Primary pulmonary non-small cell carcinomas

The college of American pathologists interlaboratory comparison program confirms a significant trend toward subcategorization based upon fine-needle aspiration cytomorphology alone

Isil Z. Yildiz-Aktas, Charles D. Sturgis, Guliz A. Barkan, Rhona J. Souers, Mostafa M. Fraig, Rodolfo Laucirica, Walid E. Khalbuss, Ann T. Moriarty

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Context.- Subtyping of non-small cell lung carcinomas (NSCLCs) is necessary for optimal patient management with specific diagnoses triggering specific molecular tests and affecting therapy. Objective.- To assess the accuracy of the participants of the College of American Pathologists Interlaboratory Comparison Program in diagnosing and subtyping NSCLC fine-needle aspiration (FNA) slides, based on morphology alone, considering preparation and participant type and trends over time. Design.- The performance of program participants was reviewed for the 5-year period spanning 2007-2011. Lung FNA challenges with reference diagnoses of adenocarcinoma and squamous cell carcinoma (SCC) were evaluated for diagnostic concordance by using a nonlinear mixed model analysis. Results.- There were 10 493 pathologist and 6378 cytotechnologist responses with concordance rates of 97.4% and 97.9% for malignancy, respectively. Overall concordance rates for subcategorization were 54.6% for adenocarcinoma and 74.9% for SCC. For the exact reference diagnoses, pathologists performed better for adenocarcinoma and cytotechnologists performed better for SCC. Accurate subcategorization of adenocarcinomas significantly increased over time with 31.5% of adenocarcinomas classified as NSCLC in 2007 and 25.5% of adenocarcinomas classified as NSCLC in 2011 (P < .001). In comparing preparation types, modified Giemsa-stained smears showed the lowest overall concordance (46.8%). Modified Giemsa-stained smears with SCCs were the least likely to be accurately subcategorized (36.4%). Conclusions.- Participants are proficient at interpreting NSCLCs as malignant by FNA but are less successful at subcategorization with cytomorphology alone. During the study period, a statistically significant trend was confirmed toward greater accuracy of subcategorization of adenocarcinomas, suggesting that participants are cognizant of the impact that more specific cytomorphologic interpretations have in directing molecular triage and therapy.

Original languageEnglish (US)
Pages (from-to)65-70
Number of pages6
JournalArchives of Pathology and Laboratory Medicine
Volume138
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Fine Needle Biopsy
Adenocarcinoma
Non-Small Cell Lung Carcinoma
Carcinoma
Lung
Squamous Cell Carcinoma
Nonlinear Dynamics
Triage
Pathologists
Therapeutics
Neoplasms

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Primary pulmonary non-small cell carcinomas : The college of American pathologists interlaboratory comparison program confirms a significant trend toward subcategorization based upon fine-needle aspiration cytomorphology alone. / Yildiz-Aktas, Isil Z.; Sturgis, Charles D.; Barkan, Guliz A.; Souers, Rhona J.; Fraig, Mostafa M.; Laucirica, Rodolfo; Khalbuss, Walid E.; Moriarty, Ann T.

In: Archives of Pathology and Laboratory Medicine, Vol. 138, No. 1, 01.01.2014, p. 65-70.

Research output: Contribution to journalArticle

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abstract = "Context.- Subtyping of non-small cell lung carcinomas (NSCLCs) is necessary for optimal patient management with specific diagnoses triggering specific molecular tests and affecting therapy. Objective.- To assess the accuracy of the participants of the College of American Pathologists Interlaboratory Comparison Program in diagnosing and subtyping NSCLC fine-needle aspiration (FNA) slides, based on morphology alone, considering preparation and participant type and trends over time. Design.- The performance of program participants was reviewed for the 5-year period spanning 2007-2011. Lung FNA challenges with reference diagnoses of adenocarcinoma and squamous cell carcinoma (SCC) were evaluated for diagnostic concordance by using a nonlinear mixed model analysis. Results.- There were 10 493 pathologist and 6378 cytotechnologist responses with concordance rates of 97.4{\%} and 97.9{\%} for malignancy, respectively. Overall concordance rates for subcategorization were 54.6{\%} for adenocarcinoma and 74.9{\%} for SCC. For the exact reference diagnoses, pathologists performed better for adenocarcinoma and cytotechnologists performed better for SCC. Accurate subcategorization of adenocarcinomas significantly increased over time with 31.5{\%} of adenocarcinomas classified as NSCLC in 2007 and 25.5{\%} of adenocarcinomas classified as NSCLC in 2011 (P < .001). In comparing preparation types, modified Giemsa-stained smears showed the lowest overall concordance (46.8{\%}). Modified Giemsa-stained smears with SCCs were the least likely to be accurately subcategorized (36.4{\%}). Conclusions.- Participants are proficient at interpreting NSCLCs as malignant by FNA but are less successful at subcategorization with cytomorphology alone. During the study period, a statistically significant trend was confirmed toward greater accuracy of subcategorization of adenocarcinomas, suggesting that participants are cognizant of the impact that more specific cytomorphologic interpretations have in directing molecular triage and therapy.",
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AU - Sturgis, Charles D.

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AU - Souers, Rhona J.

AU - Fraig, Mostafa M.

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AU - Khalbuss, Walid E.

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AB - Context.- Subtyping of non-small cell lung carcinomas (NSCLCs) is necessary for optimal patient management with specific diagnoses triggering specific molecular tests and affecting therapy. Objective.- To assess the accuracy of the participants of the College of American Pathologists Interlaboratory Comparison Program in diagnosing and subtyping NSCLC fine-needle aspiration (FNA) slides, based on morphology alone, considering preparation and participant type and trends over time. Design.- The performance of program participants was reviewed for the 5-year period spanning 2007-2011. Lung FNA challenges with reference diagnoses of adenocarcinoma and squamous cell carcinoma (SCC) were evaluated for diagnostic concordance by using a nonlinear mixed model analysis. Results.- There were 10 493 pathologist and 6378 cytotechnologist responses with concordance rates of 97.4% and 97.9% for malignancy, respectively. Overall concordance rates for subcategorization were 54.6% for adenocarcinoma and 74.9% for SCC. For the exact reference diagnoses, pathologists performed better for adenocarcinoma and cytotechnologists performed better for SCC. Accurate subcategorization of adenocarcinomas significantly increased over time with 31.5% of adenocarcinomas classified as NSCLC in 2007 and 25.5% of adenocarcinomas classified as NSCLC in 2011 (P < .001). In comparing preparation types, modified Giemsa-stained smears showed the lowest overall concordance (46.8%). Modified Giemsa-stained smears with SCCs were the least likely to be accurately subcategorized (36.4%). Conclusions.- Participants are proficient at interpreting NSCLCs as malignant by FNA but are less successful at subcategorization with cytomorphology alone. During the study period, a statistically significant trend was confirmed toward greater accuracy of subcategorization of adenocarcinomas, suggesting that participants are cognizant of the impact that more specific cytomorphologic interpretations have in directing molecular triage and therapy.

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