TY - JOUR
T1 - Reproducibility of histopathological subtypes and invasion in pulmonary adenocarcinoma. An international interobserver study
AU - Thunnissen, Erik
AU - Beasley, Mary Beth
AU - Borczuk, Alain C.
AU - Brambilla, Elisabeth
AU - Chirieac, Lucian R.
AU - Dacic, Sanja
AU - Flieder, Douglas
AU - Gazdar, Adi
AU - Geisinger, Kim
AU - Hasleton, Philip
AU - Ishikawa, Yuichi
AU - Kerr, Keith M.
AU - Lantejoul, Sylvie
AU - Matsuno, Yoshiro
AU - Minami, Yuko
AU - Moreira, Andre L.
AU - Motoi, Noriko
AU - Nicholson, Andrew G.
AU - Noguchi, Masayuki
AU - Nonaka, Daisuke
AU - Pelosi, Giuseppe
AU - Petersen, Iver
AU - Rekhtman, Natasha
AU - Roggli, Victor
AU - Travis, William D.
AU - Tsao, Ming S.
AU - Wistuba, Ignacio
AU - Xu, Haodong
AU - Yatabe, Yasushi
AU - Zakowski, Maureen
AU - Witte, Birgit
AU - Kuik, Dirk Joop
N1 - Funding Information:
1Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands; 2Mount Sinai Hospital, New York, NY, USA; 3Department of Pathology, Anatomic Pathology Columbia University Medical Center, New York, NY, USA; 4Department of Pathology, CHU A Michallon, INSERM U 823-Institut A Bonniot-University J Fourier, Grenoble, France; 5Department of Pathology, Brigham and Women′s Hospital, Boston, MA, USA; 6Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA; 7Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA; 8UT Southwestern Medical Center, Dallas, TX, USA; 9Piedmont Pathology Associates, Hickory, NC, USA; 10Department of Pathology, Hadassah Hospital, Jerusalem, Israel; 11Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan; 12Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK; 13Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; 14Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 15Department of Histopathology, Royal Brompton Hospital, London, UK; 16Department of Histopathology, The Christie NHS Foundation, Manchester, UK; 17Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori and Università degli Studi di Milano, Milan, Italy; 18Institute of Pathology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany; 19DUMC 3712, Durham, NC, USA; 20Department of Pathology, University Health Network-Princess Margaret Hospital and University of Toronto, Toronto, Canada; 21Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 22Department of Pathology and Laboratory Medicine, Aab Cardiovascular Research Institute, University of Rochester Medical Center, Rochester, NY, USA; 23Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan and 24Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
PY - 2012/12
Y1 - 2012/12
N2 - Histological subtyping of pulmonary adenocarcinoma has recently been updated based on predominant pattern, but data on reproducibility are required for validation. This study first assesses reproducibility in subtyping adenocarcinomas and then assesses further the distinction between invasive and non-invasive (wholly lepidic) pattern of adenocarcinoma, among an international group of pulmonary pathologists. Two ring studies were performed using a micro-photographic image-based method, evaluating selected images of lung adenocarcinoma histologic patterns. In the first study, 26 pathologists reviewed representative images of typical and difficult histologic patterns. A total number of scores for the typical patterns combined (n94) and the difficult cases (n21) were 2444 and 546, respectively. The mean kappa score (±s.d.) for the five typical patterns combined and for difficult cases were 0.77±0.07 and 0.38±0.14, respectively. Although 70% of the observers identified 12-65% of typical images as single pattern, highest for solid and least for micropapillary, recognizing the predominant pattern was achieved in 92-100%, of the images except for micropapillary pattern (62%). For the second study on invasion, identified as a key problem area from the first study, 28 pathologists submitted and reviewed 64 images representing typical as well as difficult examples. The kappa for typical and difficult cases was 0.55±0.06 and 0.08±0.02, respectively, with consistent subdivision by the same pathologists into invasive and non-invasive categories, due to differing interpretation of terminology defining invasion. In pulmonary adenocarcinomas with classic morphology, which comprise the majority of cases, there is good reproducibility in identifying a predominant pattern and fair reproducibility distinguishing invasive from in-situ (wholly lepidic) patterns. However, more precise definitions and better education on interpretation of existing terminology are required to improve recognition of purely in-situ disease, this being an area of increasing importance.
AB - Histological subtyping of pulmonary adenocarcinoma has recently been updated based on predominant pattern, but data on reproducibility are required for validation. This study first assesses reproducibility in subtyping adenocarcinomas and then assesses further the distinction between invasive and non-invasive (wholly lepidic) pattern of adenocarcinoma, among an international group of pulmonary pathologists. Two ring studies were performed using a micro-photographic image-based method, evaluating selected images of lung adenocarcinoma histologic patterns. In the first study, 26 pathologists reviewed representative images of typical and difficult histologic patterns. A total number of scores for the typical patterns combined (n94) and the difficult cases (n21) were 2444 and 546, respectively. The mean kappa score (±s.d.) for the five typical patterns combined and for difficult cases were 0.77±0.07 and 0.38±0.14, respectively. Although 70% of the observers identified 12-65% of typical images as single pattern, highest for solid and least for micropapillary, recognizing the predominant pattern was achieved in 92-100%, of the images except for micropapillary pattern (62%). For the second study on invasion, identified as a key problem area from the first study, 28 pathologists submitted and reviewed 64 images representing typical as well as difficult examples. The kappa for typical and difficult cases was 0.55±0.06 and 0.08±0.02, respectively, with consistent subdivision by the same pathologists into invasive and non-invasive categories, due to differing interpretation of terminology defining invasion. In pulmonary adenocarcinomas with classic morphology, which comprise the majority of cases, there is good reproducibility in identifying a predominant pattern and fair reproducibility distinguishing invasive from in-situ (wholly lepidic) patterns. However, more precise definitions and better education on interpretation of existing terminology are required to improve recognition of purely in-situ disease, this being an area of increasing importance.
KW - adenocarcinoma
KW - histopathology
KW - invasion
KW - lung
KW - reproducibility
KW - subtyping
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U2 - 10.1038/modpathol.2012.106
DO - 10.1038/modpathol.2012.106
M3 - Review article
C2 - 22814311
AN - SCOPUS:84870536556
VL - 25
SP - 1574
EP - 1583
JO - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
SN - 0893-3952
IS - 12
ER -