The Cause Of Discrepancy Between Pathologic Diagnosis And Clinical Diagnosis And Its Measures On Lymphoma

Background: Although pathological diagnosis is still the "gold standard" for the diagnosis of the disease currently, it has important significance for clinicians making therapy and assessment of prognosis, but pathological diagnosis also has its limitations, may also have been misdiagnosed and clinicians often meet for various reasons unable to obtain pathological specimens. Therefore, clinicians rely entirely on pathology to diagnosis and treat the disease is neither realistic nor possible. Lymphoma is one of the tumors which are recognized as the most difficult and the most prone to misdiagnosis in clinical practice. So we try to analysis inconsistent causes and related factors between the pathological diagnosis and clinical diagnosis and the pathological diagnosis of lymphoma.Objective: To explore factors influencing the discrepancy between clinical and pathological diagnosis and their effects in the treatment of lymphoma.Methods: The medical history, physical examination, laboratory examination, imaging and pathological data of all the clinical or pathological diagnosis of 115 cases of lymphoma patients were collected form 2014 January 1, to 2014 December 31 in The Second Affiliated Hospital of Anhui Medical University. The clinical diagnosis which was made according to the comprehensive analysis of the clinical presentation, auxiliary examination and pathological diagnosis were compared for the patients had get the pathological diagnosis, then judged the consistent between the pathological diagnosis and the pathology and clinical diagnosis. For the inconsistent case, the application of review was proposed to the pathology department of the unit by the researchers, if the consensus cannot be reached the pathological specimens would be sent to the pathology unit of the tumor hospital of Fudan University and Chinese Academy of Medical Sciences cancer hospital for consultation, analyzed the consistent of the pathological diagnosis opinions of different units. All patients were followed-up more than 6 months, made a final diagnosis according to the evolution of the disease and curative effect, judged the consistency of the clinical and pathological diagnosis, analyzed the causes of the inconsistent and its in the impact of clinical treatment.Results: Followed by more than 6 months in 115 cases lymphoma patients, 2 had no pathological diagnosis, 59 patients had nodal lymphoma and 56 patients had extranodal lymphoma. The diagnostic reliability of lymphoma was significantly difference between nodal and extanodal(p<0.05), the diagnostic reliability of nodal lymphoma was higher than extranodal. In non-Hodgkin lymphoma patients, the numbers of patients with diffuse large B-cell lymphoma and non-diffuse large B-cell lymphoma were 50 and 60, respectively. The diagnostic reliability of lymphoma was significantly difference between diffuse large B-cell lymphoma and non-diffuse large B-cell lymphoma(p<0.05). Reliability of pathological diagnosis was affected by diagnostic methods whereby incision biopsy contributed to the highest reliability(72.7%).Inconsistencies in clinical and pathological diagnosis were found in 12 cases(10.6%), resulting in moderate and mild effects on treatment in 2 and 10 cases respectively. Inconsistencies were mainly due to the locations, different pathological diagnostic methods and pathological types of lymphoma. 26 patients had consultation and concordance rate was 42.3%. The concordance rate of lymphoma was significantly difference among four types of primary pathologic diagnosis had(diffuse large B-cell lymphoma, non-diffuse large B-cell lymphoma, inflammation, Hodgkin lymphoma)(p<0.05). The higher concordance rate was inflammation and Hodgkin lymphoma. The concordance rate of lymphoma was significantly difference among levels hospitals(p<0.05), the higher concordance rate was three grade hospital.Conclusion: Data show that the difficulty of lymphoma diagnosis, the locations and pathological diagnostic methods of lymphoma contribute to the discrepancy between clinical and pathological diagnosis of lymphoma. Effective communication between clinicians and pathologist is required to match an accurate diagnosis of lymphoma.