title: Morphological and genetic classification of lung cancer: variation in practice and implications for tailored treatment.
abstract: OBJECTIVE
  Tailored therapy of lung cancer requires high-quality pathology. Tumours must be subtyped accurately and material preserved for genetic analysis upon which treatment is increasingly based. There is a presumption that pathologists have risen to this challenge, but the nature and degree of variation in practice and quality are unknown.
  
  
  RESULTS
  We collected detailed information on 1507 consecutive, newly diagnosed patients referred to 19 UK lung cancer units, ranging from district general hospitals to specialist cardiothoracic units. In only four centres were pathologists handling thoracic biopsies enrolled in the thoracic external quality assessment (EQA) scheme. Achievement of a positive diagnosis of malignancy ranged from 53 to 88%. Variation in tumour subtypes was wide, and the proportion of biopsies classified as merely 'non-small-cell lung cancer, not otherwise specified' varied from 3 to 20%, despite almost universal use of immunochemistry. The proportion of tumours tested for epidermal growth factor receptor (EGFR) gene mutation ranged from 12 to 92%.
  
  
  CONCLUSIONS
  There is considerable variation in practice among UK pathologists and arguably in the quality of pathology, raising questions about expertise, adherence to guidelines, rigour of EQA and, ultimately, the reliability of the pathology that underpins the management of lung cancer.
authors.affiliation: Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cane
authors.affiliation: National Cancer Registration Service, London, UK.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Linklater
authors.affiliation: Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Nicholson
authors.affiliation: Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Peake
authors.affiliation: Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Gosney
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification / Q000235:genetics / Q000473:pathology; D066246:ErbB Receptors / Q000235:genetics*; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000145:classification / Q000235:genetics / Q000473:pathology; D009154:Mutation / Q000502:physiology; D057285:Precision Medicine; D016526:Workload / Q000706:statistics & numerical data
chemical_list: D066246:ErbB Receptors
keywords: classification; diagnosis; genetics; lung cancer; tailored therapy