Minami Yuko, Takenaka Akemi, Hiroshima Kenzo, Yoshizawa Akihiko, Haba Reiji, Kawahara Kunimitsu, Shibuki Yasuo, Miyake Shinji, Kakinuma Hirokuni, Satoh Yukitoshi
Department of Diagnostic Pathology, National Hospital Organization Ibarakihigashi National Hospital the Center of Chest Diseases and Severe Motor & Intellectual Disabilities, Tokai-mura, Japan.
Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Acta Cytol. 2025;69(4):386-398. doi: 10.1159/000546179. Epub 2025 May 28.
Since no universal cytological classification system for lung cancer has been established, the Japanese Lung Cancer Society and the Japanese Society of Clinical Cytology (JSCC) jointly established and reported four cytological categories: negative for malignancy, atypical cells, suspicious for malignancy, and malignancy. In 2022, the WHO Reporting System for Lung Cytopathology was published. This system presented five cytological classifications, including the four cytological category classifications above and insufficient/inadequate/nondiagnostic. The creation of a classification alone is not practical in actual clinical practice. Thus, we evaluated the reproducibility of the classification through tutorials and identified the issues and problems involved in the wide dissemination of this classification.
Forty-two cases were selected from those used in previously published articles, and diagnosis and tutorial systems were created. The first diagnostic round and tutorial and the second diagnostic round were conducted on the web. Participants were recruited via the JSCC website and emails. Images (×100 and ×400) of the lesions to be diagnosed were categorizing by 4 cytological categories (benign, atypical, suspicious for malignancy, malignant), 7 suggestive pathological diagnoses, and 4 cytological features. The mean correct or incorrect answer rates for the 42 cases and the mean correct response rates for 105 participants were compared between the first and second rounds using McNemar's test and t tests to identify cases with diagnostic difficulties and high tutorial effects.
Comparing the correct response to cytological categories, the results showed that 17 of 42 cases improved significantly. The mean number of correct answers for the four cytological categories increased significantly from 16.0 (38.1%) in the first round to 20.3 (48.3%) in the second round (p < 0.001). For the seven suggestive pathological diagnoses, the mean number of correct answers increased significantly from 20.3 (48.3%) in the first round to 25.1 (59.8%) in the second round (p < 0.001). The mean number of correct responses increased significantly from 40.2 (38%) in the first round to 51.5 (49%) in the second round (p = 0.0147). Four cases were difficult to match even after the tutorial and three cases were highly affected by the tutorial. The most important basis for diagnoses was nuclear findings in the first and second rounds.
Comprehensive tutorials on diagnostic criteria are needed to effectively implement this system globally. In particular, devising ways to appropriately diagnose cancers with mild atypia or without characteristic morphology is important.
由于尚未建立通用的肺癌细胞学分类系统，日本肺癌协会和日本临床细胞学学会（JSCC）联合制定并报告了四种细胞学类别：恶性阴性、非典型细胞、恶性可疑和恶性。2022年，世界卫生组织肺细胞病理学报告系统发布。该系统提出了五种细胞学分类，包括上述四种细胞学类别分类以及不足/不充分/无法诊断。仅创建一个分类在实际临床实践中并不实用。因此，我们通过教程评估了该分类的可重复性，并确定了该分类广泛传播所涉及的问题。
从先前发表的文章中使用的病例中选取42例，创建诊断和教程系统。第一轮诊断及教程和第二轮诊断在网上进行。参与者通过JSCC网站和电子邮件招募。将待诊断病变的图像（×100和×400）按照4种细胞学类别（良性、非典型、恶性可疑、恶性）、7种提示性病理诊断和4种细胞学特征进行分类。使用McNemar检验和t检验比较42例病例第一轮和第二轮的平均正确或错误回答率以及105名参与者的平均正确回答率，以确定诊断困难的病例和教程效果显著的病例。
比较细胞学类别的正确回答情况，结果显示42例病例中有17例有显著改善。四种细胞学类别的平均正确回答数从第一轮的16.0（38.1%）显著增加到第二轮的20.3（48.3%）（p<0.001）。对于七种提示性病理诊断，平均正确回答数从第一轮的20.3（48.3%）显著增加到第二轮的25.1（59.8%）（p<0.001）。平均正确回答数从第一轮的40.2（38%）显著增加到第二轮的51.5（49%）（p = 0.0147）。4例病例即使在教程后仍难以匹配，3例病例受教程影响很大。第一轮和第二轮诊断的最重要依据都是核特征。
需要开展关于诊断标准的全面教程，以便在全球有效实施该系统。特别是，设计出适当诊断轻度非典型或无特征形态癌症的方法很重要。
