RT Journal Article
SR Electronic
T1 Difficulties in diagnostics of lung tumours in biopsies: an interpathologist concordance study evaluating the international diagnostic guidelines
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 302
OP 309
DO 10.1136/jclinpath-2020-207257
VO 75
IS 5
A1 Kajsa Ericson Lindquist
A1 Cristina Ciornei
A1 Sofia Westbom-Fremer
A1 Inga Gudinaviciene
A1 Anna Ehinger
A1 Nektaria Mylona
A1 Rodrigo Urdar
A1 Maria Lianou
A1 Franziska Svensson
A1 Tomas Seidal
A1 Felix Haglund
A1 Katalin Dobra
A1 Mátyás Béndek
A1 Erika Bardóczi
A1 Aneta Szablewska
A1 Marek Witkowski
A1 Maria Ramnefjell
A1 Luis E De Las Casas
A1 Miklos Gulyas
A1 Agnes Hegedus
A1 Patrick Micke
A1 Hans Brunnström
YR 2022
UL http://jcp.bmj.com/content/75/5/302.abstract
AB Aims Accurate and reliable diagnosis is essential for lung cancer treatment. The study aim was to investigate interpathologist diagnostic concordance for pulmonary tumours according to WHO diagnostic criteria.Methods Fifty-two unselected lung and bronchial biopsies were diagnosed by a thoracic pathologist based on a broad spectrum of immunohistochemical (IHC) stainings, molecular data and clinical/radiological information. Slides stained with H&E, thyroid transcription factor-1 (TTF-1) clone SPT24 and p40 were scanned and provided digitally to 20 pathologists unaware of reference diagnoses. The pathologists independently diagnosed the cases and stated if further diagnostic markers were deemed necessary.Results In 31 (60%) of the cases, ≥80% of the pathologists agreed with each other and with the reference diagnosis. Lower agreement was seen in non-small cell neuroendocrine tumours and in squamous cell carcinoma with diffuse TTF-1 positivity. Agreement with the reference diagnosis ranged from 26 to 45 (50%–87%) for the individual pathologists. The pathologists requested additional IHC staining in 15–44 (29%–85%) of the 52 cases. In nearly half (17 of 36) of the malignant cases, one or more pathologist advocated for a different final diagnosis than the reference without need of additional IHC markers, potentially leading to different clinical treatment.Conclusions Interpathologist diagnostic agreement is moderate for small unselected bronchial and lung biopsies based on a minimal panel of markers. Neuroendocrine morphology is sometimes missed and TTF-1 clone SPT24 should be interpreted with caution. Our results suggest an intensified education need for thoracic pathologists and a more generous use of diagnostic IHC markers.Data are available on reasonable request.