@article{cc19c401e0f34452b79d25e28d8648e6,
title = "Reproducibility of histopathological subtypes and invasion in pulmonary adenocarcinoma. An international interobserver study",
abstract = "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.",
keywords = "adenocarcinoma, histopathology, invasion, lung, reproducibility, subtyping",
author = "Erik Thunnissen and Beasley, {Mary Beth} and Borczuk, {Alain C.} and Elisabeth Brambilla and Chirieac, {Lucian R.} and Sanja Dacic and Douglas Flieder and Adi Gazdar and Kim Geisinger and Philip Hasleton and Yuichi Ishikawa and Kerr, {Keith M.} and Sylvie Lantejoul and Yoshiro Matsuno and Yuko Minami and Moreira, {Andre L.} and Noriko Motoi and Nicholson, {Andrew G.} and Masayuki Noguchi and Daisuke Nonaka and Giuseppe Pelosi and Iver Petersen and Natasha Rekhtman and Victor Roggli and Travis, {William D.} and Tsao, {Ming S.} and Ignacio Wistuba and Haodong Xu and Yasushi Yatabe and Maureen Zakowski and Birgit Witte and Kuik, {Dirk Joop}",
note = "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 Universit{\`a} 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",
year = "2012",
month = dec,
doi = "10.1038/modpathol.2012.106",
language = "English (US)",
volume = "25",
pages = "1574--1583",
journal = "Modern Pathology",
issn = "0893-3952",
publisher = "Nature Publishing Group",
number = "12",
}