenotypic and molecular genetic approach for peripheral T/NK-cell lymphomas: A North American PTCL study group project. American Journal of Surgical Pathology, 38(6), 768-775. https://doi.org/10.1097/PAS.0000000000000188