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There are many types of lymphoma and the classification is complex, which has always been a difficult point
in pathological diagnosis.
In recent years, with the emergence and application of new molecular detection technology, people's understanding of lymphoma has gradually deepened, especially in the pathological classification and molecular genetics of lymphoma
.
New classifications, key molecular changes and molecular typing are conducive to the accurate diagnosis, risk stratification, prognosis assessment and precise treatment
of lymphoma.
At the "7th Anti-Leukemia & Lymphoma International Summit Forum and CSCO Leukemia & Lymphoma Expert Committee Tour - Harbin Station" held on November 10-11, Yimaitong sincerely invited Professor Li Xiaoqiu of Fudan University Cancer Hospital to introduce the current status and future development direction of lymphoma pathological diagnosis for us
.
As the cornerstone of modern medicine, pathology is the basis of
clinical diagnosis and treatment.
As medical technology continues to evolve, so does pathology
.
Could you briefly talk about the interesting pathological advances in the field of lymphoma in recent years?
Professor Li Xiaoqiu Lymphoma
is a general term for
a group of malignant tumors that originate in lymphocytes.
According to the 5th edition of the World Health Organization (WHO) classification revised this year, lymphoma contains more than 100 subtypes, different subtypes have unique clinical characteristics, morphological characteristics, immunophenotypic and molecular genetic characteristics, and our understanding of the molecular biology of lymphoma has gradually deepened
in recent years.
For example, the common diffuse large B-cell lymphoma (DLBCL) is a very heterogeneous group of tumors, and based on genomics studies, DLBCL has been found to be further divided into different molecular subtypes, including EZB subtype (characterized by EZH2 mutations and BCL-2 translocations), MCD type (characterized by MYD88 and CD79B comutations), BN2 type ( BCL-6 fusion and NOTCH2-related gene mutation) and N1 type (NOTCH1 mutation).
Retrospective studies have revealed that DLBCL of different molecular subtypes have different prognostic characteristics, and it is hoped that future clinical studies can help us identify the risk of different subtypes and adopt more individualized treatment strategies
.
The same is true
for indolent lymphoma represented by follicular lymphoma (FL).
In the past, we emphasized that the prognosis of FL is related to histological grade, but now we pay more attention to the molecular pathogenesis of FL, which can be divided into classical FL related to BCL-2 gene rearrangement and non-classical FL unrelated to BCL-2 gene rearrangement, such as grade 3B FL, pediatric FL, and so on
.
Peripheral T-cell lymphoma (PTCL) is a relatively common group of lymphomas in China, common types include peripheral T-cell lymphoma, non-specific (PTCL-NOS), extranodal NK/T-cell lymphoma (NKTCL) associated with Epstein-Barr virus, angioimmunoblastic T-cell lymphoma (AITL), and anaplastic large cell lymphoma (ALCL) characterized by CD30 overexpression.
Recently, the understanding of the pathogenesis of these tumors has also been improved, and treatment has also made great progress
.
Advances in molecular biology have made our understanding of lymphoma more profound, and precision treatment can be carried out on the basis of accurate diagnosis, and ultimately accurate benefits
can be achieved.
Yimaitong: You explained the update of the 2022 WHO lymphoma classification for us at this meeting, can you briefly talk about the changes that the 2022 WHO lymphoma classification update will bring to the existing laboratory diagnosis and clinical practice?
Professor
Li Xiaoqiu In recent years, the diagnosis and treatment of lymphoma has increasingly emphasized the value of genetics and molecular biology, and the classification and diagnostic criteria of WHO lymphoma have also changed, which of course is inseparable from the development of laboratory diagnostic technology, from fluorescence in situ hybridization technology (FISH) that can only detect a single gene to high-throughput next-generation sequencing of multiple genes at the same time.
Advances in technology have pushed the pathological classification of lymphoma forward
.
