title: Distinguishing small cell carcinoma from non-small cell carcinoma of the lung: correlating cytologic features and performance in the College of American Pathologists Non-Gynecologic Cytology Program.
abstract: BACKGROUND
  The cytologic features of small cell carcinoma of the lung are well described. Nevertheless, some small cell carcinomas may be difficult to reproducibly distinguish from non-small cell carcinomas, and this distinction carries significant clinical importance.
  
  
  OBJECTIVE
  To correlate the cytologic features of individual cases of small cell carcinoma of the lung in fine-needle aspiration specimens from the College of American Pathologists Non-Gynecologic Peer Comparison Cytology Program with the frequency of misclassification as non- small cell carcinoma.
  
  
  METHODS
  We reviewed 1185 interpretations of 23 different cases of small cell carcinoma in lung fine-needle aspiration specimens and correlated the cytologic features noted in these cases with performance in the program.
  
  
  RESULTS
  Cases were divided into those that were frequently misclassified as non-small cell carcinoma (at least 10% of the responses, 11 cases) and those that were infrequently misclassified as non-small cell carcinoma (<5% of all responses, 12 cases). All cases had areas on the slides with classic features of small cell carcinoma. However, 10 of 11 cases that were frequently misclassified as non-small cell carcinoma had cells with either increased cytoplasm (4 cases), cytoplasmic globules (so-called paranuclear blue bodies) (3 cases), or apparent intracytoplasmic lumina (3 cases). These features were not identified in cases that were infrequently misclassified (P = .005). In addition, cases more frequently misclassified as non-small cell carcinoma tended to show better overall cellular and group preservation.
  
  
  CONCLUSIONS
  Frequent misclassification of small cell carcinoma as non-small cell carcinoma in lung fine-needle aspiration specimens in this program correlates strongly with the presence of cytoplasmic features that may suggest non-small cell carcinoma or with the presence of paranuclear blue bodies. Misclassification in this program may reflect a variety of factors, including the variation in the cytologic features of individual cases, but also the lack of wide recognition that some features of non-small cell carcinoma may also be noted in well-preserved cases of small cell carcinoma.
authors.affiliation: Department of Pathology, Baptist Hospital of Miami, Miami, Fla, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Voytek
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haja
authors.forename: David C
authors.initials: DC
authors.lastname: Wilbur
mesh_terms: D044963:Biopsy, Fine-Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000145:classification / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D002983:Clinical Competence; D022083:Cytoplasmic Structures / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000473:pathology*; D009656:North America; D010340:Pathology, Surgical / Q000193:education / Q000379:methods* / Q000592:standards; D012955:Societies, Medical