Correlation between cytological and histopathological diagnosis of non-small cell lung cancer and accuracy of cytology in the diagnosis of lung cancer

Jelena Džambas; Ivan Aleksić; Vesna Škuletić; Snežana Cerović; Dragana Tegeltija

doi:10.2298/VSP200618117D

Jelena Džambas Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ivan Aleksić Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Vesna Škuletić Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Snežana Cerović Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Dragana Tegeltija Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP200618117D

Keywords: biopsy;, bronchoscopy;, carcinoma, non-small-cell lung;, cytological techniques;, histological techniques;, prognosis;, sensitivity and specificity.

Abstract

Background/Aim. Lung cancer is one of the most common cancer types worldwide. More than 70% of patients are diagnosed with lung cancer in the advanced stages of the disease, with limited therapeutic options based on cytological and histopathological material. The value of cytology in diagnosing and subtyping non-small cell lung cancer (NSCLC) is very important for modern personalized therapies. The aim of this study was to find out the concordance between cytological and histopathological diagnosis of NSCLC and the accuracy, sensitivity, specificity, and the positive and negative predictive value of cytology in diagnosing lung cancer. Methods. A two-year retrospective study included 169 patients with cytological diagnosis of NSCLC, who, at the same time, had small biopsy and surgical specimens for histopathological diagnoses confirmation that were compared with cytological one. Histopathological diagnosis on surgical specimens was the golden standard for evaluation concordance to the cytological diagnosis of NSCLC and evaluation accuracy, specificity, sensitivity, and the positive and negative prognostic value of cytology as a diagnostic method for detecting lung cancer. Results. This study included 129 (76.3%) male and 40 (23.7%) female patients, aged between 39 and 83, with the average of 62.53 ± 7.6. There was no statistically significant difference between the ages of different genders (p = 0.207). The most frequent diagnosis among cytological diagnoses was NSCLC in 99 (58.58%) patients. Concordance between cytological and histopathological diagnoses of surgical specimens was 61.48%. There was no statistically significant difference between cytological diagnoses and histopathological diagnoses of small biopsies specimens (p = 0.856). The sensitivity, specificity, positive and negative prognostic value, and accuracy of cytology as a diagnostic method of lung cancer were 94.98%, 98.60%, 95.72%, 98.35%, and 97.71%, respectively. Conclusion. Cytological diagnosis of NSCLC is accurate, with high sensitivity, specificity, and benefits for patients. Most patients are diagnosed with advanced cancer when there is no surgical therapy option, and the only available diagnostic material is a small biopsy sampled during bronchoscopy.

References

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Can-cer 2015; 136(5): E359‒86.

Siegel CS, Moreira AL, Travis WD, Zakowski FM, Thornton HR, Riely JG, et al. Subtyping of non-small cell lung carcinoma: a comparison of small biopsy and cytology specimens. J Thorac Oncol 2011; 6(11): 1849‒56.

Travis WD, Brambilla E, Noguchi M, Nicholson A, Geisinger K, Yatabe Y, et al. Diagnosis of lung cancer in small biopsies and cytology. Arch Pathol Lab Med 2013; 137(5): 668‒84.

Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO classification of tumors of the lung, pleura, thymus and heart. 4th ed. Geneva: WHO Press; 2015.

Travis W, Brambilla E, Nicholson GA, Yatabe Y, Austin MJ, Beasley BM, et al. The 2015 World Health Organisation of lung tumors – impact of genetic, clinical and radiological advances since the 2004 classification. J Thorac Oncol 2015; 10: 1243‒60.

Michael CW, Hoda RS, Saqi A, Kazakov J, Elsheikh T, Azar N, et al. Committee I: Indications for pulmonary cytology sampling methods. Diagn Cytopathol 2016; 44(12): 1010‒3.

Kawaraya M, Gemba K, Ueoka H, Nishii K, Kiura K, Kodani T, et al. Evaluation of various cytological examinations by bron-choscopy in the diagnosis of peripheral lung cancer. Br J Can-cer 2003; 89(10): 1885‒8.

