Variations in cancer centers' use of cytology for the diagnosis of small cell lung carcinoma in the National Cancer Data Base.
BACKGROUND
Cytology is an accurate, safe, cost-effective, and guideline-recommended method for the diagnosis of small cell lung carcinoma (SCLC), but little is known about whether its use varies by treatment facility and patient characteristics.


METHODS
Methods of diagnosis (cytology vs histology) for 86,830 patients with SCLC from 1314 facilities that contributed data to a nationwide registry and associations of diagnostic methods with patient and facility characteristics were studied in bivariate and multivariate analyses.


RESULTS
The percentages of SCLC cases diagnosed by cytology in community cancer programs, comprehensive community cancer programs, academic cancer programs, and National Cancer Institute-designated cancer centers were 13.2%, 15.4%, 23.3%, and 31.3%, respectively (P < .0001). The corresponding prevalence ratios (and 95% confidence intervals [CIs]) of cytologic diagnosis using multivariate marginal logistic regression models and National Cancer Institute-designated cancer centers as the referent category were 0.45 (95% CI, 0.36-0.57), 0.52 (95% CI, 0.42-0.64), and 0.78 95% CI, (0.62-0.96), respectively. In contrast, the use of cytology varied little by patient demographic and clinical factors.


CONCLUSIONS
The substantial variation among different types of cancer centers in their use of cytology for the diagnosis of SCLC suggests a need for additional research to study reasons for these differences as well as quality-improvement interventions to encourage adherence to guidelines for SCLC diagnosis.
Intramural Research, American Cancer Society, Atlanta, Georgia.
Ted
T
Gansler
Intramural Research, American Cancer Society, Atlanta, Georgia.
Stacey A
SA
Fedewa
Intramural Research, American Cancer Society, Atlanta, Georgia.
Chun Chieh
CC
Lin
Intramural Research, American Cancer Society, Atlanta, Georgia.
Ahmedin
A
Jemal
Intramural Research, American Cancer Society, Atlanta, Georgia.
Elizabeth M
EM
Ward
D044963:Biopsy, Fine-Needle / Q000379:methods; D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000473:pathology*; D003581:Cytodiagnosis / Q000592:standards / Q000639:trends; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D054547:National Cancer Institute (U.S.) / Q000592:standards; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D058996:Quality Improvement; D012042:Registries; D014481:United States
cytopathology; health care quality assessment; registries; small cell lung carcinoma