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 M Dogan

Research output: Contribution to journalArticlepeer-review

26 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 - 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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