TY - JOUR
T1 - The use of immunohistochemistry improves the diagnosis of small cell lung cancer and its differential diagnosis : an international reproducibility study in a demanding set of cases
AU - Thunnissen, Erik
AU - Borczuk, Alain C.
AU - Flieder, Douglas B.
AU - Witte, Birgit
AU - Beasley, Mary Beth
AU - Chung, Jin-Haeng
AU - Dacic, Sanja
AU - Lantuejoul, Sylvie
AU - Russell, Prudence A.
AU - Bakker, Michael den
AU - Botling, Johan
AU - Brambilla, Elisabeth
AU - Cuba, Erienne de
AU - Geisinger, Kim R.
AU - Hiroshima, Kenzo
AU - Marchevsky, Alberto M.
AU - Minami, Yuko
AU - Moreira, Andre
AU - Nicholson, Andrew G.
AU - Yoshida, Akihiko
AU - Tsao, Ming-Sound
AU - Warth, Arne
AU - Duhig, Edwina
AU - Chen, Gang
AU - Matsuno, Yoshihiro
AU - Travis, William D.
AU - Butnor, Kelly
AU - Cooper, Wendy
AU - Mino-Kenudson, Mari
AU - Motoi, Noriko
AU - Poleri, Claudia
AU - Pelosi, Giuseppe
AU - Kerr, Keith
AU - Aisner, Seena C.
AU - Ishikawa, Yuichi
AU - Buettner, Reinhard H.
AU - Keino, Naoto
AU - Yatabe, Yasushi
AU - Noguchi, Masayuki
PY - 2017
Y1 - 2017
N2 - Introduction The current WHO classification of lung cancer states that a diagnosis of SCLC can be reliably made on routine histological and cytological grounds but immunohistochemistry (IHC) may be required, particularly (1) in cases in which histologic features are equivocal and (2) in cases in which the pathologist wants to increase confidence in diagnosis. However, reproducibility studies based on hematoxylin and eosin–stained slides alone for SCLC versus large cell neuroendocrine carcinoma (LCNEC) have shown pairwise κ scores ranging from 0.35 to 0.81. This study examines whether judicious use of IHC improves diagnostic reproducibility for SCLC. Methods Nineteen lung pathologists studied interactive digital images of 79 tumors, predominantly neuroendocrine lung tumors. Images of resection and biopsy specimens were used to make diagnoses solely on the basis of morphologic features (level 1), morphologic features along with requested IHC staining results (level 2), and all available IHC staining results (level 3). Results For the 19 pathologists reading all 79 cases, the rate of agreement for level 1 was 64.7%, and it increased to 73.2% and 77.5% in levels 2 and 3, respectively. With IHC, κ scores for four tumor categories (SCLC, LCNEC, carcinoid tumors, and other) increased in resection samples from 0.43 to 0.60 and in biopsy specimens from 0.43 to 0.64. Conclusions Diagnosis using hematoxylin and eosin staining alone showeds moderate agreement among pathologists in tumors with neuroendocrine morphology, but agreement improved to good in most cases with the judicious use of IHC, especially in the diagnosis of SCLC. An approach for IHC in the differential diagnosis of SCLC is provided.
AB - Introduction The current WHO classification of lung cancer states that a diagnosis of SCLC can be reliably made on routine histological and cytological grounds but immunohistochemistry (IHC) may be required, particularly (1) in cases in which histologic features are equivocal and (2) in cases in which the pathologist wants to increase confidence in diagnosis. However, reproducibility studies based on hematoxylin and eosin–stained slides alone for SCLC versus large cell neuroendocrine carcinoma (LCNEC) have shown pairwise κ scores ranging from 0.35 to 0.81. This study examines whether judicious use of IHC improves diagnostic reproducibility for SCLC. Methods Nineteen lung pathologists studied interactive digital images of 79 tumors, predominantly neuroendocrine lung tumors. Images of resection and biopsy specimens were used to make diagnoses solely on the basis of morphologic features (level 1), morphologic features along with requested IHC staining results (level 2), and all available IHC staining results (level 3). Results For the 19 pathologists reading all 79 cases, the rate of agreement for level 1 was 64.7%, and it increased to 73.2% and 77.5% in levels 2 and 3, respectively. With IHC, κ scores for four tumor categories (SCLC, LCNEC, carcinoid tumors, and other) increased in resection samples from 0.43 to 0.60 and in biopsy specimens from 0.43 to 0.64. Conclusions Diagnosis using hematoxylin and eosin staining alone showeds moderate agreement among pathologists in tumors with neuroendocrine morphology, but agreement improved to good in most cases with the judicious use of IHC, especially in the diagnosis of SCLC. An approach for IHC in the differential diagnosis of SCLC is provided.
UR - https://hdl.handle.net/1959.7/uws:63801
U2 - 10.1016/j.jtho.2016.12.004
DO - 10.1016/j.jtho.2016.12.004
M3 - Article
SN - 1556-0864
VL - 12
SP - 334
EP - 346
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 2
ER -