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Objective: To evaluate the diagnostic accuracy of bronchial biopsy specimens in establishing the specific cell type in primary lung cancer, and to study the influence of several factors on this accuracy.
Design: The patients with lung cancer diagnosed by bronchoscopic biopsy specimens, who subsequently underwent thoracotomy were studied. Pathology archive preparations of bronchial biopsy specimens and thoracotomy materials were reexamined by one pathologist. The following characteristics were evaluated in each patients: age, sex, bronchoscopic morphologic findings, location of bronchial lesion, presence of necrosis, tumor type, and degree of cell differentiation.
Patients: This study included 140 patients with primary lung cancer. Five patients were women and 135 were men with a mean age of 58.5 years (range 19 to 71).
Interventions: All of the pathology preparations were reexamined by one pathologist.
Results: Of the 140 patients, 124 (88.6%) had cell agreement. The overall concordance was 0.65. The best agreement was obtained for squamous
cell carcinoma (Kappa, 0.68). Stage of the tumor and presence of necrosis had no effect on cell type agreement. Cell type accuracy was higher in central lesions than peripheral lesions (p=0.06). Mass lesions had higher histologic concordance than infiltrative lesions (p<0.05). Similar result was demonstrated by the degree of differentiation (p<0.01); the less the histologic differentiation, the greater the presence of diagnostic errors.
Conclusion: Many factors, such as tumor type, degree of cell differentiation, and the type of bronchial lesion can affect the cell agreement. We think that there will be difficulties in establishing the cell type by bronchoscopic biopsy especially in poorly differentiated tumors, large cell carcinoma and adenosquamous carcinoma.