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Open Access Research

Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast

Douglas S Gomes, Simone S Porto, Débora Balabram and Helenice Gobbi*

Author Affiliations

Breast Pathology Laboratory, School of Medicine, Federal University of Minas Gerais (UFMG), Av. Professor Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil

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Diagnostic Pathology 2014, 9:121  doi:10.1186/1746-1596-9-121

Published: 19 June 2014

Abstract

Background

This study aimed to assess inter-observer variability between the original diagnostic reports and later review by a specialist in breast pathology considering lobular neoplasias (LN), columnar cell lesions (CCL), atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS) of the breast.

Methods

A retrospective, observational, cross-sectional study was conducted. A total of 610 breast specimens that had been formally sent for consultation and/or second opinions to the Breast Pathology Laboratory of Federal University of Minas Gerais were analysed between January 2005 and December 2010. The inter-observer variability between the original report and later review was compared regarding the diagnoses of LN, CCL, ADH, and DCIS. Statistical analyses were conducted using the Kappa index.

Results

Weak correlations were observed for the diagnoses of columnar cell change (CCC; Kappa = 0.38), columnar cell hyperplasia (CCH; Kappa = 0.32), while a moderate agreement (Kappa = 0.47) was observed for the diagnoses of flat epithelial atypia (FEA). Good agreement was observed in the diagnoses of atypical lobular hyperplasia (ALH; Kappa = 0.62) and lobular carcinoma in situ (LCIS; Kappa = 0.66). However, poor agreement was observed for the diagnoses of pleomorphic LCIS (Kappa = 0.22). Moderate agreement was observed for the diagnoses of ADH (Kappa = 0.44), low-grade DCIS (Kappa = 0.47), intermediate-grade DCIS (Kappa = 0.45), and DCIS with microinvasion (Kappa = 0.56). Good agreement was observed between the diagnoses of high-grade DCIS (Kappa = 0.68).

Conclusions

According to our data, the best diagnostic agreements were observed for high-grade DCIS, ALH, and LCIS. CCL without atypia and pleomorphic LCIS had the worst agreement indices.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1640072350119725 webcite.

Keywords:
Breast cancer; Lobular neoplasia; Columnar cell lesions; Atypical ductal hyperplasia; Ductal carcinoma in situ; Inter-observer variability; Agreement

Abstract

Introdução

O objetivo do estudo foi avaliar a variabilidade interobservador entre os diagnósticos do laudo original e após revisão por especialista em patologia mamária considerando as neoplasias lobulares (NL), lesões células colunares (LCC), hiperplasia ductal atípica (HAD) e carcinoma ductal in situ (CDIS) em biopsias mamárias.

Métodos

Estudo retrospectivo, observacional, do tipo transversal. Um total de 610 casos de espécimes mamários que foram enviados formalmente para consultoria e/ou segunda opinião ao Laboratório de Patologia Mamária da Universidade Federal de Minas Gerais foram analisados entre janeiro de 2005 e dezembro de 2010. A variabilidade interobservador entre o laudo original e o laudo de revisão foi comparada entre os diagnósticos de NL, LCC, HDA e CDIS. A análise estatística foi realizada pelo índice de Kappa.

Resultados

Observamos uma concordância fraca para os diagnósticos de alterações de células colunares (ACC; Kappa = 0,38), e hiperplasia de células colunares (HCC; Kappa = 0,32), enquanto uma concordância moderada (Kappa = 0,47) foi observada para o diagnóstico de atipia epitelial plana (AEP). A concordância foi considerada boa para os diagnósticos de hiperplasia lobular atípica (Kappa = 0,62) e carcinoma lobular in situ (CLIS; Kappa = 0,66). Entretanto, a concordância foi considerado baixa para o diagnóstico de CLIS pleomórfico (Kappa = 0,22). Concordância moderada foi observada para os diagnósticos de HLA (Kappa = 0,44), CDIS de baixo grau (Kappa = 0,47), CDIS de grau intermediário (Kappa = 0,45) e CDIS microinvasor (Kappa = 0,56). Boa concordância foi observada para o diagnóstico de CDIS de alto grau (Kappa = 0,68).

Conclusão

De acordo com nossos dados, as melhores concordâncias diagnósticas foram observadas entre CDIS de alto grau, HLA e CLIS. As LCC sem atipias e o CLIS pleomórfico tiveram os piores índices de concordância.