From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Yildiz-Aktas and Khalbuss); the Department of Pathology, Cellnetix, Everett, Washington (Dr Sturgis); the Department of Pathology, Loyola University, Maywood, Illinois (Dr Barkan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Louisville, Louisville, Kentucky (Dr Fraig); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); and the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty).
Arch Pathol Lab Med. 2014 Jan;138(1):65-70. doi: 10.5858/arpa.2013-0015-CP.
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.
背景-非小细胞肺癌（NSCLC）的亚型分类对于患者的最佳管理非常必要，因为特定的诊断会触发特定的分子检测，并影响治疗。目的-仅基于形态学评估美国病理学家学院（College of American Pathologists）实验室间比较计划（Interlaboratory Comparison Program）参与者诊断和亚型分类 NSCLC 细针抽吸（FNA）切片的准确性，同时考虑制片和参与者类型以及随时间的变化趋势。设计-回顾了 2007-2011 年 5 年期间该计划参与者的表现。使用非线性混合模型分析评估具有腺癌和鳞状细胞癌（SCC）参考诊断的肺 FNA 挑战在诊断一致性方面的表现。结果-有 10493 位病理学家和 6378 位细胞技术专家做出了回应，恶性肿瘤的一致性率分别为 97.4%和 97.9%。腺癌的亚分类总体一致性率为 54.6%，SCC 为 74.9%。对于确切的参考诊断，病理学家在腺癌方面的表现更好，细胞技术专家在 SCC 方面的表现更好。腺癌的准确亚分类随着时间的推移显著增加，2007 年有 31.5%的腺癌被归类为 NSCLC，2011 年有 25.5%的腺癌被归类为 NSCLC（P<.001）。在比较制片类型时，改良吉姆萨染色涂片的总体一致性最低（46.8%）。改良吉姆萨染色涂片的 SCC 最不可能被准确地亚分类（36.4%）。结论-参与者通过 FNA 熟练地判断 NSCLC 为恶性，但仅通过细胞形态学进行亚型分类的成功率较低。在研究期间，证实了亚分类腺癌准确性的统计学显著趋势，这表明参与者意识到更具体的细胞形态学解释在指导分子分诊和治疗方面的影响。
