Mature B-cell lymphoma/leukemia in children and adolescents: Intergroup pathologist consensus with the Revised European-American Lymphoma Classification

Background: The Revised European-American Lymphoma (R.E.A.L.) Classificatio n criteria were evaluated in the international protocol FAB LMB 96 Treatmen t of Mature B-Cell Lymphoma/Leukemia: A SFOP LMB 96/CCG-5961/UKCCSG NHL 960 0 Cooperative Study. This includes B-lineage lymphomas: Burkitt's lymphoma (including ALL-L3); high-grade B-cell lymphoma, Burkitt-like; diffuse large B-cell lymphoma (excluding anaplastic large cell Ki-1 lymphoma). Patients and methods: Cases were independently reviewed by eight hematopath ologists from the three cooperative national groups (two SFOP, two CCG, fou r UKCCSG), without prior discussion of classification criteria or guideline s for case rejection. Consensus diagnosis was determined by each national c ooperative group, and final consensus diagnosis established when at least t wo national consensus diagnoses were in agreement, or following group agree ment at a multiheaded microscope. Results: Two hundred eight cases were reviewed, with final consensus diagno sis established in two hundred three. The percent agreement of each group's national consensus diagnosis with final consensus diagnosis was 86%, 86% a nd 71%. The percent agreement of the group's national consensus diagnosis w ith final consensus diagnosis for Burkitt's and diffuse large B-cell lympho ma were 88% and 80%, respectively, but only 42% for Burkitt-like lymphoma. Conclusions: International panel review of mature B-cell lymphoma/leukemia in children and adolescents highlighted difficulties in subclassification, particularly with Burkitt-like, which is a 'provisional entity' in the R.E. A.L. Classification. The absence of previous discussion of classification a nd guidelines for case rejection may in part explain the discrepancy betwee n pathologists. These results underline that morphology may need to be comp lemented by other studies, such as molecular genetics and cytogenetics, to discriminate between the mature B-cell lymphomas.