The reliance on molecular techniques for pathological diagnosis is also becoming more apparent, for example, for high-grade B-cell lymphoma with MYC and BCL2 gene rearrangements and Burkitt-like lymphoma with 11q abnormalities, FISH testing
is indispensable for diagnosis.
For difficult lymphoma cases with morphological and immunophenotypic atypia, we can also use some molecular techniques to detect related genetic abnormalities to assist in the diagnosis
.
In short, although lymphoma is not highly dependent on molecular diagnostic technology like leukemia, the advancement of diagnostic technology will surely promote the update of lymphoma clinical practice, which is also the future development trend
.
Medical Pulse Communication: Pathologists are called "doctors' doctors", the structure of lymphoid tissue is special and heterogeneous, and the diagnosis of lymphoma is one of
the difficulties in pathology.
Could you please talk about the current dilemma in the pathological diagnosis of lymphoma and the future development trend?
Professor Li Xiaoqiu
The pathological diagnosis of lymphoma is challenging, on the one hand, because the body's immune system is complex, correspondingly, immune system tumors are also very complex, varied, different types are different, even the same type There are individual differences, so the diagnosis is very difficult
.
On the other hand, the differentiation between lymphoma and benign lymphoid hyperplasia is also a great challenge
.
How can we break through the dilemma of pathological diagnosis of lymphoma? First of all, it is necessary to strengthen the training of practitioners, lymphoid and blood pathology is highly professional, for pathologists, especially grassroots doctors, there is a general lack of standardized training, so first of all, we must strengthen professional training
。 Secondly, grassroots patients are more scattered, pathologists are difficult to accumulate experience, so there are indeed certain difficulties in widely carrying out accurate diagnosis of lymphoma at the grassroots level, we are more inclined to solve the diagnosis of difficult cases through regional pathology centers, and radiate the experience of experts to a wider area for more peers to learn and learn from, so as to drive and improve the level of pathological diagnosis in the region, which may also be a direction
for future efforts.
In addition, with the continuous integration of artificial intelligence technology and pathological diagnosis, it may be expected that the diagnosis and treatment experience of experts will be quickly replicated through artificial intelligence in the future to provide real-time decision-making support for pathologists, thereby benefiting more lymphoma patients, which is also a direction
worth trying.
Professor Li Xiaoqiu
Chief physician and doctoral supervisor
Deputy Director of the Department of Pathology, Fudan University Cancer Hospital, Head of the Department of Lymphoid Hematopoietic Pathology
Deputy Chief Expert of the Multidisciplinary Comprehensive Diagnosis and Treatment Group of Lymphoma of Fudan University Cancer Hospital
Consultant of the expert group of the lymphoma specialty construction project of the Capacity Building and Continuing Education Center of the National Health Commission of China and the leader of the pathology team
Vice Chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association
Member of the Standing Committee of the Hematological Oncology Professional Committee of the Chinese Anti-Cancer Association and Vice Chairman of the Follicular Lymphoma Working Group
Member of the Standing Committee of the Lymphoma Expert Committee of the Chinese Society of Clinical Oncology (CSCO).
Consultant of the Pathology Group of Lymphatic Hematopoietic System, Pathology Branch of Chinese Medical Association
Member of the Lymphoid Hematology Group of the Oncology Branch of the Chinese Medical Association
Member of the Standing Committee of the Lymphoma Professional Committee of the Chinese Geriatric Health Care Association
Member of the Standing Committee of the Lymphatic Disease Professional Committee of the Chinese Medical Education Association
Standing Director of Precision Medicine Branch of Chinese Association of Ethnic Medicine
Member of the Standing Committee of the Pathology Professional Committee of the China Association for the Promotion of International Exchanges in Healthcare
Author of the WHO Classification of Hematopoietic Lymphomas (2022), the WHO Classification of Head and Neck Tumors (2017, 2022), the WHO Classification of Tumors of the Digestive System (2019) and the WHO Classification of Skin Tumors (2023).
Editor: Faline Reviewed: Professor Li Xiaoqiu Typesetting: Wenting Executive: Moly
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