A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma

A clinical evaluation of the International Lymphoma Study Group Classification of non-Hodgkin's lymphoma: a report of the Non-Hodgkin's Lymphoma Classification Project

https://medicinainternaucv.files.wordpress.com/2013/02/exceso-de-confianza-como-causa-de-error-diagnc3b3stico.pdf

Overconfidence as a cause of diagnostic error in medicine.

Pathfinder is an expert system that assists surgical pathologists with the diagnosis of lymph-node diseases. The program is one of a growing number of normative expert systems that use probability and decision theory to acquire, represent, manipulate, and explain uncertain medical knowledge. In this article, we describe Pathfinder and our research in uncertain-reasoning paradigms that was stimulated by the development of the program. We discuss limitations with early decision-theoretic methods for reasoning under uncertainty and our initial attempts to use non-decision-theoretic methods. Then, we describe experimental and theoretical results that directed us to return to reasoning methods based in probability and decision theory.

Toward normative expert systems: Part I. The Pathfinder project.

Records of 105 patients with central nervous system (CNS) lymphoma were analyzed in order to better define the incidence, setting, and management of CNS lymphoma and the role for CNS prophylaxis. Survival was best for patient under 30 years of age treated with whole-brain irradiation and intrathecal (IT) chemotherapy whose CNS involvement was an isolated event (median survival time, 1.8 years). Survival was worst for patients over 30 years of age whose CNS invasion occurred at a time of progressive systemic lymphoma (median time ten weeks if treated with whole-brain irradiation with or without IT chemotherapy). The risk of CNS invasion was greatest for those with lymphoblastic lymphoma. Among patients with Stage IIE, III, or IV histiocytic lymphoma, the risk of CNS involvement was greatest for those with progressive or relapsing disease or involvement of the testes, peripheral blood, or epidural space of the spinal cord.

Central Nervous System Involvement in non-Hodgkin 's Lymphoma: An Analysis of 105 Cases

Pathology Panel for Lymphoma Clinical Studies: A Comprehensive Analysis of Cases Accumulated Since Its Inception

Some thoughts on the requirements for a theory of biology.

The Lukes and Collins classification is based on the premise that malignant lymphomas (ML) should be classified on the basis of immunologic markers and that the B, T or „undefined” nature of these tumors can be morphologically recognized. The difficulties of achieving this are discussed in this study. The „undefined” type of these investigators posed a particular problem since it appears to be a heterogeneous group which includes ML currently classified as „histiocytic,” lymphoblastic and undifferentiated. The prognosis appeared to be closely related to cytologic types in both the Rappaport and the Lukes and Collins classifications. In the follicular center cell (FCC) lymphomas the overall median survival of patients with follicular lymphomas was longer than that of patients with diffuse lymphoma (p < 0.0001). Extending this comparison to cell types we found longer median survivals of follicular lymphomas in each subgroup but with variable statistical significance. For all cleaved cell lymphoma the p value was 0.02, for the small cleaved cell type 0.16, for the large cleaved cell type 0.09 and for the large noncleaved cell type 0.1. The lymphomas which we identified as being of the diffuse large cleaved FCC type seemed to have a relatively favorable prognosis in comparison to other diffuse large cell lymphomas (p ρ 0.08). However, within this latter group a morphologic separation into large noncleaved FCC, immunoblastic, and true histiocytic seemed difficult. For the purpose of this study, however, we attempted to apply the designation of immunoblastic sarcoma to tumors composed of large lymphoid cells with plasmacytoid features, but found no differences in survival when comparing it with diffuse large noncleaved FCC tumors.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%28197801%2941%3A1%3C303%3A%3AAID-CNCR2820410142%3E3.0.CO%3B2-G

Non-Hodgkin's lymphomas: a clinicopathologic study comparing two classifications.

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Pathology Panel for Lymphoma Clinical Studies: A Comprehensive Analysis of Cases Accumulated Since Its Inception

Some thoughts on the requirements for a theory of biology.

Non-Hodgkin's lymphomas: a clinicopathologic study comparing two classifications.