Interobserver variation is a significant limitation in the diagnosis of Burkitt lymphoma

• Published in: Indian journal of medical and paediatric oncology 2014-01, Vol.35 (1), p.44-53
• Main Authors: Rane, Swapnil Ulhas, Shet, Tanuja, Sridhar, Epari, Bhele, Sanica, Gaikwad, Vaishali, Agale, Shubhangi, Shinde, Sweety, Prabhat, Daksha, Fernandes, Gwendolyn, Hastak, Meenal, Tampi, Chandralekha, Narurkar, Swati, Patel, Keyuri, Madiwale, Chitra, Shah, Ketki, Shah, Laxmi, Sawaimoon, Satyakam, Lad, Purnima
• Format: Article
• Language: English
• Subjects: Accuracy; Burkitt's lymphoma; Cancer; Diagnosis; Lymphoma; Meetings; Monte Carlo simulation; Original; ORIGINAL ARTICLE
• ISSN: 0971-5851; 0975-2129
• DOI: 10.4103/0971-5851.133721

Abstract Context: The pathology of classic Burkitt lymphoma (BL) remains a challenge despite being a well-defined entity, in view of the significant overlap with atypical BL and B-cell lymphoma intermediate between DLBL (diffuse large B cell lymphoma) and BL. They are difficult to be segregated in resource-limited setups which lack molecular testing facilities. This is further affected by interobserver variability and experience of the reporting pathologist. Aims: The aim of our study was to quantitate variability among a group of pathologists with an interest in lymphomas (albeit with variable levels of experience) and quantitate the benefit of joint discussions as a tool to increase accuracy and reduce interobserver variability of pathologists, in the diagnosis of BL in a resource-limited setup. Materials and Methods: A set of 25 non-Hodgkin lymphoma cases in which a diagnosis of BL was entertained were circulated to 14 participating pathologist within the Mumbai lymphoma study group. A proforma recorded the morphologic and immunohistochemical features perceived during the initial independent diagnosis followed by a consensus meeting for discussion on morphology and additional information pertinent to the case. Statistical analysis and Results: The concordance was poor for independent diagnosis among all the pathologists with kappa statistics (±SE) of 0.168 (±0.018). Expert lymphoma pathologists had the highest (albeit only fair) concordance (kappa = 0.373 ± 0.071) and general pathologists the lowest concordance (kappa = 0.138 ± 0.035). Concordance for morphological diagnosis was highest among expert lymphoma pathologists (kappa = 0.356 ± 0.127). Revision of diagnoses after consensus meeting was highest for B-cell lymphoma intermediate between DLB and BL. To conclude, interobserver variation is a significant problem in BL in the post WHO 2008 classification era. Experience with a larger number of cases and joint discussion exercises such as the one we conducted are needed as they represent a simple and effective way of improving diagnostic accuracy of pathologists working in a resource-limited setup.