A Population-Based Analysis of Application of WHO Nomenclature in Pathology Reports of Pulmonary Neuroendocrine Tumors Jules L. Derks, MD, Robert Jan.

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A Population-Based Analysis of Application of WHO Nomenclature in Pathology Reports of Pulmonary Neuroendocrine Tumors Jules L. Derks, MD, Robert Jan van Suylen, MD, PhD, Erik Thunnissen, MD, PhD, Michael A. den Bakker, MD, PhD, Egbert F. Smit, MD, PhD, Harry J.M. Groen, MD, PhD, Ernst J.M. Speel, MS, PhD, Anne-Marie C. Dingemans, MD, PhD Journal of Thoracic Oncology Volume 11, Issue 4, Pages 593-602 (April 2016) DOI: 10.1016/j.jtho.2015.12.106 Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Flowchart presenting an overview of selection of conclusions from pathology reports after manual screening of 7989 pathology conclusion texts. After application of exclusion criteria, 3052 unique patient conclusions were eligible for diagnostic nomenclature analysis. PALGA, Dutch Pathology Registry; SCLC, small cell lung cancer; NSCC, non–small cell cancer; LCC, large cell carcinoma; DIPNEC, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia; NEC, neuroendocrine carcinoma; NOS, not otherwise specified; DD, differential diagnosis; Ca, carcinoma; Diff, differentiation. Journal of Thoracic Oncology 2016 11, 593-602DOI: (10.1016/j.jtho.2015.12.106) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 An overview of diagnoses with non-WHO nomenclature versus diagnoses made according to the WHO nomenclature and separated for the following clusters: carcinoid, high-grade neuroendocrine carcinoma and LCC/NSCC, and carcinoma with neuroendocrine features or differentiation. The exact number of all retrieved diagnoses based on non-WHO nomenclature can be found in Supplementary Table 1. WHO, World Health Organization; NOS, not otherwise specified; Diff, differentiation; NSCC, non–small cell carcinoma; LCC, large cell carcinoma. Journal of Thoracic Oncology 2016 11, 593-602DOI: (10.1016/j.jtho.2015.12.106) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 3 (A) Overview of all diagnoses clustered as carcinoid and separated for type of sampling method. (B) Overview of all diagnoses clustered as high-grade neuroendocrine carcinomas and separated for type of sampling method. (C) Overview of sampling methods used to diagnose all typical/atypical and carcinoid NOS diagnoses from 2003 to 2012. (D) Overview of sampling methods used to diagnose LCNEC from 2003 to 2012. *The diagnosis of carcinoid NOS presented here is a combination of the diagnoses “carcinoid, no atypical features; carcinoid, unsure whether typical or atypical; and carcinoid NOS” from Supplementary Table 1. †Here the nonsurgically obtained biopsy specimen is a referral for the cluster of transbronchial and endobronchial biopsy specimens and needle biopsy specimens. WHO, World Health Organization; NOS, not otherwise specified; SCLC, small cell lung cancer; LCNEC large cell neuroendocrine carcinoma; NSCLC, non–small cell lung cancer; LCNEM, large cell carcinoma with neuroendocrine morphological features but not neuroendocrine immunohistochemistrical staining results. Journal of Thoracic Oncology 2016 11, 593-602DOI: (10.1016/j.jtho.2015.12.106) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions