Interobserver agreement among histological patterns and diagnosis in lung adenocarcinomas

Abstract

Objective:The aim of this study was to investigate the interobserver agreement in determination of the dominant histological pattern and the final diagnosis in lung adenocarcinomas. Material and Method:A total of 12 patients with a diagnosis of primary lung adenocarcinoma were included in the study. twelve pathologists from eight study centers were asked first to determine the dominant histological pattern in these cases and then to decide whether the final diagnosis was in situ, minimally invasive or invasive adenocarcinoma. Results:The kappa value for the agreement in determining the dominant pattern among the pathologists was 0.36 (p<0.001), with the values for the lepidic, acinar, papillary, solid, micropapillary patterns and mucinous character of adenocarcinoma being 0.34, 0.28, 0.30, 0.80, 0.16 and 0.38 respectively (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). none of the cases was diagnosed as in situ adenocarcinoma. On the other hand, the kappa value for the agreement in differentiating minimally invasive from invasive adenocarcinoma among reviewers was 0.17 (p<0.001). Conclusion:The agreement among pathologists in determining the subtype of lung adenocarcinomas that depends on the identification of the dominant pattern was at intermediate level. In addition, the agreement in deciding whether the case is minimally invasive or invasive, was at low level. The criteria defining the histological patterns should be clarified and described in more detail. Educational activities and larger multicenter studies might be helpful in improving the agreement and standardization. ÖZAmaç: bu çalışmanın amacı, akciğer adenokarsinomunda baskın histolojik patern belirlemede ve nihai tanı konusunda değerlendiriciler arası uyumun araştırılmasıdır. Gereç ve Yöntem:Komplet cerrahi rezeksiyon uygulanan ve mikst tipte primer akciğer adenokarsinom tanılı 12 olgu çalışmaya alındı. Çalışma sekiz merkezden 12 patologun katılımı ile yapıldı. Değerlendiricilerden baskın patern tayini ile son tanı olarak invaziv adenokarsinom, minimal invaziv adenokarsinom arasında seçim yapmaları istendi. Bulgular: Patologlar arasında baskın patern uyumunda kappa değeri 0.36 idi. lepidik, asiner, papiller, solid, mikropapiller ve musinöz paternde uyum sırasıyla 0,34, 0,28, 0,30, 0,80, 0,16, 0,38 (p<0,001, p<0,001, p<0,001, p<0,001, p<0,001, p<0,001) idi. Hiçbir olgu in situ adenokarsinom tanısı almadı. Minimal invaziv adenokarsinom ve invaziv adenokarsinom tanısı için değerlendiriciler arasındaki uyum düşüktü (kappa değeri 0,17 (p<0,001)).Sonuç: Patologlar arası akciğer adenokarsinomunu baskın patern saptamasında uyum orta düzeyde bulundu. Minimal invaziv adenokarsinom ile İAK arası uyum ise düşük düzeyde idi. Histolojik patern kriterleri daha açık ve daha detaylı olarak tanımlanmalıdır. Eğitim programları ve çok merkezli çalışmalar tanıların standardizasyon ve uyumunu geliştirilebilir.

8th Edition Tumor, Node, and Metastasis T-Stage Prognosis Discrepancies: Solid Component Diameter Predicts Prognosis Better than Invasive Component Diameter

“…However, this problem is not only in our facility but also in pathological diagnostic centers worldwide. This is because the concordance rate for the pathological diagnosis of lung adenocarcinoma, especially for invasion, is known to be low, even among pulmonary pathologists [ 3 , 4 ]. Six pulmonary pathologists digitally reviewed 60 slides of small lung adenocarcinoma in three rounds, and interobserver agreement was fair to moderate; the range of the measured invasive component in a single case was up to 19.2 mm among observers [ 15 ].…”

“…For some time, there have been disagreements among pathologists regarding the diagnosis of lung adenocarcinoma subtypes [ 3 ]. When lung adenocarcinoma diagnoses individually reviewed by two lung pathologists are compared, the diagnostic concordance is only 82.4% [ 4 ].…”

“…Moreover, the measurement of the pathological invasion diameter differs among pathologists who specialize in lung cancer. Urer et al reported that the agreement between deciding whether the case is minimally invasive or invasive was low [ 3 ]. General hospitals, more so than high-volume centers dedicated to cancer, often question the accuracy of the diameter of pathological invasion measurements in signifying invasiveness.…”

Large nest micropapillary pattern of lung adenocarcinoma has poorer prognosis than typical floret pattern: analysis of 1,062 resected tumors

“…However, the MP-p criteria fail to define a "large tumor cell nest which does not form a pseudo papillary structure". This flaw in the MP-p definition may cause considerable discrepancies in MP-p diagnosis among different observers (11)(12)(13).…”

“…All specimens were reviewed by two pathologists (KK and AY) who were blinded to patient information, and all histological parameters were established by consensus after discussion. The average number of tumor specimens reviewed for each case was 3.3 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. According to the 2015 WHO classification (1), each tumor was subjected to comprehensive histological subtyping, and the percentage of each histological component was recorded in 5% increments.…”