Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group
| Autor: | Hans Theodor Eich, Beate Klimm, Jan Kriz, Harald Stein, Heinz Haverkamp, Bastian von Tresckow, Peter Borchmann, Robert Semrau, Paul J Bröckelmann, Michael Fuchs, Annette Plütschow, Karolin Behringer, Andreas Engert, Diana Wongso, Volker Diehl, Dennis A. Eichenauer, Helen Goergen, Teresa Halbsguth, Christian Baues, Carsten Kobe, Markus Dietlein |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Diagnostic Imaging Male Quality Control medicine.medical_specialty Adolescent Clinical Decision-Making Lower risk Treatment and control groups Young Adult Software Design Internal medicine Medicine Humans Multicenter Studies as Topic Stage (cooking) Diagnostic Errors Aged Neoplasm Staging Retrospective Studies Observer Variation Clinical Trials as Topic business.industry Patient Selection Mediastinum Mediastinal mass Hematology Middle Aged Hodgkin Disease Surgery Clinical Practice Hodgkin lymphoma Histopathology Female Risk Adjustment Lymph Nodes business Clinical risk factor |
| Zdroj: | British journal of haematology. 171(4) |
| ISSN: | 1365-2141 |
| Popis: | Summary 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. |
| Databáze: | OpenAIRE |
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