Wa. Wells et al., Pathologists' agreement with experts and reproducibility of breast ductal carcinoma-in-situ classification schemes, AM J SURG P, 24(5), 2000, pp. 651-659
Citations number
39
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Several histologic classifications for breast ductal carcinoma in situ (DCI
S) have been proposed. This study assessed the diagnostic agreement and rep
roducibility of three DCIS classifications (Holland [HL], modified Lagios [
LA], and Van Nuys [VN]) by comparing the interpretations of pathologists wi
thout expertise in boast pathology with those of three breast pathology exp
erts, each a proponent of one classification. Seven nonexpert pathologists
in New Hampshire and three experts evaluated 40 slides of DCIS according to
the three classifications. Twenty slides were reinterpnted by each nonexpe
rt pathologist. Diagnostic accuracy (nonexperts compared with experts) and
reproducibility were evaluated using inter- and intrarater techniques (kapp
a statistic). Final DCIS grade and nuclear grade were reported most accurat
ely among nonexpert pathologists using HL (kappa = 0.53 and 0.49, respectiv
ely) compared with LA and VN (kappa = 0.29 and 0.35, respectively, for both
classifications). An intermediate DCIS grade was assessed most accurately
using HL and LA, and a high grade (group 3) was assessed most accurately us
ing VN. Diagnostic reproducibility was highest using HL (kappa = 0.49). The
VN interpretation of necrosis (present or absent) was reported more accura
tely than the LA criteria (extensive, focal, or absent; kappa = 0.59 and 0,
45, respectively), but reproducibility of each was comparable (kappa = 0.48
and 0.46, respectively). Intrarater agreement was high overall. Comparing
all three classifications, final DCIS grade was reported best using HL. Nuc
lear grade (cytodifferentiation) using HL and the presence or absence of ne
crosis were the criteria diagnosed most accurately and reproducibly. Establ
ishing one internationally approved set of interpretive definitions, with a
cceptable accuracy and reproducibility among both pathologists with and wit
hout expertise in breast pathology interpretation, will assist researchers
in evaluating treatment effectiveness and characterizing the natural histor
y of DCIS breast lesions.