Is centralized histopathology review necessary for screen-detected breast lesions?

To address quality requirements fur breast pathology in the Australian scre ening programme, one breast cancer Screening and Assessment Service initiat ed a process of central pathologic review of all lesions detected through t he service. The aim of this study was to measure concordance between the in itial and review pathology, and to assess the merit of routine review. Conc ordance was measured by observed agreement and the kappa statistic for 267 women with 273 lesions. Concordance was excellent for the four classificati on schemes examined, good for the identification of benign lesions and hype rplasia, and excellent for the identification of DCIS or invasive carcinoma . For the sub-categorization of hyperplasias and invasive carcinomas concor dance was good, but was poor for the sub-typing of DCIS, Initial and review concordance was acceptable, suggesting that disagreement among pathologist s may not present a major impediment to the provision of dependable diagnos es. Full case review is unnecessary for benign lesions or invasive carcinom a, but should be maintained for DCIS and hyperplasias. (C) 1999 Harcourt Pu blishers Ltd.