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How reliable is the diagnosis of lung cancer using small biopsy
specimens? Report of a UKCCCR Lung Cancer Working Party.Thorax.
1993 Nov;48(11):1135-9.
BACKGROUND--A
study was undertaken to investigate the accuracy of typing of a
series of bronchial carcinomas by experienced pathologists with an
interest in lung cancer from the examination of bronchoscopic biopsy
specimens. METHODS--Eighty bronchial biopsy specimens showing
positive results for bronchial carcinoma were circulated to five
pathologists, who recorded diagnostic criteria and diagnosis for
each. Diagnoses were then compared with the diagnosis agreed from
the resection specimen corresponding to each biopsy specimen. A
"non-small cell carcinoma, not further specified" classification
group was introduced for small biopsy specimens. RESULTS--A
diagnostic accuracy of 75% was achieved for squamous cell
carcinomas, 66% for small cell carcinomas, and 50% for
adenocarcinomas. There was diagnostic confusion between small cell
and non-small cell carcinoma in less than 10% of cases. The
introduction of a non-specific non-small cell classification
improved diagnostic accuracy by 10-15% for each non-small cell
tumour group. CONCLUSIONS--There are appreciable inaccuracies in
applying the World Health Organisation's 1981 classification of lung
cancer to the diagnosis of bronchial carcinoma from small biopsy
specimens and these inaccuracies have been measured. They can be
diminished by introducing a less specific "non-small cell" category
for use with this sort of biopsy material. Care should be taken not
to overinterpret small biopsy specimens in lung cancer.
Diagnosis of
lung cancer by fibreoptic bronchoscopy: problems in the histological
classification of non-small cell carcinomas.Thorax.
1984 Mar;39(3):175-8.
Specific
cell typing in lung cancer has important implications for assessment
of prognosis and the planning of treatment. Cell typing is, however,
often difficult and the problem has been compounded by the universal
use of the flexible fibreoptic bronchoscope, which yields specimens
only 2 mm in diameter. We have reviewed the records of 107 patients
who had a diagnosis of lung cancer established by fibreoptic
bronchoscopy and who subsequently underwent staging biopsy or
surgical resection. Examination of tissue obtained by surgical
resection yielded a different cell type from that identified in
specimens obtained at fibreoptic bronchoscopy in 11 of 32 patients
with a bronchial biopsy specimen diagnostic of squamous cell, three
of 44 patients with a diagnosis of adenocarcinoma, six of seven
thought to have a poorly differentiated carcinoma, and 21 of 24
patients with a diagnosis of large cell carcinoma. In all, 41 of the
107 surgically removed specimens (38%) differed in cell type from
their corresponding bronchoscopic specimens. Accurate cell typing by
specimens obtained at fibreoptic bronchoscopy may be extremely
difficult. If clearcut morphological criteria cannot be satisfied,
the diagnosis of "lung cancer, non-small cell type" should be made.
Fibreoptic
bronchoscopy: effect of multiple bronchial biopsies on diagnostic
yield in bronchial carcinoma.Thorax.
1982 Sep;37(9):684-7
The findings
in bronchial biopsy specimens obtained at fibreoptic bronchoscopy in
271 patients with bronchial carcinoma were reviewed. Fifty-nine per
cent of 703 specimens taken from the site of bronchoscopically
visible tumours in 215 patients provided evidence of carcinoma.
Unequivocal histological evidence of carcinoma was obtained in 78.6%
of the 215 patients with visible tumours. When only one biopsy
specimen was taken evidence of carcinoma was obtained in 65.2% of
cases. At least five biopsy specimens were required to provide a
greater than 90% probability of obtaining at least one positive
sample. The anatomical site of the tumour had no significant effect
on the proportion of biopsy specimens that were positive or the
frequency of obtaining at least one positive sample. When extrinsic
bronchial compression was the only visible abnormality evidence of
carcinoma was obtained by bronchial biopsy in 26.8% of 56 cases.
Bronchoscopic and percutaneous aspiration biopsy in the diagnosis of
bronchial carcinoma cell type.Thorax.
1982 Jun;37(6):462-5.
The cell
type of bronchial carcinoma predicted from the results of bronchial
biopsy at fibreoptic or rigid bronchoscopy or of percutaneous
aspiration lung biopsy was compared with the type determined by
histological examination of specimens obtained by thoracotomy,
biopsy of an extrapulmonary metastasis, or necropsy in 180 cases.
The rates of agreement with the final diagnosis were 95.7% for
bronchial biopsy through the fibreoptic bronchoscope and 86.5%
through the rigid bronchoscope. For percutaneous biopsy, which was
usually carried out on tumours inaccessible to the bronchoscope, the
rate of agreement was 61%, significantly lower than by the other
methods (p less than 0.001). The diagnosis of oat-cell carcinoma by
any technique was very reliable. Bronchial biopsy was more reliable
than was percutaneous biopsy in diagnosing squamous-cell carcinoma.
With any technique the commonest error was the incorrect diagnosis
of squamous-cell carcinoma or adenocarcinoma as large-cell
undifferentiated carcinoma.
Observer
variability in histopathological reporting of non-small cell lung
carcinoma on bronchial biopsy specimens.J
Clin Pathol. 1996 Feb;49(2):130-3
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 Schiff). 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 kappa statistics. RESULTS: Where
the participants were confident in their classification, they were
actually quite good at sub-classifying the non-small cell carcinoma
sections (kappa = 0.71, standard error = 0.058). Overall, however,
the results were only fair (kappa = 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 (kappa = 0.73)
and adenocarcinoma (kappa = 0.83) were well recognised.
Observer
variability in histopathological reporting of malignant bronchial
biopsy specimens.J
Clin Pathol. 1994 Aug;47(8):711-3.
AIMS--To
evaluate the ability of histopathologists to classify lung
carcinomas on bronchial biopsy material using the current World
Health Organisation (WHO) classification. METHODS--Eleven
histopathologists each reviewed 100 randomly selected bronchial
biopsy specimens which had originally been reported as showing lung
carcinoma. A single haematoxylin and eosin stained section from each
case was circulated and a standard proforma completed. These were
analysed using kappa statistics. RESULTS--The histopathologists were
excellent at distinguishing between small cell and non-small-cell
carcinoma kappa = 0.86), but not so good at subclassifying the
non-small cell carcinoma group kappa = 0.25). CONCLUSIONS--The
clinically important distinction between small cell and non-small
cell carcinoma of the lung is reliably made by competent
histopathologists even on limited material.
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