From the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City. Dr Murugan is now with MD Anderson Cancer Center, Houston, Texas.
Arch Pathol Lab Med. 2014 Jan;138(1):105-9. doi: 10.5858/arpa.2012-0750-OA.
The new, international, multidisciplinary classification of lung adenocarcinoma, from the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society, presents a paradigm shift for diagnostic pathologists.
To validate our ability to apply the recommendations in reporting on non-small cell lung cancer cases.
A test based on the new non-small cell lung cancer classification was administered to 16 pathology faculty members, senior residents, and fellows before and after major educational interventions, which included circulation of articles, electronic presentations, and live presentations by a well-known lung pathologist. Surgical and cytologic (including cell-block material) reports of lung malignancies for representative periods before and after the educational interventions were reviewed for compliance with the new guidelines. Cases were scored on a 3-point scale, with 1 indicating incorrect terminology and/or highly inappropriate stain use, 2 indicating correct diagnostic terminology with suboptimal stain use, and 3 indicating appropriate diagnosis and stain use. The actual error type was also evaluated.
The average score on initial testing was 55%, increasing to 88% following the educational interventions (60% improvement). Of the 54 reports evaluated before intervention, participants scored 3 out of 3 points on 15 cases (28%), 2 of 3 on 31 cases (57%), and 1 of 3 on 8 cases (15%). Incorrect use of stains was noted in 23 of 54 cases (43%), incorrect terminology in 15 of 54 cases (28%), and inappropriate use of tissue, precluding possible molecular testing, in 4 out of 54 cases (7%). Of the 55 cases after intervention, participants scored 3 out of 3 points on 46 cases (84%), 2 of 3 on 8 cases (15%), and 1 of 3 on 1 case (2%). Incorrect use of stains was identified in 9 of 55 cases (16% of total reports), and inappropriate use of tissue, precluding possible molecular testing, was found in 1 of the 55 cases (2%).
The study results demonstrated marked improvement in the pathologists' understanding and application of the new non-small cell lung cancer classification recommendations, which was sufficient to validate our use of the system in routine practice. The results also affirm the value of intensive education on, and validation of, pathologists' use of a classification or diagnostic algorithm.
国际肺癌研究协会/美国胸科学会/欧洲呼吸学会发布的新的国际性、多学科肺腺癌分类为诊断病理学家带来了范式转变。
验证我们在报告非小细胞肺癌病例时应用这些建议的能力。
在主要教育干预之前和之后，对 16 名病理科教员、高级住院医师和研究员进行了一项基于新的非小细胞肺癌分类的测试，其中包括文章传阅、电子演示和由知名肺病理学家进行的现场演示。在教育干预之前和之后的代表性时期，对肺癌的手术和细胞学（包括细胞块材料）报告进行了审查，以确定其是否符合新指南。病例按 3 分制评分，1 分表示术语不正确和/或染色使用不当，2 分表示诊断术语正确但染色使用不当，3 分表示诊断和染色使用恰当。还评估了实际错误类型。
初始测试的平均得分为 55%，在教育干预后提高到 88%（提高了 60%）。在 54 份报告中，有 15 份（28%）参与者得 3 分，31 份（57%）得 2 分，8 份（15%）得 1 分。在 54 份报告中，有 23 份（43%）存在染色使用不当，15 份（28%）存在术语不正确，4 份（7%）存在组织使用不当，无法进行可能的分子检测。在 55 份干预后的报告中，有 46 份（84%）得 3 分，8 份（15%）得 2 分，1 份（2%）得 1 分。有 9 份（16%的总报告）存在染色使用不当，1 份（2%）存在组织使用不当，无法进行可能的分子检测。
研究结果表明，病理学家对新的非小细胞肺癌分类建议的理解和应用有了显著提高，这足以验证我们在常规实践中使用该系统的能力。研究结果还肯定了对病理学家使用分类或诊断算法进行强化教育和验证的价值。
