Observer variability in histopathological reporting of non-small cell lung carcinoma on bronchial biopsy specimens.

Abstract

Aims-To evaluate the ability of histopathologists to sub-classify non-small cell lung carcinomas on bronchial biopsy material using the current World Health Organisation (WHO) classification. Methods-Twelve histopathologists each reviewed 100 randomly selected bronchial biopsy specimens which had originally been reported as showing non-small cell lung carcinoma. For each case, two sections were circulated, one stained by haematoxylin and eosin and the other by a standard method for mucin (alcian blue/ periodic acid Schifi). The participants were allowed to indicate their degree of confidence in their classification of each case. A standard proforma was completed and the results were analysed using K statistics. Results-Where the participants were confident in their classification, they were actually quite good at sub-classifying the non-small cell carcinoma sections (K = 0-71, standard error=0.058). Overall, however, the results were only fair (K= 0'39, standard error= 0.034). Conclusions-The majority of non-small cell lung carcinomas can be correctly categorised on adequate bronchial biopsy material. Where a confident diagnosis was made, both squamous carcinoma (K = 0.73) and adenocarcinoma (K = 0-83) were well recognised. (J Clin Pathol 1996;49:130-133)

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

“…However, agreement is lower for determination of NSCLC subtype. The agreement seen for both determination of NSCLC subtype (k50.278, 95% CI 0.075-0.481) and distinction of SCLC from NSCLC is consistent with agreement previously reported for bronchial biopsy specimens [8,22,23].…”

“…Interobserver agreement and confidence may differ based on the experience of reporting pathologists. While agreement may be higher between experienced pulmonary pathologists, interobserver agreement noted in this study is comparable to that reported by BURNETT et al [8] among pathologists not experienced in evaluation of lung pathology. This suggests that our findings may accurately represent clinical practice in the majority of centres worldwide where anatomical pathologists report on EBUS-TBNA specimens rather than specialist pulmonary pathologists.…”

“…The study did not use IHC to achieve cytological diagnosis nor did the authors examine interobserver variability in cytological diagnosis, which our study suggests may be significant, and for 60% of patients, only endobronchial biopsies were available as the reference test. Given the significant interobserver variability [8] and limited diagnostic accuracy [23] for such specimens, the clinical utility of these findings is uncertain.…”

“…Diagnoses were recorded on a specifically designed pro forma, first utilised by BURNETT et al [8] and outlined in the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS )/European Respiratory Society (ERS) guidelines for classification of NSCLC in small biopsy/cytology specimens [12]. Pathologists were also asked to record on the form whether they were confident or had some doubt regarding the diagnosis.…”

“…Significant interobserver variability between pathologists in the subclassification of NSCLC subtypes in small specimens obtained at routine flexible bronchoscopy has previously been observed, with only ''fair'' agreement observed among pathologists examining NSCLC in endobronchial biopsies [8]. Cytological specimens are subject to significantly higher interobserver variability than histologic specimens [9].…”