LAUSR

both histological and cytological specimens, it also provides clear evidence that IHC rates cannot be taken in isolation as a satisfactory marker of a pathology department’s performance. Understanding the components of the immunohistochemistry ‘denominator’ are therefore essential. Awareness of factors including specimen type and quality are necessary to reach an accurate conclusion. Guidelines and any proposed College mandatory audits need to reflect and acknowledge probable variation between centres depending on individual case mix, especially where there is more extensive use of cytology for primary diagnosis. Failure to do so may result in pathologists being pressured to over-interpret morphological features in cases where no material for IHC is available in order to avoid using the term NSCLC-NOS. What the patient requires is the pathologist to give an honest opinion on the available material and if further, more detailed, classification is needed then submission of a further specimen may be required. While audits to ensure quality improvement across pathology departments are essential, recognition of factors beyond the pathologist’s control is also necessary to ensure that an accurate picture is established. Addressing these issues through discussion and education of clinical colleagues with regard to the changing tissue requirements for full pathological and molecular assessment may go some way towards improved sample acquisition and quality.