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Ductal carcinoma in situ of the breast: modified black nuclear grading system revisited

Fernando Schuh, Jorge Villanova Biazús, José Antônio Cavalheiro, Christiane Cardoso Falcão, Alessandra de Freitas Ventura, Erika Resetkova, Diego Uchoa, Maria Isabel Edelweiss


Background: This study aims to determine the pathologists’ agreement of modified Black nuclear grading system and Holland classification applied to cases of ductal carcinoma in situ (DCIS).

Methods: Forty-three cases of breast lesions diagnosed as DCIS were selected to interobserver analysis. Eight pathologists received the same set of digitized images from microscopy of DCIS cases, and answered a questionnaire containing the criteria to compose the modified Black nuclear grade and Holland classification. In order to determine interobserver agreement and diagnostic accuracy, a web-based survey was created. It organizes the information collected from each participant pathologist providing the histological grading of the cases in both classification systems.

Result: Comparing the two classifications studied, there was a similar interobserver agreement among both schemes, showing Kappa value of 0.28 ± 0.02 for the modified Black nuclear grade and 0.32 ± 0.02 for the Holland classification. Hence the reliability for the applied to cases of DCIS was considered acceptable. The agreement among all pathologists and the gold standard pathologist similarly followed the results of the interobserver agreement, showing to be acceptable, with Kappa for de overall mode value 0.33 + 0.10 for modified Black nuclear grade and 0.55 + 0.10 for Holland classification (p = 0.07). The findings of Kappa for the mode values among specialists in breast pathology and general pathologists were, respectively, 0.34 + 0.11 (acceptable) and 0.26 + 0.10 (acceptable) for the modified Black nuclear grade and 0.50 + 0.10 (acceptable) and 0.26 + 0.10 (acceptable) for Holland classification. Breast pathology specialists showed similar reproducibility for both evaluated classifications than pathologists not devoted to this subject.

Conclusion: The diagnostic accuracy was similar for modified Black nuclear grading system regarding Holland classification system.


classification; ductal carcinoma in situ; scoring system; interobserver reproducibility

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