Aim-To determine interobserver and intra-observer agreement in the assessment of cytological grade and intraduct necrosis in pure duct carcinoma in situ (DCIS) of the breast. Methods-Sixty unselected cases with illustrated diagnostic criteria were circulated to 19 practising histopathologists. Results-Overall agreement was moderate for cytological grade in three categories: 71% agreement; weighted ( w), 0.36; intraduct necrosis in three categories (absent, present, extensive): 76% agreement; w, 0.57; and the Van Nuys classification system: 73% agreement; w, 0.48. Agreement was no better among observers participating in the National External Quality Assurance Programme. Intraobserver agreement for cytological assessment (69.6% agreement; w, 0.52) and intraduct necrosis (68.3% agreement; w, 0.48) was moderate, suggesting that individual variation rather than precision of criteria contributes to the lack of agreement. Conclusions-Moderate agreement on observations can be achieved by nonspecialist pathologists, with better agreement on necrosis than cytological grade. There was evidence of consistent individual bias towards over or under scoring cytological grade, which could be corrected with adequate and prompt feedback. (J Clin Pathol 2000;53:596-602)
The study has shown that lymphoma is a relatively common cause of surgical lymphadenopathy. Given the limitations of FNAC, all suspicious lymph nodes should be biopsied following FNAC even if the FNAC is reported normal or demonstrating reactive changes only. With the more widespread application of molecular techniques, and the development of improved minimally-invasive procedures, percutaneous and endoscopic techniques may come to dominate, however, at present; the surgeon still has an important role to play in the diagnosis if not treatment of lymphomas.
For staging purposes the designation of a tumour as invading perinephric tissues should be limited to those cases that have tumour cells invading the perinephric fat.
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