Granulomatous inflammation - An underestimated cause of false-positive diagnoses in lung fine-needle aspirates

Observations from the college of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program

Manon Auger, Ann T. Moriarty, Rodolfo Laucirica, Rhona Souers, Beth Anne Chmara, Lisa A. Fatheree, David C. Wilbur

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Context: The false-positive rate for fine-needle aspirates of the lung has been cited as less than 1% for granulomatous inflammation, comprising one of the known causes of false-positive diagnoses. Objective: To determine the rate of false-positive diagnoses of granulomatous inflammation for lung fineneedle aspirates by assessing the false-positive response rate in the context of the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. Design: We performed a retrospective review of 1092 participant responses for lung fine-needle aspirate challenges with the reference diagnosis of specific infections/granulomatous inflammation from 1998 to 2008 from the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. False-positive rates by participant type (pathologist versus cytotechnologist), general diagnosis category, reference diagnosis, and preparation type were analyzed for the pathologists' responses. Results: Of the 502 general category responses for pathologists, 428 (85.3%) were benign, 55 (11%) were malignant, and 19 (3.8%) were suspicious. There was no difference in the false-positive rate between preparations (P =.76) or participants (P =.39). Of those responses by pathologists that were benign, only 68.7% (292 of 425) were an exact match to granulomatous inflammation. Non-small cell carcinoma, adenocarcinoma, and squamous carcinoma represented 64% of false-positive/suspicious responses, while small cell carcinoma and carcinoid comprised 13%. Conclusion: In an interlaboratory comparison program, granulomatous inflammation represents an important cause of false-positive/ suspicious responses in lung fine-needle aspirates (14.8%) and is much higher than false-positive rates reported historically in clinical studies. These results highlight the importance of granulomatous inflammation as a mimic of carcinoma.

Original languageEnglish (US)
Pages (from-to)1793-1796
Number of pages4
JournalArchives of Pathology and Laboratory Medicine
Volume134
Issue number12
StatePublished - Dec 1 2010
Externally publishedYes

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Needles
Inflammation
Lung
Carcinoma
Small Cell Carcinoma
Carcinoid Tumor
Pathologists
Squamous Cell Carcinoma
Pneumonia
Adenocarcinoma
Infection

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Granulomatous inflammation - An underestimated cause of false-positive diagnoses in lung fine-needle aspirates : Observations from the college of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. / Auger, Manon; Moriarty, Ann T.; Laucirica, Rodolfo; Souers, Rhona; Chmara, Beth Anne; Fatheree, Lisa A.; Wilbur, David C.

In: Archives of Pathology and Laboratory Medicine, Vol. 134, No. 12, 01.12.2010, p. 1793-1796.

Research output: Contribution to journalArticle

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title = "Granulomatous inflammation - An underestimated cause of false-positive diagnoses in lung fine-needle aspirates: Observations from the college of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program",
abstract = "Context: The false-positive rate for fine-needle aspirates of the lung has been cited as less than 1{\%} for granulomatous inflammation, comprising one of the known causes of false-positive diagnoses. Objective: To determine the rate of false-positive diagnoses of granulomatous inflammation for lung fineneedle aspirates by assessing the false-positive response rate in the context of the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. Design: We performed a retrospective review of 1092 participant responses for lung fine-needle aspirate challenges with the reference diagnosis of specific infections/granulomatous inflammation from 1998 to 2008 from the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. False-positive rates by participant type (pathologist versus cytotechnologist), general diagnosis category, reference diagnosis, and preparation type were analyzed for the pathologists' responses. Results: Of the 502 general category responses for pathologists, 428 (85.3{\%}) were benign, 55 (11{\%}) were malignant, and 19 (3.8{\%}) were suspicious. There was no difference in the false-positive rate between preparations (P =.76) or participants (P =.39). Of those responses by pathologists that were benign, only 68.7{\%} (292 of 425) were an exact match to granulomatous inflammation. Non-small cell carcinoma, adenocarcinoma, and squamous carcinoma represented 64{\%} of false-positive/suspicious responses, while small cell carcinoma and carcinoid comprised 13{\%}. Conclusion: In an interlaboratory comparison program, granulomatous inflammation represents an important cause of false-positive/ suspicious responses in lung fine-needle aspirates (14.8{\%}) and is much higher than false-positive rates reported historically in clinical studies. These results highlight the importance of granulomatous inflammation as a mimic of carcinoma.",
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AU - Moriarty, Ann T.

AU - Laucirica, Rodolfo

AU - Souers, Rhona

AU - Chmara, Beth Anne

AU - Fatheree, Lisa A.

AU - Wilbur, David C.

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N2 - Context: The false-positive rate for fine-needle aspirates of the lung has been cited as less than 1% for granulomatous inflammation, comprising one of the known causes of false-positive diagnoses. Objective: To determine the rate of false-positive diagnoses of granulomatous inflammation for lung fineneedle aspirates by assessing the false-positive response rate in the context of the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. Design: We performed a retrospective review of 1092 participant responses for lung fine-needle aspirate challenges with the reference diagnosis of specific infections/granulomatous inflammation from 1998 to 2008 from the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. False-positive rates by participant type (pathologist versus cytotechnologist), general diagnosis category, reference diagnosis, and preparation type were analyzed for the pathologists' responses. Results: Of the 502 general category responses for pathologists, 428 (85.3%) were benign, 55 (11%) were malignant, and 19 (3.8%) were suspicious. There was no difference in the false-positive rate between preparations (P =.76) or participants (P =.39). Of those responses by pathologists that were benign, only 68.7% (292 of 425) were an exact match to granulomatous inflammation. Non-small cell carcinoma, adenocarcinoma, and squamous carcinoma represented 64% of false-positive/suspicious responses, while small cell carcinoma and carcinoid comprised 13%. Conclusion: In an interlaboratory comparison program, granulomatous inflammation represents an important cause of false-positive/ suspicious responses in lung fine-needle aspirates (14.8%) and is much higher than false-positive rates reported historically in clinical studies. These results highlight the importance of granulomatous inflammation as a mimic of carcinoma.

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