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Difficulties in diagnostics of lung tumours in biopsies : An interpathologist concordance study evaluating the international diagnostic guidelines

Ericson Lindquist, Kajsa LU ; Ciornei, Cristina LU ; Westbom-Fremer, Sofia LU orcid ; Gudinaviciene, Inga ; Ehinger, Anna LU orcid ; Mylona, Nektaria ; Urdar, Rodrigo ; Lianou, Maria LU ; Svensson, Franziska and Seidal, Tomas , et al. (2021) In Journal of Clinical Pathology
Abstract

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... (More)

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.

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@article{38b8149a-0c14-4751-9433-f209bd9535d1,
  abstract     = {{<p>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&amp;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.</p>}},
  author       = {{Ericson Lindquist, Kajsa and Ciornei, Cristina and Westbom-Fremer, Sofia and Gudinaviciene, Inga and Ehinger, Anna and Mylona, Nektaria and Urdar, Rodrigo and Lianou, Maria and Svensson, Franziska and Seidal, Tomas and Haglund, Felix and Dobra, Katalin and Béndek, Mátyás and Bardóczi, Erika and Szablewska, Aneta and Witkowski, Marek and Ramnefjell, Maria and De Las Casas, Luis E. and Gulyas, Miklos and Hegedus, Agnes and Micke, Patrick and Brunnström, Hans}},
  issn         = {{0021-9746}},
  keywords     = {{diagnosis; immunohistochemistry; lung neoplasms}},
  language     = {{eng}},
  month        = {{02}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Journal of Clinical Pathology}},
  title        = {{Difficulties in diagnostics of lung tumours in biopsies : An interpathologist concordance study evaluating the international diagnostic guidelines}},
  url          = {{http://dx.doi.org/10.1136/jclinpath-2020-207257}},
  doi          = {{10.1136/jclinpath-2020-207257}},
  year         = {{2021}},
}