Department of Pathology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Histopathology. 2010 Feb;56(3):356-63. doi: 10.1111/j.1365-2559.2010.03486.x.
To test the hypothesis that the published morphological criteria permit reliable segregation of small cell carcinoma of the lung (SCLC) and large cell neuroendocrine carcinoma (LCNEC) cases by determining the interobserver variation.
One hundred and seventy cases of SCLC, LCNEC and cases diagnosed as neuroendocrine lung carcinoma before LCNEC had been established as a diagnostic category were retrieved from the archives of the assessor's institutes. A representative haematoxylin and eosin section from each case was selected for review. Batches of cases were circulated among nine pathologists with a special interest in pulmonary pathology. Participants were asked to classify the cases histologically according to the 2004 World Health Organization (WHO) criteria. The diagnoses were collected and kappa values calculated. Unanimity of diagnosis was achieved for only 20 cases; a majority diagnosis was reached for 115 cases. In 35 cases no consensus diagnosis could be reached. There was striking variability amongst assessors in diagnosing SCLC and LCNEC. The overall level of agreement for all cases included in this study was fair (kappa=0.40).
Using non-preselected cases, the morphological WHO criteria for diagnosing SCLC and LCNEC leave room for subjective pathological interpretation, which results in imprecise categorization of SCLC and LCNEC cases.
通过确定观察者间的变异来检验发表的形态学标准是否能够可靠地区分小细胞肺癌（SCLC）和大细胞神经内分泌癌（LCNEC）的假设。
从评估机构的档案中检索了 170 例 SCLC、LCNEC 和在 LCNEC 被确立为诊断类别之前被诊断为神经内分泌肺癌的病例。从每个病例中选择一个有代表性的苏木精和伊红切片进行审查。将病例分批分发给 9 位对肺部病理学有特殊兴趣的病理学家。要求参与者根据 2004 年世界卫生组织（WHO）标准对病例进行组织学分类。收集诊断并计算kappa 值。只有 20 例达到一致诊断；115 例达到多数诊断。在 35 例中，无法达成共识诊断。在诊断 SCLC 和 LCNEC 方面，评估者之间存在显著的差异。包括在本研究中的所有病例的总体一致性水平为中等（kappa=0.40）。
使用非预选病例，用于诊断 SCLC 和 LCNEC 的形态学 WHO 标准存在主观病理解释的空间，这导致 SCLC 和 LCNEC 病例的分类不准确。
