Lymph node classification systems in cutaneous T-cell lymphoma. Evidence for the utility of the working formulation of non-Hodgkin's lymphomas for clinical usage

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Abstract
Background. This study was undertaken to compare three classification schemes used to evaluate lymph nodes (LN) obtained from patients with cutaneous T‐cell lymphoma (CTCL): a modified Rappaport classification, the National Cancer Institute‐Veterans Administration (NCI‐VA) classification based on the relative numbers of cerebriform cells in the paracortical areas, and the Dutch classification based on the presence of cerebriform cells with large nuclei in mycosis fungoides (MF) and diffuse infiltration by cerebriform cells in Sézary syndrome. Methods. A study set of 195 LN obtained from patients with CTCL (MF, Sézary syndrome, and nonepidermotropic T‐cell lymphomas) and 14 LN from patients with benign dermatoses was reviewed independently by three groups of pathologists familiar with each classification system. Results. Each classification system provided useful prognostic information. However, contrary to prior reports, no significant difference in survival was apparent in patients with uneffaced LN when classified according to the NCI‐VA (LN0–2 versus LN3) or Dutch (Gr0–1 versus Gr2) ratings. In addition, all classification systems demonstrated a poor survival time associated with effaced LN. By combining results from the modified Rappaport and Dutch classifications, three prognostic groups could be identified based on cell morphology: a low‐grade category with a small cell histologic subtype (median survival time, 40 months); a high‐grade immunoblastic subtype (median survival time, 9 months) composed of cells with an oval nucleus containing a large, usually solitary central nucleolus; and an intermediate‐grade category composed of all cases without the distinctive small cell and immunoblastic morphologies (median survival time, 26 months). Conclusions. The authors propose that clearly involved LN in CTCL can be categorized on the basis of cell morphology into prognostic groups analogous to what has been proposed for the Working Formulation for Non‐Hodgkin's Lymphomas for Clinical Usage.