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What should be the morphologic criteria for the subdivision of follicular
lymphomas?
BN Nathwani, GE Metter, TP Miller, JS Burke, RB Mann, M Barcos, CR Kjeldsberg, DO Dixon, CD Winberg and CC Whitcomb
The members of the Pathology Panel for Lymphoma Clinical Studies undertook
a collaborative study with the hope of resolving some of the controversies
regarding the criteria and methods for the subclassification of follicular
lymphomas (FLs). A group of 105 patients with FL were subclassified by
seven hematopathologists according to two methods. In the first method,
cases were subclassified according to the Rappaport, Lukes and Collins, and
Working Formulation systems. In each of these systems, FLs are
subclassified by estimation of the different cell populations, without
actual counting of cells. In the second method, precise counts of different
cells were made according to the standard and modified Berard methods. With
this counting method, diagnoses were independently derived, based on counts
provided by the seven pathologists, for large cleaved (LC), small
noncleaved (SNC), and large noncleaved (LNC) cells. To ascertain what
method and which criteria are most useful in predicting survival, we made
clinicopathologic correlations. When the subjective (first method)
diagnoses were rendered, and when the consensus diagnoses of the seven
pathologists were used, there were no significant differences in survival
among patients with the different subtypes. On the other hand, when we used
the counting method of Berard (second method) and the cut- off points for
the cell counts suggested by him for the subclassification, we were able to
divide the patient population into prognostic subgroups. Because the
cut-off points proposed by Berard are not derived objectively, we made
statistical comparisons of survival curves to determine cut-off points (and
thus to establish objective criteria). We found that the patient population
could be separated into at least two prognostic groups, for SNC and/or LNC
and for SNC + LNC + LC cells. The cut-off points which we derived differed
with cell type, however. Until the usefulness of these new cut-off points
is established, we recommend that the cut-off points and the counting
method of Berard be used for the subclassification of FL. Because the
choice of treatment for the different subtypes of FL is totally dependent
on the histologic diagnosis, and because of the variability among the
diagnoses of pathologists, treatment planning is difficult.
Volume 68,
Issue 4,
pp. 837-845,
10/01/1986
Copyright © 1986 by The American Society of Hematology
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