Interobserver agreement among histological patterns and diagnosis in lung adenocarcinomas

Halide Nur Urer,Yasemin Ozluk,Rengin Ahiskali,Handan Zeren,Silvana Geleff,Kursat Yildiz,Sebnem Batur,Pinar Firat,Neslihan Fener,Naciye Arda,Leyla Cinel,Buge Oz,Emine Dilek Yilmazbayhan,Atilla Uysal,Gerhard Dekan

doi:10.5146/tjpath.2014.01231

Halide Nur Urer, Yasemin Ozluk + Show 13 more

Open Access

https://doi.org/10.5146/tjpath.2014.01231

Copy DOI

Abstract

The aim of this study was to investigate the interobserver agreement in determination of the dominant histological pattern and the final diagnosis in lung adenocarcinomas. A total of 12 patients with a diagnosis of primary lung adenocarcinoma were included in the study. Twelve pathologists from eight study centers were asked first to determine the dominant histological pattern in these cases and then to decide whether the final diagnosis was in situ, minimally invasive or invasive adenocarcinoma. The kappa value for the agreement in determining the dominant pattern among the pathologists was 0.36 (p < 0.001), with the values for the lepidic, acinar, papillary, solid, micropapillary patterns and mucinous character of adenocarcinoma being 0.34, 0.28, 0.30, 0.80, 0.16 and 0.38 respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). None of the cases was diagnosed as in situ adenocarcinoma. On the other hand, the kappa value for the agreement in differentiating minimally invasive from invasive adenocarcinoma among reviewers was 0.17 (p < 0.001). The agreement among pathologists in determining the subtype of lung adenocarcinomas that depends on the identification of the dominant pattern was at intermediate level. In addition, the agreement in deciding whether the case is minimally invasive or invasive, was at low level. The criteria defining the histological patterns should be clarified and described in more detail. Educational activities and larger multicenter studies might be helpful in improving the agreement and standardization.

Highlights

Lung adenocarcinomas (ACs) are different from other organ ACs due to the presence of heterogeneous tumors with morphological diversity [1]
The coexistence of more than one histological pattern is observed in 80-90% of tumors, and determining the dominant pattern in the tumor is important in terms of disease prognosis [2,3,4]
We aimed to investigate the interobserver agreement in terms of the dominant histological AC pattern and final diagnosis of AC

Summary

Introduction

Lung adenocarcinomas (ACs) are different from other organ ACs due to the presence of heterogeneous tumors with morphological diversity [1]. The coexistence of more than one histological pattern (mixed-type) is observed in 80-90% of tumors, and determining the dominant pattern in the tumor is important in terms of disease prognosis [2,3,4]. According to the 2011 consensus report of the International Association for the Study of Lung Cancer, American Thoracic Society and the European Respiratory Society (IASLC/ATS/ERS), identifying the dominant pattern as well as other histological patterns in AC along with defining the terms “in situ AC” and “minimally invasive AC” were important prognostic and predictive factors (Table I) [5]. The various studies have highlighted the prognostic importance of the new AC classification system [6,7].

Results

Discussion

Conclusion