Histo-cytological diagnostic accuracy in lung cancer
A. Proietti
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Search for more papers by this authorL. Boldrini
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Search for more papers by this authorG. Alì
Unit of Pathologic Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorA. Servadio
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Search for more papers by this authorC. Lupi
Unit of Pathologic Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorE. Sensi
Unit of Pathologic Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorM. Miccoli
Department of Translational Rearch, New Technologies in Medicine and Surgery, Pisa, Italy
Search for more papers by this authorA. Ribechini
Unit of Thoracic Endoscopy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorA. Chella
Unit of Pneumology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorM. Lucchi
Unit of Thoracic Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorP. Leocata
Unit of Pathology, Experimental Medicine Department, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorA. Mussi
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Thoracic Surgery, University of Pisa, Pisa, Italy
Search for more papers by this authorCorresponding Author
G. Fontanini
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Correspondence:
Professor G. Fontanini, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Roma 57, 56126 Pisa, Italy.
Tel.: +39 050 992983; Fax: +39 050 992481
E-mail: [email protected]
Search for more papers by this authorA. Proietti
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Search for more papers by this authorL. Boldrini
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Search for more papers by this authorG. Alì
Unit of Pathologic Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorA. Servadio
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Search for more papers by this authorC. Lupi
Unit of Pathologic Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorE. Sensi
Unit of Pathologic Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorM. Miccoli
Department of Translational Rearch, New Technologies in Medicine and Surgery, Pisa, Italy
Search for more papers by this authorA. Ribechini
Unit of Thoracic Endoscopy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorA. Chella
Unit of Pneumology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorM. Lucchi
Unit of Thoracic Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Search for more papers by this authorP. Leocata
Unit of Pathology, Experimental Medicine Department, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorA. Mussi
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Thoracic Surgery, University of Pisa, Pisa, Italy
Search for more papers by this authorCorresponding Author
G. Fontanini
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy
Correspondence:
Professor G. Fontanini, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Roma 57, 56126 Pisa, Italy.
Tel.: +39 050 992983; Fax: +39 050 992481
E-mail: [email protected]
Search for more papers by this authorAbstract
Objective
The majority of patients with lung cancer are treated on the basis of a diagnosis made from the analysis of a small tumour biopsy or a cytological sample and histotype is becoming a critical variable in clinical workup as it has led to the introduction of newer biologically targeted therapies. Consequently, simply classifying cancers as small cell lung cancers or non-small cell lung cancers is no longer sufficient.
Methods
From 2009 to 2011, a review of the histo-cytological database was conducted to identify all small biopsy and cytology specimens collected for diagnostic purposes in patients with a thoracic lesion. In total, 941 patients were studied by examining exfoliative and/or aspirative cytological samples. To establish the accuracy of these methods, cytological and biopsy diagnoses were compared with each other and with subsequent resection specimens when available. Moreover, during the diagnostic workup, we examined a validated panel of immunohistochemical markers.
Results
The diagnostic concordance of pre-operative diagnoses with surgical samples was high in both cytology and biopsy samples [κ = 0.71, confidence interval (CI) = 0.6–0.81; P < 0.0001 and κ = 0.61, CI = 0.41–0.82; P < 0.0001 respectively; good agreement] but concordance between cytology and biopsy was moderate (κ = 0.5, CI = 0.43–0.54; P < 0.0001). Immunohistochemistry-aided diagnoses were definitive for histotype in 92.8% of both cytology (206/222) and biopsy (155/167) specimens.
Conclusion
We found that lung cancer diagnosis and subtyping of cytology and biopsy samples are highly feasible and concordant; thus, the diagnostic approach to lung cancer does not require more invasive procedures.
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