233 Reproducibility study on invasiveness of pulmonary AdC with a modified classification with an otherwise large lepidic component. C) The tutorial before the 2nd round was focusing on recognizing the lepidic component in iatrogenic collapse. Biological collapse was specifically mentioned after the 2nd round before the 3rd round. The best outcome of this study is the kappa of 0.62 in the coached third round, showing promise that better specification and standardization of criteria and better education on the revised classification. may be as a way out of the current situation. However, this was obtained by feedback provided by the peers and the heatmap. This is information that is generally not available. Nevertheless, the content was apparently acceptable for most pathologists and the kappa 0.62 is markedly better than the previous reported scores in intercontinental reproducibility studies14. Training of pathologists in pulmonary adenocarcinoma may reach high agreement rates340. D) In the real world, Pathologists hesitate to make the diagnosis of AIS in fear of a possible recurrence and E) possible legal implications. The financial consequences of being sued and a verdict are not affordable. In summary, there is significant interobserver variation in the measurements of invasive size and assignment of invasive patterns among pathologists. However, using refined morphological criteria along with CK7 and elastin staining can help improve recognition of collapsed AIS. The formal recognition of collapsed AIS can aid in identifying low-risk lesions that are wholly non-invasive. Acknowledgements Erik Thunnissen would like to express his great appreciation to all participating pathologists for their commitment and dedication of many hours in reading of the cases for three rounds, of which the third one was not even anticipated beforehand. 15
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