Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden.
Department of Genetics and Pathology, Laboratory Medicine Region Skåne, Lund, Sweden.
J Clin Pathol. 2022 May;75(5):302-309. doi: 10.1136/jclinpath-2020-207257. Epub 2021 Feb 5.
Accurate and reliable diagnosis is essential for lung cancer treatment. The study aim was to investigate interpathologist diagnostic concordance for pulmonary tumours according to WHO diagnostic criteria.
Fifty-two unselected lung and bronchial biopsies were diagnosed by a thoracic pathologist based on a broad spectrum of immunohistochemical (IHC) stainings, molecular data and clinical/radiological information. Slides stained with H&E, thyroid transcription factor-1 (TTF-1) clone SPT24 and p40 were scanned and provided digitally to 20 pathologists unaware of reference diagnoses. The pathologists independently diagnosed the cases and stated if further diagnostic markers were deemed necessary.
In 31 (60%) of the cases, ≥80% of the pathologists agreed with each other and with the reference diagnosis. Lower agreement was seen in non-small cell neuroendocrine tumours and in squamous cell carcinoma with diffuse TTF-1 positivity. Agreement with the reference diagnosis ranged from 26 to 45 (50%-87%) for the individual pathologists. The pathologists requested additional IHC staining in 15-44 (29%-85%) of the 52 cases. In nearly half (17 of 36) of the malignant cases, one or more pathologist advocated for a different final diagnosis than the reference without need of additional IHC markers, potentially leading to different clinical treatment.
Interpathologist diagnostic agreement is moderate for small unselected bronchial and lung biopsies based on a minimal panel of markers. Neuroendocrine morphology is sometimes missed and TTF-1 clone SPT24 should be interpreted with caution. Our results suggest an intensified education need for thoracic pathologists and a more generous use of diagnostic IHC markers.
准确和可靠的诊断对于肺癌的治疗至关重要。本研究旨在根据世界卫生组织（WHO）的诊断标准，调查肺肿瘤的病理学家间诊断一致性。
一位胸科病理学家根据广泛的免疫组化（IHC）染色、分子数据和临床/影像学信息，对 52 例未经选择的肺和支气管活检进行诊断。用 H&E、甲状腺转录因子-1（TTF-1）克隆 SPT24 和 p40 染色的切片进行扫描，并以数字形式提供给 20 名不了解参考诊断的病理学家。病理学家独立诊断病例，并表示是否需要进一步的诊断标志物。
在 31 例（60%）病例中，≥80%的病理学家彼此之间以及与参考诊断意见一致。非小细胞神经内分泌肿瘤和弥漫性 TTF-1 阳性的鳞状细胞癌的一致性较低。20 名病理学家中，每位病理学家的诊断与参考诊断的一致性从 26%到 45%不等（50%-87%）。在 52 例病例中，有 15-44 例（29%-85%）病理学家要求进行额外的 IHC 染色。在近一半（36 例中的 17 例）恶性病例中，一位或多位病理学家在不需要额外的 IHC 标志物的情况下，主张与参考诊断不同的最终诊断，这可能导致不同的临床治疗。
在基于最小标志物面板的情况下，对小的未经选择的支气管和肺活检，病理学家间的诊断一致性为中等。神经内分泌形态有时会被遗漏，并且 TTF-1 克隆 SPT24 的解读应谨慎。我们的结果表明，胸科病理学家需要加强教育，更广泛地使用诊断性 IHC 标志物。