Šimundić AM. Measures of diagnostic accuracy: basic defini-tions. EJIFCC 2009; 19(4): 203‒11.

Monaco ES. Cytopathology of lung cancer: moving from mor-phology to molecular. Diagn Histopathol 2012; 18(8): 313‒20.

Dela Cruz SC, Tanoue TL, Matthay AR. Lung cancer: epidemiology, etiology and prevention. Clin Chest Med 2011; 32(4): 605‒44.

De Groot MP, Wu CC, Carter WB, Munden FR. The epidemiology of lung cancer. Transl Lung Cancer Res 2018; 7(3): 220‒33.

Gaur DS, Kusum A, Harsh M, Kohli S, Kishore S, Pathak VP. Efficacy of bronchial brushings and transbronchial needle aspirtion in diagnosing carcinoma lung. J Cytol 2007; 24 (1): 46‒50.

Ghildiyal S, Acharya S, Thakur B, Rawat J, Kumar R. Cytopathology of Pulmonary Lesions: A Tertiary Care Center Experience. J Cytol 2018; 35(4): 212‒6.

Pavani M, Geetha C, Ericson LP, Deshpande KA. Efficacy and utility of bronchial cytology in diagnosing lung lesions and its histopathologic correlation. Ind J Pathol Oncol 2017; 4(2): 221‒6.

National Guide to Good Clinical Practice for the Diagnosis and Treatment of Lung Cancer. Belgrade: Agency for Accredi-tation of Health Institutions of Serbia; 2012. (Serbian)

Horn L, Lovly MC, Johnson HD. Neoplasms of the lung. In: Kasper LD, Hauser LS, Larry Jameson J, Fauci SA, Loscalzo J, editors. Harison’s principle of internal medicine. 19th ed. New York: McGrow-Hill Education; 2015: p. 506‒26.

Tomar V, Vijay N, Nuwal P, Dixit R. Comparative study of bronchoalveolar lavage, bronchial brushing, and FNAC in diagnosing malignant neoplasms of lung. J Cytol 2016; 33: 210‒3.

Sakr L, Roll P, Payan MJ, Liprandi A, Dutau H, Astoul P, et al. Cytology-based treatment decision in primary lung cancer: is it accurate enough? Lung Cancer 2012; 75(3): 293‒9.

Shukla S, Malhotra KP, Husain N, Gupta A, Anand N. The utility of cytology in the diagnosis of adenocarcinoma lung: a tertiary care center study. J Cytol 2015; 32(3): 159‒64.

Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, et al. International association for the study of lung cancer/American Thoracic Society/ European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6(2): 244‒85.

Kapila K, Al-Ayadhy B, Francis IM, George SS, Al-Jassar A. Sub-classification of pulmonary non-small cell lung carcinoma in fine needle aspirates using a limited immunohistochemistry panel. J Cytol 2013; 30(4): 223‒5.

Zakowski FM, Rekhtman N, Auger M, Booth NC, Crothers B, Ghofrani M, et al. Morphologic accuracy in differentiating pri-mary lung adenocarcinoma from squamous cell carcinoma in cytology specimens. Arch Pathol Lab Med 2016; 140(10): 1116‒20.

Idowu OM, Powers NC. Lung cancer cytology: potential pitfalls and mimics – a review. Int J Clin Exp Pathol 2010; 3(4): 367‒85.

Oliaro A, Filosso Pl, Cavalo A, Giobbe R, Mossetti C, Lyberis P, et al. The significance of intrapulmonary metastasis in non-small cell lung cancer: upstaging or downstaging? A re-appraisal for the next TNM staging system. Eur J Cardiothorac Surg 2008; 34(2): 438‒43, discussion 443.

Joseph TP, Joseph CP, Jayalakshmy PS, Poothiode U. Diagnostic challenges in cytology of mucoepidermoid carcinoma: report of 6 cases with histological correlation. J Cytol 2015; 32(1): 21‒4.