Ductal carcinoma in situ of the breast: modified black nuclear grading system revisited
Keywords:
classification, ductal carcinoma in situ, scoring system, interobserver reproducibility
Abstract
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.References
1. Ernster VL, Ballard-Barbash R, Barlow WE, et al.: Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 2002, 94:1546–1554.
2. Ernster VL, Barclay J, Kerlikowske K, et al.: Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996, 275:913–918.
3. Kerlikowske, K: Epidemiology of Ductal Carcinoma In Situ. J Natl Cancer Inst Monogr 2010, 41:139-141.
4. Tavassoli FA, Devilee P (Eds): World Health Organization Classification of Tumours. Pathology and genetics of tumours of the breast and female genital organs. IARC Press: Lyon 2003, 60-81.
5. Fisher B, Dignam J, Wolmark N, et al.: Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. Journal of Clinical Oncology 1998, 16: 441-452.
6. Fisher ER, Costantino J, Fisher B, et al.: Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17: Intraductal carcinoma (ductal carcinoma in situ). Cancer 1995, 75:1310-19.
7. Julien JP, Bijker N, Fentiman IS, et al.: Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000, 355:528-33.
8. Kane RL, Virnig BA, Shamliyan T, et al.: The Impact of Surgery, Radiation, and Systemic Treatment on Outcomes in Patients With Ductal Carcinoma In Situ. J Natl Cancer Inst Monogr 2010, 41:130-133.
9. Burstein HJ, Polyak K, Wong JS, et al.: Ductal carcinoma in situ of the breast. N Engl J Med 2004, 350:1430-41.
10. Harris JR, Lippman ME, Morrow M, Osborne CK: Diseases of the breast. Lippincott Williams e Wilkins; 2004.
11. Rosen PP, Oberman H: Tumors of the mammary gland. Armed Forces Institute of Pathology; 1993.
12. Lagios MD, Margolin FR, Westdahl PR, et al.: Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989, 63: 618-624.
13. Schwartz GF, Finkel GC, Garcia JC, et al.: Subclinical ductal carcinoma in situ of the breast. Treatment by local excision and surveillance alone. Cancer 1992, 70:2468-74.
14. Badve S, A'Hern RP, Ward AM, et al.: Prediction of local recurrence of ductal carcinoma in situ of the breast using five histological classifications: a comparative study with long follow-up. Hum Pathol 1998, 29:915-23.
15. Goldhirsch A, Glick JH, Gelber AS, et al.: Meeting Highlights: International expert consensus on the primary therapy of Early Breast Cancer 2005. Annals of Oncology 2005, 16:1569-83.
16. Page DL, Dupont WD, Rogers LW, et al.: Intraductal carcinoma of breast: Follow up after biopsy only. Cancer 1982, 49:751-758.
17. Bethwaite P, Smith N, Delahunt B, et al.: Reproducibility of a new classification schemes for pathology of ductal carcinoma in situ of the breast. J Clin Pathol 1998, 51:450-4.
18. Douglas-Jones AG, Morgan JM, Appleton MA, et al.: Consistency in the observation of feature used to classify duct carcinoma in situ (DCIS) of the breast. J Clin Pathol 2000, 53:596-602.
19. Salles MA, Mattos MA, Resende IM, et al.: Análise interobservador no diagnóstico histopatológico do carcinoma ductal in situ da mama. Rev Brasil Ginecol Obstet 2005, 27:1-6.
20. Scott MA, Lagios MD, Axelsson K, et al.: Ductal Carcinoma in situ of the Breast: Reproducibility of Histological Subtype Analysis. Hum Pathol 1997, 28:967-73.
21. Sloane JP, Amendoeira I, Apostolikas N, et al.: Consistency achieved by 23 European pathologists in categorizing ductal carcinoma in situ of the breast using five classifications. Hum Pathol 1998, 10:1056-62.
22. Sneige N, Lagios MD, Schwarting R, et al. Interobserver reproducubility of the Lagios nuclear grading system for ductal carcinoma in situ. Hum Pathol 1999, 30:257-62.
23. Wells WA, Carney PA, Eliassen MS, et al.: Pathologists' agreement with experts and reproducibility of breast ductal carcinoma in situ classification schemes. Am J Surg Pathol 2000, 24:651-9.
24. Holland R, Peterse JL, Millis RR, et al.: Ductal carcinoma in situ: A proposal for a new classification. Semin Diagn Pathol 1994, 11:167-70.
25. Silverstein MJ, Lagios MD, Craig PH, et al.: A prognostic index for ductal carcinoma in situ of the breast. Cancer 1996, 77:2226-2274.
26. Black MM, Barclay TH, Hankey BF, et al.: Prognosis in breast cancer utilizing histologic characteristics of the primary tumor. Cancer 1975, 36:2048-55.
27. Black MM, Opler SR, Speer FD: Survival in breast cancer cases in relation to the structure of the primary tumor and regional lymph nodes. Surgery Gynecology & Obstetrics 1995, 100:543-51.
28. Tavassoli FA: Patology of the Breast. McGraw-Hill, 1999.
29. Fisher ER, Redmond C, Fisher B: Histologic grading of breast cancer. Pathol Annu 1980, 15:239-51.
30. Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-74.
31. Svanholm H, Staklint H, Gundersen HJG, et al.: Reproducibility of histomorphologic diagnosis with special reference to the kappa statistic. APMIS 1989, 97:689-698.
