Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey

Ghofrani, Mohiedean; Tapia, Beatriz; Tavassoli, Fattaneh A.

doi:10.1007/s00428-006-0245-y

Cited by 36 publications

(26 citation statements)

References 27 publications

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“…Most of the studies investigating concordance rates documented that high interobserver variation was mostly due to problems in differentiating atypical ductal hyperplasia and low-grade ductal carcinoma in situ. 8,11,[19][20][21][22] The category specific k-value was lowest for atypical ductal hyperplasia (0.43 for stages 1 and 2) in this study. These results are similar to studies by Palli et al 8 and MacGrogan et al, 23 with the lowest category specific k-values for the diagnosis of atypical ductal hyperplasia (0.38 and 0.36, respectively).…”

Section: Discussioncontrasting

confidence: 49%

“…These results are still within the range of observations seen in prior studies. [7][8][9][10][11][18][19][20] The preselection of difficult/challenging cases could also have had a significant impact on the results of the study. This is illustrated by the low number of cases (11%) with complete agreement, as well as the low intraobserver agreement in stages 1 and 2 of the study.…”

Section: Discussionmentioning

confidence: 99%

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Atypical ductal hyperplasia: interobserver and intraobserver variability

et al. 2011

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Interobserver reproducibility in the diagnosis of benign intraductal proliferative lesions has been poor. The aims of the study were to investigate the inter-and intraobserver variability and the impact of the addition of an immunostain for high-and low-molecular weight keratins on the variability. Nine pathologists reviewed 81 cases of breast proliferative lesions in three stages and assigned each of the lesions to one of the following three diagnoses: usual ductal hyperplasia, atypical ductal hyperplasia and ductal carcinoma in situ. Hematoxylin and eosin slides and corresponding slides stained with ADH-5 cocktail (cytokeratins (CK) 5, 14. 7, 18 and p63) by immunohistochemistry were evaluated. Concordance was evaluated at each stage of the study. The interobserver agreement among the nine pathologists for diagnosing the 81 proliferative breast lesions was fair (j-value ¼ 0.34). The intraobserver j-value ranged from 0.56 to 0.88 (moderate to strong). Complete agreement among nine pathologists was achieved in only nine (11%) cases, at least eight agreed in 20 (25%) cases and seven or more agreed in 38 (47%) cases. Following immunohistochemical stain, a significant improvement in the interobserver concordance (overall j-value ¼ 0.50) was observed (P ¼ 0.015). There was a significant reduction in the total number of atypical ductal hyperplasia diagnosis made by nine pathologists after the use of ADH-5 immunostain. Atypical ductal hyperplasia still remains a diagnostic dilemma with wide variation in both inter-and intraobserver reproducibility among pathologists. The addition of an immunohistochemical stain led to a significant improvement in the concordance rate. More importantly, there was an 8% decrease in the number of lesions classified as atypical ductal hyperplasia in favor of usual hyperplasia; in clinical practice, this could lead to a decrease in the number of surgeries carried out for intraductal proliferative lesions.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Atypical ductal hyperplasia: interobserver and intraobserver variability

et al. 2011

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“…The subjectivity of interpreting breast lesions when quantitative criteria are used (atypical ductal hyperplasia versus ductal carcinoma in situ and papilloma versus papilloma with atypia or papillary carcinoma) has been well addressed in the pathology literature. [18][19][20] The cases that were discrepant in our study were the types of lesions that generally cause variability in interpretation. It is to be noted that variability in the histologic interpretations, which resulted from failure to recognize focal tissue changes or changes in the final categorization between reads, occurred in both WSI and OM.…”

Section: Commentmentioning

confidence: 67%

Multi-Institutional Comparison of Whole Slide Digital Imaging and Optical Microscopy for Interpretation of Hematoxylin-Eosin–Stained Breast Tissue Sections

Krishnamurthy¹,

Mathews²,

McClure³

et al. 2013

Archives of Pathology & Laboratory Medicine

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Context.-Whole slide imaging (WSI) is now used for educational purposes, for consultation, and for archiving and quantitation of immunostains. However, it is not routinely used for the primary diagnosis of hematoxylineosin-stained tissue sections.Objective.-To compare WSI using the Aperio digital pathology system (Aperio Technologies, Inc, Vista, California) with optical microscopy (OM) for the interpretation of hematoxylin-eosin-stained tissue sections of breast lesions.Design.-The study was conducted at 3 clinical sites; 3 breast pathologists interpreted 150 hematoxylin-eosinstained slides at each site, 3 times each by WSI and 3 times each by OM. For WSI, slides were scanned using an Aperio ScanScope and interpreted on a computer monitor using Aperio ImageScope software and Aperio Spectrum data management software. Pathologic interpretations were recorded using the College of American Pathologists breast checklist. WSI diagnoses were compared with OM diagnoses for accuracy, precision (interpathologist variation), and reproducibility (intrapathologist variation). Results were considered accurate only if the interpretation matched exactly between WSI and OM. The proportion of accurate results reported by each pathologist was expressed as a percentage for the comparison of the 2 platforms.Results.-The accuracy of WSI for classifying lesions as not carcinoma or as noninvasive (ductal or lobular) or invasive (ductal, lobular, or other) carcinoma was 90.5%. The accuracy of OM was 92.1%. The precision and reproducibility of WSI and OM were determined on the basis of pairwise comparisons (3 comparisons for each slide, resulting in 36 possible comparisons). The overall precision of WSI was 90.5% in comparison with 92.1% for OM; reproducibility of WSI was 91.6% in comparison with 94.5% for OM, respectively.Conclusions.-In this study, we demonstrated that WSI and OM have similar accuracy, precision, and reproducibility for interpreting hematoxylin-eosin-stained breast tissue sections. Further clinical studies using routine surgical pathology specimens would be useful to confirm these findings and facilitate the incorporation of WSI into diagnostic practice. (Arch Pathol Lab Med. 2013;137:1733-1739 doi: 10.5858/arpa.2012-0437-OA) T he practice of surgical pathology relies on image-based light microscopy diagnosis, which enables the detailed evaluation of the cytologic and architectural features of hematoxylin-eosin (H&E)-stained tissue sections. Significant recent technological advancements have allowed for the acquisition and storage of high-quality digital images. Several commercially available platforms are available for scanning H&E-stained tissue sections, generating digital whole slide images (WSI) for viewing and interpretation. The field of digital pathology is rapidly evolving toward the creation of a digital environment for interpreting and managing pathologic information contained in a glass slide.Several applications of digital pathology are currently being embraced by pathologists. Whole slide imaging is ...

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“…Elles doivent par conséquent faire l'objet d'une exérèse avec repérage compte tenu de la fréquence des lésions invasives associées. ces lésions histologiques à risque sont toutes des • marqueurs de risque de survenue de cancer du sein homo-ou controlatéral par rapport à la population générale [53] ; le RR est majoré par d'autres facteurs : âge, antécé-• dents familiaux (modèle de Gail) ; la décision thérapeutique repose sur une prise en • charge pluridisciplinaire ; la diffi culté dans l'indication chirurgicale réside • dans le risque de sous-évaluation mais aussi de surtraitement ; malgré l'introduction de critères « anatomopatho-• logiques », il existe toujours une grande variabilité interobservateur [59,112]. L'apport récent de la biologie moléculaire peut contribuer à la caractérisation de ces lésions pour adapter la prise en charge théra-peutique dans un contexte multidisciplinaire…”

Section: Dossierunclassified