Department of Respiratory Medicine, Level 1, Centre for Medical Research, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
Eur Respir J. 2012 Sep;40(3):699-705. doi: 10.1183/09031936.00109711. Epub 2012 Feb 9.
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) may diagnose suspected lung cancer. Determination of non-small cell lung cancer (NSCLC) subtype may guide therapy in select patients. Small-volume biopsies may be subject to significant interobserver variability in subtype determination. Three pathologists independently reviewed specimens from 60 patients who underwent EBUS-TBNA for diagnosis/staging of suspected/known NSCLC. Smear, haematoxylin and eosin (H&E) and immunohistochemistry (IHC) specimens were reviewed without reference to other specimen types obtained from the same patient. Final diagnoses, and degree of confidence in the diagnosis, were recorded for each specimen. Almost perfect agreement was seen for distinguishing between small cell lung cancer and NSCLC for all specimen types. Agreement in determination of NSCLC subtype for smear, H&E and IHC specimens was slight (κ=0.095, 95% CI -0.164-0.355), fair (κ=0.278, 95% CI 0.075-0.481) and moderate (κ=0.564, 95% CI 0.338-0.740), respectively. Perfect agreement was seen when all three observers were confident of diagnoses made on IHC specimens. Interobserver agreement in interpretation of EBUS-TBNA specimens is moderate for determination of NSCLC subtype. Agreement is highest following examination of IHC specimens. Clinicians should be aware of the degree of pathologist confidence in the tissue diagnosis prior to commencement of subtype-specific therapy for NSCLC.
经支气管超声引导下经支气管针吸活检（EBUS-TBNA）可用于诊断疑似肺癌。非小细胞肺癌（NSCLC）亚型的确定可能会指导特定患者的治疗。小体积活检在亚型确定方面可能存在显著的观察者间差异。3 位病理学家独立评估了 60 例接受 EBUS-TBNA 以诊断/分期疑似/已知 NSCLC 的患者的标本。对涂片、苏木精和伊红（H&E）和免疫组织化学（IHC）标本进行了无参考其他来自同一患者的标本类型的审查。为每个标本记录了最终诊断和对诊断的信心程度。对于所有标本类型，小细胞肺癌和 NSCLC 的区分几乎存在完美的一致性。对于涂片、H&E 和 IHC 标本的 NSCLC 亚型确定的一致性为轻微（κ=0.095，95%CI -0.164-0.355）、一般（κ=0.278，95%CI 0.075-0.481）和中度（κ=0.564，95%CI 0.338-0.740）。当所有 3 位观察者对 IHC 标本的诊断有信心时，观察到了完美的一致性。在确定 NSCLC 亚型方面，EBUS-TBNA 标本的观察者间一致性为中度。在检查 IHC 标本后，一致性最高。在开始 NSCLC 亚型特异性治疗之前，临床医生应该了解病理学家对组织诊断的信心程度。
