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Unformatted text preview: Arch Pathol Lab MedVol 129, May 2005 Small Cell Versus NonSmall Cell Carcinoma Renshaw et al 619 Distinguishing Small Cell Carcinoma From NonSmall Cell Carcinoma of the Lung Correlating Cytologic Features and Performance in the College of American Pathologists Non-Gynecologic Cytology Program Andrew A. Renshaw, MD; Theresa M. Voytek, MD; Jennifer Haja, CT(ASCP); David C. Wilbur, MD; for the Cytology Committee, College of American Pathologists Context. The cytologic features of small cell carcinoma of the lung are well described. Nevertheless, some small cell carcinomas may be difficult to reproducibly distinguish from nonsmall cell carcinomas, and this distinction car- ries significant clinical importance. Objective. To correlate the cytologic features of indi- vidual cases of small cell carcinoma of the lung in fine- needle aspiration specimens from the College of American Pathologists Non-Gynecologic Peer Comparison Cytology Program with the frequency of misclassification as non small cell carcinoma. Design. We reviewed 1185 interpretations of 23 dif- ferent cases of small cell carcinoma in lung fine-needle aspiration specimens and correlated the cytologic features noted in these cases with performance in the program. Results. Cases were divided into those that were fre- quently misclassified as nonsmall cell carcinoma (at least 10% of the responses, 11 cases) and those that were in- frequently misclassified as nonsmall cell carcinoma ( , 5% of all responses, 12 cases). All cases had areas on the slides with classic features of small cell carcinoma. However, 10 of 11 cases that were frequently misclassified as nonsmall cell carcinoma had cells with either increased cytoplasm (4 cases), cytoplasmic globules (so-called paranuclear blue bodies) (3 cases), or apparent intracytoplasmic lumina (3 cases). These features were not identified in cases that were infrequently misclassified ( P 5 .005). In addition, cases more frequently misclassified as nonsmall cell carcinoma tended to show better overall cellular and group preser- vation. Conclusions. Frequent misclassification of small cell carcinoma as nonsmall cell carcinoma in lung fine-needle aspiration specimens in this program correlates strongly with the presence of cytoplasmic features that may suggest nonsmall cell carcinoma or with the presence of para- nuclear blue bodies. Misclassification in this program may reflect a variety of factors, including the variation in the cytologic features of individual cases, but also the lack of wide recognition that some features of nonsmall cell car- cinoma may also be noted in well-preserved cases of small cell carcinoma....
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