title: Histo-cytological diagnostic accuracy in lung cancer.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathological Anatomy, University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Proietti
authors.forename: L
authors.initials: L
authors.lastname: Boldrini
authors.forename: G
authors.initials: G
authors.lastname: Alì
authors.forename: A
authors.initials: A
authors.lastname: Servadio
authors.forename: C
authors.initials: C
authors.lastname: Lupi
authors.forename: E
authors.initials: E
authors.lastname: Sensi
authors.forename: M
authors.initials: M
authors.lastname: Miccoli
authors.forename: A
authors.initials: A
authors.lastname: Ribechini
authors.forename: A
authors.initials: A
authors.lastname: Chella
authors.forename: M
authors.initials: M
authors.lastname: Lucchi
authors.forename: P
authors.initials: P
authors.lastname: Leocata
authors.forename: A
authors.initials: A
authors.lastname: Mussi
authors.forename: G
authors.initials: G
authors.lastname: Fontanini
mesh_terms: D000368:Aged; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006652:Histological Techniques; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged
keywords: cytology; diagnostic concordance; histology; immunohistochemistry; lung cancer