Reproducibility of histological diagnosis of breast lesions: Results of a panel in Italy

doi:10.1016/0959-8049(95)00609-5

European Journal of Cancer

Volume 32, Issue 4, April 1996, Pages 603-607

https://doi.org/10.1016/0959-8049(95)00609-5 Get rights and content

Abstract

Sixteen pathologists independently examined and classified a series of 81 breast lesions selected from the files of several Italian Pathology Departments in the context of a national task force on breast cancer (FONCAM). A four category classification system was used for analysis; according to the majority diagnosis (MD), simply defined as the most frequently reported in the panel, the series included 37 benign lesions without atypia (45.7%), nine atypical hyperplasias (11.1%), 18 in situ (22.2%) and 17 invasive carcinomas (21.0%). Concordance, estimated for all possible pair-wise comparisons between pathologists, was good (mean kappa value: 0.59). A comparison between the diagnoses of each pathologist and the panel majority diagnosis was also made. Overall, a global kappa value of 0.72 was found (range 0.57–0.85), with category-specific values being excellent for invasive carcinoma (0.89) and benign lesions without atypia (0.77), relatively good for in situ carcinoma (0.69) but poor for atypical hyperplasia (0.38). These results confirm that quality assurance procedures are particularly indicated for large screening programmes for breast cancer, and suggest that for atypical lesions strict diagnostic criteria should be adopted.

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The purpose of this study was to assess whether general pathologists are able to make as accurate and reproducible a diagnosis on large-core needle biopsies as on open breast biopsy specimens. A total of 688 patients underwent a stereotactic large-core (14G) needle biopsy and subsequent surgical excision of 718 non-palpable breast lesions. Forty-two pathologists from 10 departments of pathology (generalists) made a diagnosis on both the needle and open biopsy specimens. Afterwards, three pathologists and two radiologists with extensive experience in breast pathology (experts) diagnosed all of the biopsy specimens. The general pathologists made a similar histological diagnosis as the experts in 632 (88%) of the needle biopsies and 649 (90%) of the open biopsy specimens. Accordingly, the interobserver agreement for the diagnosis of large-core needle biopsies between the general and experts pathologists was excellent (kappa 0.83) and not significantly different from the interobserver agreement for the diagnosis of open breast biopsies (kappa 0.86). However, many inconsistencies were observed in the category of borderline lesions: only 24% of the large-core needle biopsies and 43% of the open biopsies with an expert diagnosis of ‘borderline’ were diagnosed similarly by the general pathologists. Additionally, the risk of benign/malignant inconsistencies between general pathologists and experts was approximately 1 in 55 for both needle and open biopsies.
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Citation Excerpt :
Despite efforts to consolidate opinions and criteria through discussion, no change occurred to the reviewer agreement over time (data not shown). Nevertheless, it is equivalent to other reports16,18–24 of reproducibility for the Nottingham grading system9 detailed in Table 10. In this context, a factor to emphasise is the imperfect section quality occasionally experienced in fixation, processing, or both, an issue that also applies to scoring lymphatic vascular invasion.
Three pathologists reviewed slides and reports of cancers arising in both the study and control populations of the U.K. trial of annual mammography screening from age 40 years. A total of 875 cases were scored independently as noninvasive, microinvasive, or invasive cancer, with the last also evaluated for histology grade, type, and lymphatic vascular invasion. Of these, 870 (99.2%) were confirmed malignant, 1 case had cytology only, and 5 were judged by all reviewers as benign. Reviewer complete concordance for the three classes of malignancy was achieved in 826 (95%) and majority agreement in 31 (3.6%) of 870 with complete data. All three readers recorded grade in 736 cancers, giving a kappa statistic of 0.69, 0.52, and 0.66 for grades I, II, and III, respectively, and 0.61 overall. Agreement that the cancer was special type or not was obtained in 671 (89.0%) with complete concordance in the nature of the type in 504 and majority view in 167; another 58 (7.7%) were characterised as “part special” pattern, with type disagreement in 23 (3%). The kappa statistic for single type subcategories in those cancers was substantial, at 0.68 overall. This improved to 0.76 for the last 230 invasive cancers after the pathologists agreed more explicit criteria for type discrimination. There was almost perfect agreement between original and review diagnosis of breast malignancy for both noninvasive/microinvasive and invasive cancer (kappa 0.84 and 0.91, respectively), justifying confidence in the diagnosis of breast cancer by U.K. pathologists. The specialists agreed substantially on qualitative histology features of type and grade of cancers, and improved further for typing by defining criteria. These consensus data, along with invasive size and node status, are reliable for use as surrogate measures of outcome, and to enhance interpretation of effect, when the trial case population sources are disclosed. HUM PATHOL 33:365-371. Copyright 2002, Elsevier Science (USA). All rights reserved.

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Original paperReproducibility of histological diagnosis of breast lesions: Results of a panel in Italy

Abstract

Clin Lab Med

Path Res Pract

Estimates of worldwide incidence of eighteen major cancers in 1985

Int J Cancer

Estimates of the worldwide mortality from eighteen major cancers in 1985. Implications for prevention and projections of future burden

Int J Cancer

Borderline epithelial lesions of the breast

Am J Surg Pathol

Recent trends in the management of breast cancer. 1. Carcinoma in situ of the breast

Can J Surg

A comparison of the results of longterm follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast

Cancer

Benign breast disease and breast cancer: a case-control study in a cohort in Italy

Int J Cancer

Breast cancer risk associated with proliferative breast disease and atypical hyperplasia

Cancer

Histopathologic classification of breast cancer in Sweden and Italy: a comparison between two pathologists

Tumori

Quality assurance in anatomic pathology

Am J Clin Palhol

A comprehensive quality assessment program on the autopsy service

Am J Clin Pathol

Original paper
Reproducibility of histological diagnosis of breast lesions: Results of a panel in Italy