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Difficulties in diagnostics of lung tumours in biopsies: an interpathologist concordance study evaluating the international diagnostic guidelines.

  • Ericson Lindquist, Kajsa1, 2
  • Ciornei, Cristina2
  • Westbom-Fremer, Sofia2, 3
  • Gudinaviciene, Inga2
  • Ehinger, Anna2, 3
  • Mylona, Nektaria2
  • Urdar, Rodrigo2
  • Lianou, Maria2
  • Svensson, Franziska4
  • Seidal, Tomas4
  • Haglund, Felix5, 6
  • Dobra, Katalin7, 8
  • Béndek, Mátyás8
  • Bardóczi, Erika8
  • Szablewska, Aneta9
  • Witkowski, Marek10
  • Ramnefjell, Maria11
  • De Las Casas, Luis E12
  • Gulyas, Miklos13
  • Hegedus, Agnes13
  • And 2 more
  • 1 Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden. , (Sweden)
  • 2 Department of Genetics and Pathology, Laboratory Medicine Region Skåne, Lund, Sweden. , (Sweden)
  • 3 Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden. , (Sweden)
  • 4 Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden. , (Sweden)
  • 5 Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden. , (Sweden)
  • 6 Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden. , (Sweden)
  • 7 Department of Pathology, Division of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden. , (Sweden)
  • 8 Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, Stockholm, Sweden. , (Sweden)
  • 9 Department of Pathology and Cytology, Blekinge Hospital Karlskrona, Karlskrona, Sweden. , (Sweden)
  • 10 Department of Pathology, Kalmar County Hospital, Kalmar, Sweden. , (Sweden)
  • 11 Department of Pathology, Haukeland University Hospital, Bergen, Norway. , (Norway)
  • 12 Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • 13 Department of Immunology, Genetics and Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden. , (Sweden)
  • 14 Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden [email protected]. , (Sweden)
Published Article
Journal of Clinical Pathology
Publication Date
May 01, 2022
DOI: 10.1136/jclinpath-2020-207257
PMID: 33547095


Accurate and reliable diagnosis is essential for lung cancer treatment. The study aim was to investigate interpathologist diagnostic concordance for pulmonary tumours according to WHO diagnostic criteria. Fifty-two unselected lung and bronchial biopsies were diagnosed by a thoracic pathologist based on a broad spectrum of immunohistochemical (IHC) stainings, molecular data and clinical/radiological information. Slides stained with H&E, thyroid transcription factor-1 (TTF-1) clone SPT24 and p40 were scanned and provided digitally to 20 pathologists unaware of reference diagnoses. The pathologists independently diagnosed the cases and stated if further diagnostic markers were deemed necessary. In 31 (60%) of the cases, ≥80% of the pathologists agreed with each other and with the reference diagnosis. Lower agreement was seen in non-small cell neuroendocrine tumours and in squamous cell carcinoma with diffuse TTF-1 positivity. Agreement with the reference diagnosis ranged from 26 to 45 (50%-87%) for the individual pathologists. The pathologists requested additional IHC staining in 15-44 (29%-85%) of the 52 cases. In nearly half (17 of 36) of the malignant cases, one or more pathologist advocated for a different final diagnosis than the reference without need of additional IHC markers, potentially leading to different clinical treatment. Interpathologist diagnostic agreement is moderate for small unselected bronchial and lung biopsies based on a minimal panel of markers. Neuroendocrine morphology is sometimes missed and TTF-1 clone SPT24 should be interpreted with caution. Our results suggest an intensified education need for thoracic pathologists and a more generous use of diagnostic IHC markers. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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