BACKGROUND: Distinguishing small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC) of the lung is difficult with little information about interobserver variability. METHODS: One hundred twenty-nine cases of resected SCLC and LCNEC were independently evaluated by four pathologists and classified according to the 2004 World Health Organization criteria. Agreement was regarded as "unanimous" if all four pathologists agreed on the classification. The kappa statistic was calculated to measure the degree of agreement between pathologists. We also measured cell size using image analysis, and receiver-operating-characteristic curve analysis was performed to evaluate cell size in predicting the diagnosis of high-grade neuroendocrine (NE) carcinomas in 66 cases. RESULTS: Unanimous agreement was achieved in 55.0% of 129 cases. The kappa values ranged from 0.35 to 0.81. Morphometric analysis reaffirmed that there was a continuous spectrum of cell size from SCLC to LCNEC and showed that tumors with cells falling in the middle size range were difficult to categorize and lacked unanimous agreement. CONCLUSIONS: Our results provide an objective explanation for considerable interobserver variability in the diagnosis of high-grade pulmonary NE carcinomas. Further studies would need to define more stringent and objective definitions of cytologic and architectural characteristics to reliably distinguish between SCLC and LCNEC.
BACKGROUND: Distinguishing small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC) of the lung is difficult with little information about interobserver variability. METHODS: One hundred twenty-nine cases of resected SCLC and LCNEC were independently evaluated by four pathologists and classified according to the 2004 World Health Organization criteria. Agreement was regarded as "unanimous" if all four pathologists agreed on the classification. The kappa statistic was calculated to measure the degree of agreement between pathologists. We also measured cell size using image analysis, and receiver-operating-characteristic curve analysis was performed to evaluate cell size in predicting the diagnosis of high-grade neuroendocrine (NE) carcinomas in 66 cases. RESULTS: Unanimous agreement was achieved in 55.0% of 129 cases. The kappa values ranged from 0.35 to 0.81. Morphometric analysis reaffirmed that there was a continuous spectrum of cell size from SCLC to LCNEC and showed that tumors with cells falling in the middle size range were difficult to categorize and lacked unanimous agreement. CONCLUSIONS: Our results provide an objective explanation for considerable interobserver variability in the diagnosis of high-grade pulmonary NE carcinomas. Further studies would need to define more stringent and objective definitions of cytologic and architectural characteristics to reliably distinguish between SCLC and LCNEC.
Entities:
Keywords:
Image analysis; Large cell neuroendocrine carcinoma; Lung; Observer variation; Small cell lung carcinoma
Authors: Michael A den Bakker; Sten Willemsen; Katrien Grünberg; L Arnold Noorduijn; Matthijs F M van Oosterhout; Robert J van Suylen; Wim Timens; Bart Vrugt; Anne Wiersma-van Tilburg; Frederik B J M Thunnissen Journal: Histopathology Date: 2010-02 Impact factor: 5.087
Authors: John M Varlotto; Laura Nyshel Medford-Davis; Abram Recht; John C Flickinger; Eric Schaefer; Dani S Zander; Malcolm M DeCamp Journal: J Thorac Oncol Date: 2011-06 Impact factor: 15.609
Authors: W D Travis; R I Linnoila; M G Tsokos; C L Hitchcock; G B Cutler; L Nieman; G Chrousos; H Pass; J Doppman Journal: Am J Surg Pathol Date: 1991-06 Impact factor: 6.394