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  Table of Contents    
LETTER TO EDITOR  
Year : 2014  |  Volume : 57  |  Issue : 3  |  Page : 522-523
Spectrum of lymph node pathology: Inadequate data, challenging issues


Department of Pathology and Laboratory Medicine, Columbia Asia Referral Hospital, Malleswaram, Bengaluru, Karnataka, India

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Date of Web Publication14-Aug-2014
 

How to cite this article:
Pai SA, Kulkarni JD. Spectrum of lymph node pathology: Inadequate data, challenging issues. Indian J Pathol Microbiol 2014;57:522-3

How to cite this URL:
Pai SA, Kulkarni JD. Spectrum of lymph node pathology: Inadequate data, challenging issues. Indian J Pathol Microbiol [serial online] 2014 [cited 2020 Jun 5];57:522-3. Available from: http://www.ijpmonline.org/text.asp?2014/57/3/522/138821


Editor,

Roy et al. [1] document the spectrum of pathology affecting the lymph node in their hospital, and we note, with pleasure and some surprise that - unlike the case in most hospitals - clinical details were available on the requisition form! However, we suggest that mining the patients charts for follow-up data would have yielded more rewarding information. As it stands, these diagnoses have been made at a single point in the history of the disease. Given that many pathologic processes have a wide spectrum of morphologic appearances, it is possible that some of these diagnoses could have been at variance with the final outcome. For instance, were any of the cases of Kikuchi's disease actually precursors of systemic lupus erythematosus? [2] What was the cause of the lymph node infarction in the four cases? Did the patients with infarcted nodes undergo repeat node biopsies? If so, what were the diagnoses?

Roy et al. also miss out on some essential points. They state, in their introduction, "there is a paucity of information on the spectrum of diseases affecting lymph nodes from this region." However, the absence of any references in their paper would automatically suggest to the casual reader that there is no earlier published data of this kind from India. This is not so. In 2007, Mohan et al. published a paper on the various lesions affecting the lymph node in a university hospital practice. [3] Subsequently, in 2012, we published data on our experience with lymph node pathology in a private hospital practice. [4] It is possible that the latter paper was published in Natl Med J India only around the time that Roy et al. submitted their paper to this journal and thus may not have been available to the authors; however, the paper by Mohan et al. [3] should not have been missed in a literature search.

Because Roy et al. do not refer to the above papers; they miss out on a chance to compare their findings with the published data - something which is the crux of any paper. We note, for instance, that cancer formed as much as 53% of their cases, while that of Mohan et al., also in a university hospital, was only 25%. Does this high percentage reflect a referral bias?

Other questions also arise: What were the sites of the lymph node biopsies? What has the impact of fine-needle aspiration been on the practice of lymph node surgical biopsy? How many of the tubercular lymphadenitis were acid fast bacilli positive? How many cases needed recuts or special stains or immunohistochemistry for classification in the review? How many cases had to be reclassified after retrospective review? If there was a revised diagnosis, how many of these would qualify as serious errors, which would lead to change in management? How many revised diagnoses were because of a change in medical thinking or because of a new concept? How many revised diagnoses were because of access to new antibodies, which may not have been available at the time of initial diagnosis? (The authors state categorically "cases were retrieved from the departmental archives and reviewed". Our understanding of this statement is that all slides - and not merely the reports - were reviewed. Given that the period of the study is from 2007 to 2012, and the WHO 2008 classification has been used, we expect that there may been at least some changes in the diagnoses).

There are more than mere academic issues in raising such queries. The result of such studies should be not only to document empirical data, but also to act as a guide to the future. There are also obvious ethical concerns, which arise when one retrospectively learns of an error committed by an earlier colleague - or by oneself. Does one inform the patient of the earlier error? What are the legal implications? What does one do if one realizes that a particular colleague is responsible for a significantly large number of errors?

We are unclear about this and look forward to the opinions and thoughts of other readers of this journal, on this matter.

 
   References Top

1.
Roy A, Kar R, Basu D, Badhe BA. Spectrum of histopathologic diagnosis of lymph node biopsies: A descriptive study from a tertiary care center in South India over 5½ years. Indian J Pathol Microbiol 2013;56:103-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Pai SA. Kikuchi-like lymphadenitis may be an early manifestation of SLE. J Indian Med Assoc 2004;102:330.  Back to cited text no. 2
    
3.
Mohan A, Reddy MK, Phaneendra BV, Chandra A. Aetiology of peripheral lymphadenopathy in adults: Analysis of 1724 cases seen at a tertiary care teaching hospital in southern India. Natl Med J India 2007;20:78-80.  Back to cited text no. 3
    
4.
Pai SA, Kulkarni JD. Lymph node biopsy audit in a private hospital. Natl Med J India 2012;25:184.  Back to cited text no. 4
    

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Correspondence Address:
Sanjay A Pai
Department of Pathology and Laboratory Medicine, Columbia Asia Referral Hospital, Malleswaram, Bengaluru - 560 055, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.138821

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