Validation of interobserver agreement in lung cancer assessment: hematoxylin-eosin diagnostic reproducibility for non-small cell lung cancer: the 2004 World Health Organization classification and therapeutically relevant subsets.

Journal Article (Journal Article)

CONTEXT: Precise subtype diagnosis of non-small cell lung carcinoma is increasingly relevant, based on the availability of subtype-specific therapies, such as bevacizumab and pemetrexed, and based on the subtype-specific prevalence of activating epidermal growth factor receptor mutations. OBJECTIVES: To establish a baseline measure of interobserver reproducibility for non-small cell lung carcinoma diagnoses with hematoxylin-eosin for the current 2004 World Health Organization classification, to estimate interobserver reproducibility for the therapeutically relevant squamous/nonsquamous subsets, and to examine characteristics that improve interobserver reproducibility. DESIGN: Primary, resected lung cancer specimens were converted to digital (virtual) slides. Based on a single hematoxylin-eosin virtual slide, pathologists were asked to assign a diagnosis using the 2004 World Health Organization classification. Kappa statistics were calculated for each pathologist-pair for each slide and were summarized by classification scheme, pulmonary pathology expertise, diagnostic confidence, and neoplastic grade. RESULTS: The 12 pulmonary pathology experts and the 12 community pathologists each independently diagnosed 48 to 96 single hematoxylin-eosin digital slides derived from 96 cases of non-small cell lung carcinoma resection. Overall agreement improved with simplification from the comprehensive 44 World Health Organization diagnoses (κ  =  0.25) to their 10 major header subtypes (κ  =  0.48) and improved again with simplification into the therapeutically relevant squamous/nonsquamous dichotomy (κ  =  0.55). Multivariate analysis showed that higher diagnostic agreement was associated with better differentiation, better slide quality, higher diagnostic confidence, similar years of pathology experience, and pulmonary pathology expertise. CONCLUSIONS: These data define the baseline diagnostic agreement for hematoxylin-eosin diagnosis of non-small cell lung carcinoma, allowing future studies to test for improved diagnostic agreement with reflex ancillary tests.

Full Text

Duke Authors

Cited Authors

  • Grilley-Olson, JE; Hayes, DN; Moore, DT; Leslie, KO; Wilkerson, MD; Qaqish, BF; Hayward, MC; Cabanski, CR; Yin, X; Socinski, MA; Stinchcombe, TE; Thorne, LB; Allen, TC; Banks, PM; Beasley, MB; Borczuk, AC; Cagle, PT; Christensen, R; Colby, TV; Deblois, GG; Elmberger, G; Graziano, P; Hart, CF; Jones, KD; Maia, DM; Miller, CR; Nance, KV; Travis, WD; Funkhouser, WK

Published Date

  • January 2013

Published In

Volume / Issue

  • 137 / 1

Start / End Page

  • 32 - 40

PubMed ID

  • 22583114

Pubmed Central ID

  • PMC5787023

Electronic International Standard Serial Number (EISSN)

  • 1543-2165

Digital Object Identifier (DOI)

  • 10.5858/arpa.2012-0033-OA


  • eng

Conference Location

  • United States