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An online quiz uncovers limitations of morphology in equivocal lung cytology
Author(s) -
Glatz Katharina,
Savic Spasenija,
Glatz Dieter,
Francz Gilbert,
Barascud Audrey,
Grilli Bruno,
Herzog Michelle,
Dalquen Peter,
Feichter Georg,
Spieler Peter,
Tamm Michael,
Bubendorf Lukas
Publication year - 2006
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22286
Subject(s) - medicine , cytology , atypia , lung cancer , medical diagnosis , biopsy , lung , cytopathology , pathology , cancer , radiology
BACKGROUND. Equivocal atypia in respiratory cytology can be a diagnostic challenge. In such cases fluorescence in situ hybridization (FISH) may be used for the analysis of chromosomal aberrations and often allows a reliable distinction of benign and malignant cells. METHODS. An online picture gallery of 30 respiratory cytologic preparations comprising 23 specimens with equivocal cytology as well as 5 positive and 2 negative controls was prepared ( www.unibas.ch/patho/lungenzyto/loesung/ ). The final diagnoses were confirmed by clinical follow‐up or biopsy or both. Each of the illustrated cell groups was analyzed by multitarget FISH after PAP image capturing and automatic relocalization. RESULTS. The online questionnaire was completed by 137 cytomorphologists from all continents. The control cases were assessed accurately to a significantly higher percentage than the equivocal cases. In equivocal cases participants more often made false‐positive than false‐negative diagnoses. In 2 patients with benign conditions (tuberculosis and pulmonary capillaritis) the rate of false‐positive answers was remarkably high (31.4% and 62.8% respectively). The result of the 20 best‐performing participants for the 5 cases with the highest percentage of inaccurate answers was not better than if they had chosen their answer by chance. CONCLUSIONS. These data illustrate that single cells or cell clusters of a subgroup of equivocal lung cytology are a diagnostic challenge even for highly experienced morphologists. Internet‐based tests are able to reveal limitations of cytomorphology. Cancer (Cancer Cytopathol) 2006; © 2006 American Cancer Society.