EU-US pathology panel for uniform diagnosis in randomised controlled trials for CT screening of lung cancer

¹ Depts of Pathology Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
² Aberdeen University School of Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland
³ Grenoble, INSERM U578, France
⁴ Florence, Dept of Human Pathology and Oncology, University of Florence, Italy
⁵ Dept of Pathology, University of Colorado Health Science Center, Aurora, CO USA
⁶ Dept of Pathology, KAS Herlev, div. Gentofte, Hellerup, Denmark
⁷ Dept of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
⁸ Fox Chase Cancer Center, Philadelphia, PA, USA

^* To whom correspondence should be addressed. E-mail: e.thunnissen{at}cwz.nl.

	Abstract

RCT for lung cancer screening using HRCT are now underway. In order to allow future effective comparison of the different trials as well as strengthening conclusions based upon the analysis of larger data sets, uniformity and consistency of pathology diagnosis is essential. The aim of this study is to determine the effectiveness of the learning process in this difficult area of diagnostic pathology.

Eight pathologists received two CD-ROMs with digital images of 30 cases each. After diagnosing the first series, selected background reading was provided. Kappa scores were calculated for each pathologist and each category and compared to the consensus score.

The readings of the first series showed a moderate agreement kappa score: mean and standard deviation for "8"(all 8 categories) and "2" categories was 0.53±0.05 and 0.65±0.04, respectively. The kappa "2" score distinguished between categories denoting benign and malignant lesions. The second series resulted in a good agreement kappa score: mean and standard deviation for "8" and "2" categories was 0.65±0.06 and 0.81±0.02.

In conclusion, this study demonstrates that screen-detected cases pose particular problems for pathologists and that a trained pathology panel serving RCT is likely to lead to more consistent and accurate tissue diagnosis.