Episode 15 - Added value of pathology consultations in CLs: a review

In this episode of BJD Talks, Sam and Meera discuss the article ‘Added value of pathology consultations in cutaneous lymphomas: a 2-year review from the Dutch national referral and expertise centre’ by Doeleman et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljaf184 

*This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists* 

Transcript

SPEAKER_01 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_00 0:04

And I'm Mira. In this episode, we will be discussing the article by Tom Dolman et al. Added Value of Pathology Consultations in Cutaneous Lymphomas, a two-year review from the Dutch National Referral and Expertise Centre from May 2025.

SPEAKER_01 0:20

Cutaneous lymphomas, or CLs, are a fascinating yet complex area of dermatology. These rare skin malignancies require a combination of clinical, histological, immunophenotypic, and molecular assessments for accurate diagnosis. Without this, the risk of misdiagnosis increases dramatically, leading to incorrect treatments and adverse outcomes.

SPEAKER_00 0:43

Indeed, this study by Dolman at Al highlights the importance of expert pathology consultations. Over two years, they reviewed 239 cases submitted to the Dutch National Referral Centre for CLs. Their analysis demonstrates how specialist involvement can clarify ambiguous diagnoses and ensure patients received the most appropriate care.

SPEAKER_01 1:06

The researchers classified pathology submissions from 2020 and 2021 as either informative, when the initial diagnosis was clear enough to guide treatment, or ambiguous, where the diagnosis lacked diagnostic precision. They then assessed whether expert opinions agreed with, enhanced or contradicted the initial findings.

SPEAKER_00 1:27

And the numbers are striking. In 59% of cases, there was agreement between expert pathologists and initial diagnoses. Even so, these consultations served to validate findings for the originating pathologists. Ambiguity, however, reduced significantly from 36% to just 13%. Crucially, in 12% of cases, the centre identified substantial diagnostic disagreements that could have seriously impacted treatment if left uncorrected.

SPEAKER_01 1:58

A particularly interesting finding was the role of expert input in identifying cases of mycosis fungoides. This is the most common cutaneous T cell lymphoma, but is challenging to diagnose early, as it often mimics benign conditions like eczema. With advanced immunophenotyping, the center uncovered several missed diagnoses here.

SPEAKER_00 2:19

Similarly, primary cutaneous follicle center lymphoma, or PCFCL, was another area of frequent uncertainty. These cases were commonly misdiagnosed as pseudolymphomas, which are benign lymphoid proliferations. As PCFCL lacks specific tumour markers, accurate diagnosis required careful interpretation of histological patterns combined with clinical data.

SPEAKER_01 2:43

Another notable group included CD30 positive lympoproliferative disorders, such as lymphomatoid papillosis and primary cutaneous anaplastic large cell lymphoma. While CD30 staining is useful, it's not exclusive to these disorders, meaning precise diagnosis again relies heavily on integrative expertise.

SPEAKER_00 3:02

The study also emphasised that diagnoses can evolve with further clinical pathological correlation. Final diagnoses shifted in 11% of cases during follow-up. It's a reminder that pathology is an ongoing process involving collaboration across disciplines.

SPEAKER_01 3:19

So, Mira, what would you say is the key takeaway for listeners?

SPEAKER_00 3:24

I'd say the message is simple. For complex conditions like CLs, seeking early consultation at specialized centres is essential. This doesn't just confirm challenging cases, but also prevents potentially serious diagnostic errors. Specialist input significantly impacts care quality.

SPEAKER_01 3:42

Precisely.