title: An online quiz uncovers limitations of morphology in equivocal lung cytology.
abstract: BACKGROUND
  Equivocal atypia in respiratory cytology can be a diagnostic challenge. In such cases fluorescence in situ hybridization (FISH) may be used for the analysis of chromosomal aberrations and often allows a reliable distinction of benign and malignant cells.
  
  
  METHODS
  An online picture gallery of 30 respiratory cytologic preparations comprising 23 specimens with equivocal cytology as well as 5 positive and 2 negative controls was prepared (www.unibas.ch/patho/lungenzyto/loesung). The final diagnoses were confirmed by clinical follow-up or biopsy or both. Each of the illustrated cell groups was analyzed by multitarget FISH after PAP image capturing and automatic relocalization.
  
  
  RESULTS
  The online questionnaire was completed by 137 cytomorphologists from all continents. The control cases were assessed accurately to a significantly higher percentage than the equivocal cases. In equivocal cases participants more often made false-positive than false-negative diagnoses. In 2 patients with benign conditions (tuberculosis and pulmonary capillaritis) the rate of false-positive answers was remarkably high (31.4% and 62.8% respectively). The result of the 20 best-performing participants for the 5 cases with the highest percentage of inaccurate answers was not better than if they had chosen their answer by chance.
  
  
  CONCLUSIONS
  These data illustrate that single cells or cell clusters of a subgroup of equivocal lung cytology are a diagnostic challenge even for highly experienced morphologists. Internet-based tests are able to reveal limitations of cytomorphology.
authors.affiliation: Department for Pathology, Institute for Pathology, University Hospital, Basel, Switzerland. katharina.glatz@unibas.ch
authors.forename: Katharina
authors.initials: K
authors.lastname: Glatz
authors.forename: Spasenija
authors.initials: S
authors.lastname: Savic
authors.forename: Dieter
authors.initials: D
authors.lastname: Glatz
authors.forename: Gilbert
authors.initials: G
authors.lastname: Francz
authors.forename: Audrey
authors.initials: A
authors.lastname: Barascud
authors.forename: Bruno
authors.initials: B
authors.lastname: Grilli
authors.forename: Michelle
authors.initials: M
authors.lastname: Herzog
authors.forename: Peter
authors.initials: P
authors.lastname: Dalquen
authors.forename: Georg
authors.initials: G
authors.lastname: Feichter
authors.forename: Peter
authors.initials: P
authors.lastname: Spieler
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: Lukas
authors.initials: L
authors.lastname: Bubendorf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000235:genetics / Q000473:pathology*; D002869:Chromosome Aberrations; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009862:Online Systems / Q000458:organization & administration*; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires