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Accuracy, Concordance, and Reproducibility of Histologic Diagnosis in Cutaneous T-Cell Lymphoma
An EORTC Cutaneous Lymphoma Project Group Study
Marco Santucci, MD;
Annibale Biggeri, MD;
Alfred C. Feller, MD;
Günter Burg, MD;
for the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group
Arch Dermatol. 2000;136:497-502.
Objective To assess the level of observer variability in the histologic identification of cutaneous T-cell lymphoma (CTCL) and its discrimination from diseases with similar histologic features.
Design Cutaneous T-cell lymphoma specimens and randomly mixed controls were evaluated twice by 3 examiners.
Settings The European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group.
Patients The study was conducted with histologic specimens from 32 patients with mycosis fungoides (MF). In addition, 13 specimens of spongiotic, lichenoid, or psoriasiform simulators of MF were blindly and randomly mixed with the CTCL specimens as controls.
Main Outcome Measures To evaluate the accuracy and concordance among and individual reproducibility of raters of histologic diagnoses.
Results Overall, the concordance among raters was fair to moderate (range, 0.283-0.562; weighted overall  , 0.412). Individual reproducibility of examiners ranged from moderate to almost perfect (range, 0.473-0.896; weighted overall , 0.709) and was not significantly different for the definite lymphoma (range, 0.551-0.921; overall , 0.802) and nonlymphoma (range, 0.368-0.950; overall , 0.793) categories. Accuracy was similarly variable among raters: sensitivity ranged from 49.3% to 78.1% (overall , 0.654), and specificity (control series) ranged from 46.2% to 69.2% (overall , 0.595). Adding the diagnoses of probable lymphoma to those of definite lymphoma, sensitivity ranged between 73.5% and 84.9%. Although for each examiner there was a trend toward a lower sensitivity in the detection of early lesions compared with later lesions, the difference in sensitivity between the 2 groups was not statistically significant.
Conclusions The levels of concordance and reproducibility found in this investigation were similar to those obtained with comparable studies in the most varied fields of pathology, confirming that the identification of CTCL for our observers did not cause particular problems. Our findings also revealed that pitfalls in CTCL identification are not only limited to early lymphomatous lesions, as commonly postulated.
From the Dipartimento di Patologia Umana ed Oncologia (Dr Santucci) and Dipartimento Statistico (Dr Biggeri), Università degli Studi di Firenze, Florence, Italy; Institut für Pathologie, Medizinische Universität zu Lübeck, Lübeck, Germany (Dr Feller); and Dermatologischen Klinik, Universitätsspital Zürich, Zurich, Switzerland (Dr Burg). Additional information about the EORTC Cutaneous Lymphoma Project Group is available at http://www.eortc.be/menu.htm.
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