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Time trends in rates of Hodgkin lymphoma histologic subtypes: true incidence changes or evolving diagnostic practice?
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10 2015
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Source: Cancer Epidemiol Biomarkers Prev. 24(10):1474-1488
[PDF-2.41 MB]
Details:
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Alternative Title:Cancer Epidemiol Biomarkers Prev
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Personal Author:
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Description:Background
Histologic subtypes of classical Hodgkin lymphoma (cHL) (e.g., nodular sclerosis (NS), mixed cellularity (MC), not otherwise specified (NOS)) are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for MC and increases for NOS require examination.
Methods
We analyzed detailed histology-specific HL incidence rates in 1992–2011 U.S. SEER data (n=21,372) and reviewed a regional subset of 2007–11 NOS pathology reports for insight into diagnostic practices.
Results
cHL rates were stable until 2007, then decreased for whites (annual percent change (APC) and 95% confidence interval, −3.6% (−5.6%, −1.5%)). NS rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992–2011, MC rates declined (APC −4.0% (−4.7%, −3.3%)) whereas NOS rates rose (5.3% (4.5%, 6.2%)) overall and in most patient groups. 2007–11 NOS age-specific rates were more similar to MC rates for 1992–96 than 2007–11. Trends in combined rates were minimal, supporting increasing misclassification of MC, LD, and specific NS subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%).
Conclusion
Recent NS rate declines largely represent true incidence changes. Long-term rate decreases for MC and other less-common subtypes, and increases for NOS (comprising ~30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice.
Impact
Diminishing histologic subtyping undermines future surveillance and epidemiologic study of HL. Guideline-based use of excisional biopsies and more coding quality control are warranted.
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Pubmed ID:26215294
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Pubmed Central ID:PMC4592457
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Volume:24
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Issue:10
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