The histopathology of bronchogenic carcinoma and its relation to growth rate, metastasis, and prognosis

Abstract

During the course of a prospective study in which 6,136 older men were examined by photofluorogram and questionnaire every 6 months, 179 developed proved bronchogenic carcinoma. Histologic sections were obtained in 161 cases and classified by a panel of 3 pathologists using a modified World Health Organization classification. The panel agreed with the diagnoses made by the hospital pathologists in most of those originally classified as squamous cell or adenocarcinoma but classified 30% of the undifferentiated carcinomas as squamous cell tumors. The panelists placed most of these in the anaplastic subgroup (lc). Unanimity was highest for squamous cell carcinoma and within this group the extent of agreement was best for the most highly differentiated subgroup (la). Five‐year survival rates were poor (10%), but equal for men with squamous cell and adenocarcinoma. These findings can be explained by the biologic character of the cancer types; squamous cell carcinomas have rapid growth rates and moderate metastatic potential, while adenocarcinomas have slow growth rates but high metastatic potential.

Environmental Associations and Histopathologic Patterns of Carcinoma of the Lung: The Challenge and Dilemma in Epidemiologic Studies

“…A study by Feinstein and associates (75), among 5 pathologists who reviewed 50 lung cancers, revealed a between-observer variability of 2 to 42070 (most marked for poorly differentiated specimens), and a within-observer variability of 2 to 20070. Weiss and associates (76) reported only 400/0 unanimity among 3 pathologists in a review of 161 cases of lung cancer. The poorest agreement, 250/0, occurred with small cell carcinoma.…”

“…It is unfortunate that observer variability was not reported in the studies of the uranium miners, particularly in view of the 25% disagreement reported in earlier studies among pathologists diagnosing small cell carcinoma (75,76). The effect of age on distributions of cell types of lung cancer requires careful attention in studies of environmental exposures inasmuch as small cell carcinoma seems to have a high proportion in young age groups, whereas squamous carcinoma has a high proportion in older age groups (table 2).…”

Survival Rates of Lung Cancer According to Histological Type

“…The various ways in which the data have been reported make it almost impossible to refer to the results of other series and make a comparison. However, there have been discrepancies in prognosis, mainly for squamous cell and adenocarcinoma, in series in which tumours have been classified under the same histological headings (Galofre' et al, 1964;Jackman et al;Jones et al, 1967;Weiss et al, 1970). One may say that unanimity in criteria for classification does not exist (Weiss et al, 1970).…”

“…However, there have been discrepancies in prognosis, mainly for squamous cell and adenocarcinoma, in series in which tumours have been classified under the same histological headings (Galofre' et al, 1964;Jackman et al;Jones et al, 1967;Weiss et al, 1970). One may say that unanimity in criteria for classification does not exist (Weiss et al, 1970). However, as the survival pattern by histological type varies in relation to the stage of the tumour, discrepancies in survival reported by other authors may reasonably be accepted as a different distribution by stage of the tumours in the various series.…”

Diagnostic agreement in the histopathological evaluation of lung cancer tissue in a population-based case-control study

“…Weiss et al observed that the agreement between pathologists increases if more than one slides is available for review [31]. However, this study was conducted before the introduction of the WHO 1981 classification and it is not clear whether their results are generalizable to the current classification and currently available ancillary techniques.…”