Consistency in the observation of features used to classify duct carcinoma in situ (DCIS) of the breast

Abstract

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)

Effect of experience of pathologist on the inter-observer reproducibility of the Nottingham grade

“…High degree of agreement between two individual observers is achieved by pathologists who are working in the same department very closely in routine practice, often presenting each other's work at meetings with continuous feedback (18). This also may explain the substantial agreement achieved in the present study for nuclear pleomorphism, as both authors work in the same department with continuous feedback of each other's work.…”

Tissue microarray analyses of G1/S-regulatory proteins in ductal carcinoma in situ of the breast indicate that low cyclin D1 is associated with local recurrence

“…Classification systems based on various differentiation aspects of DCIS seem to be clinically relevant, as the nuclear grade is strongly associated with disease recurrence (Ringberg et al, 2000;Boland et al, 2003). Unfortunately, the interobserver reproducibility of the analyses is low (Douglas-Jones et al, 2000;Wells et al, 2000) and there is still a need for a more objective basis for the classification of DCIS. Andersen et al (1988) have further stressed the aspect of growth pattern in DCIS .…”

Cytologic Findings with Histologic Correlation in 43 Cases of Mammary Intraductal Adenocarcinoma Diagnosed by Aspiration Biopsy

“…35 Classification systems based on nuclear grading and amount of necrosis have shown the most reproducibility. 36 Thus cases of DCIS diagnosed by AB should include evaluation of nuclear grade and evidence of necrosis. Additionally, nuclear grade in DCIS has been shown to be an important prognostic indicator and a significant predictor of recurrence after breast-conserving therapy.…”