32. Douglas-Jones AG, Gupta SK, Attanoos RL, et al.: A critical appraisal of six modern classifications of ductal carcinoma in situ of the breast (DCIS): correlation with grade of associate invasive carcinoma. Histopathology 1996, 29:397-409.
2. Ernster VL, Barclay J, Kerlikowske K, et al.: Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996, 275:913–918.
3. Kerlikowske, K: Epidemiology of Ductal Carcinoma In Situ. J Natl Cancer Inst Monogr 2010, 41:139-141.
4. Tavassoli FA, Devilee P (Eds): World Health Organization Classification of Tumours. Pathology and genetics of tumours of the breast and female genital organs. IARC Press: Lyon 2003, 60-81.
5. Fisher B, Dignam J, Wolmark N, et al.: Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. Journal of Clinical Oncology 1998, 16: 441-452.
6. Fisher ER, Costantino J, Fisher B, et al.: Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17: Intraductal carcinoma (ductal carcinoma in situ). Cancer 1995, 75:1310-19.
7. Julien JP, Bijker N, Fentiman IS, et al.: Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000, 355:528-33.
8. Kane RL, Virnig BA, Shamliyan T, et al.: The Impact of Surgery, Radiation, and Systemic Treatment on Outcomes in Patients With Ductal Carcinoma In Situ. J Natl Cancer Inst Monogr 2010, 41:130-133.
9. Burstein HJ, Polyak K, Wong JS, et al.: Ductal carcinoma in situ of the breast. N Engl J Med 2004, 350:1430-41.
10. Harris JR, Lippman ME, Morrow M, Osborne CK: Diseases of the breast. Lippincott Williams e Wilkins; 2004.
11. Rosen PP, Oberman H: Tumors of the mammary gland. Armed Forces Institute of Pathology; 1993.
12. Lagios MD, Margolin FR, Westdahl PR, et al.: Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989, 63: 618-624.
13. Schwartz GF, Finkel GC, Garcia JC, et al.: Subclinical ductal carcinoma in situ of the breast. Treatment by local excision and surveillance alone. Cancer 1992, 70:2468-74.
14. Badve S, A'Hern RP, Ward AM, et al.: Prediction of local recurrence of ductal carcinoma in situ of the breast using five histological classifications: a comparative study with long follow-up. Hum Pathol 1998, 29:915-23.
15. Goldhirsch A, Glick JH, Gelber AS, et al.: Meeting Highlights: International expert consensus on the primary therapy of Early Breast Cancer 2005. Annals of Oncology 2005, 16:1569-83.
16. Page DL, Dupont WD, Rogers LW, et al.: Intraductal carcinoma of breast: Follow up after biopsy only. Cancer 1982, 49:751-758.
17. Bethwaite P, Smith N, Delahunt B, et al.: Reproducibility of a new classification schemes for pathology of ductal carcinoma in situ of the breast. J Clin Pathol 1998, 51:450-4.
18. Douglas-Jones AG, Morgan JM, Appleton MA, et al.: Consistency in the observation of feature used to classify duct carcinoma in situ (DCIS) of the breast. J Clin Pathol 2000, 53:596-602.
19. Salles MA, Mattos MA, Resende IM, et al.: Análise interobservador no diagnóstico histopatológico do carcinoma ductal in situ da mama. Rev Brasil Ginecol Obstet 2005, 27:1-6.
20. Scott MA, Lagios MD, Axelsson K, et al.: Ductal Carcinoma in situ of the Breast: Reproducibility of Histological Subtype Analysis. Hum Pathol 1997, 28:967-73.
21. Sloane JP, Amendoeira I, Apostolikas N, et al.: Consistency achieved by 23 European pathologists in categorizing ductal carcinoma in situ of the breast using five classifications. Hum Pathol 1998, 10:1056-62.
22. Sneige N, Lagios MD, Schwarting R, et al. Interobserver reproducubility of the Lagios nuclear grading system for ductal carcinoma in situ. Hum Pathol 1999, 30:257-62.
23. Wells WA, Carney PA, Eliassen MS, et al.: Pathologists' agreement with experts and reproducibility of breast ductal carcinoma in situ classification schemes. Am J Surg Pathol 2000, 24:651-9.
24. Holland R, Peterse JL, Millis RR, et al.: Ductal carcinoma in situ: A proposal for a new classification. Semin Diagn Pathol 1994, 11:167-70.
25. Silverstein MJ, Lagios MD, Craig PH, et al.: A prognostic index for ductal carcinoma in situ of the breast. Cancer 1996, 77:2226-2274.
26. Black MM, Barclay TH, Hankey BF, et al.: Prognosis in breast cancer utilizing histologic characteristics of the primary tumor. Cancer 1975, 36:2048-55.
27. Black MM, Opler SR, Speer FD: Survival in breast cancer cases in relation to the structure of the primary tumor and regional lymph nodes. Surgery Gynecology & Obstetrics 1995, 100:543-51.
28. Tavassoli FA: Patology of the Breast. McGraw-Hill, 1999.
29. Fisher ER, Redmond C, Fisher B: Histologic grading of breast cancer. Pathol Annu 1980, 15:239-51.
30. Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-74.
31. Svanholm H, Staklint H, Gundersen HJG, et al.: Reproducibility of histomorphologic diagnosis with special reference to the kappa statistic. APMIS 1989, 97:689-698.
32. Douglas-Jones AG, Gupta SK, Attanoos RL, et al.: A critical appraisal of six modern classifications of ductal carcinoma in situ of the breast (DCIS): correlation with grade of associate invasive carcinoma. Histopathology 1996, 29:397-409.
Published
2015-07-12
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