Histopathological systems of breast cancer classification: reproducibility and clinical significance.

Abstract

SUMMARY The inter-and intraobserver reproducibilities of the histopathological systems of breast cancer classification suggested by the World Health Organisation (WHO), the Armed Forces Institute of Pathology (AFIP) and Ackerman have been analysed. The reproducibilities of the three classification systems were only "fair" to "moderate" and no correlation with the five-year recurrence rate was found. Our results indicate that these classification systems are without biological significance and are useless for prognosis in the individual patient.When the tumours were classified according to degree of differentiation (high, moderate, low) or graded according to WHO (which includes both differentiation and nuclear atypia), however, there was a significant correlation with the five-year recurrence rate. Yet even such "reduced" subdivisions are of no value in judging prognosis for the individual patient at the time of diagnosis; rather, they are useful only in the follow-up analysis of groups of patients. The cancers were unilateral and none had been given preoperative radiotherapy. The methods of operation varied. Either a simple mastectomy, radical mastectomy or mastectomy with exploration or exaeresis of the axilla was performed. After the operation for mammary carcinoma the patients were regularly checked at their local hospitals. Information concerning the occurrence of metastases or death was obtained from hospital records. The patients were followed up for five years. TYPES OF SPECIMENSMaterial for histopathological examination was obtained from all the patients subjected to surgical intervention-that is, exploratory biopsy or mastectomy. On removal all specimens were marked by the surgeon at the 12 o'clock position. Immediately after removal, the tumour was cut through and the two longest, perpendicular diameters were measured.A slice (approx 3 mm thick) of the tumour and its 392 on 31 March 2019 by guest. Protected by copyright.

Inter- and intraobserver variability in the histopathological diagnosis of medullary carcinoma of the breast, and its prognostic implications

“…In our study the overall interobserver agreement regarding the diagnoses of TMC, AMC, and NMC in the first and second evaluation is 72% and 68%, respectively, corresponding to Kappa values of 0.55 and 0.52, which are both moderate according to Landis & Koch [17]. Stenkvist et al [21] have examined the interobserver reproducibilities of the histopathological systems of breast cancer classification suggested by WHO, AFIP, and Ackerman, and they found the best reproducibility in the WHO system with an equal assessment of 76% and a Kappa of 0.49, which again according to Landis & Koch is moderate and thus equates with the reproducibilities in our study. Another study of observer variability in the reporting of breast lesions has been performed by Swanson Beck et al [22], who used a simplified six point classsification system that covered the range from normal tissue to invasive carcinoma.…”

“…In the study by Stenkvist et al [21] the intraobserver variation in the WHO system of pathologists i and 2 was 76% and 69%, respectively, with corresponding Kappa values of 0.49 and 0.38, which can be interpreted as 'moderate' and 'fair'. In the study by Swanson Beck et al the average intraobserver agreement was 78%.…”

Predictive value of c-erbB-2, p53, cathepsin-D and histology of the primary tumour in metastatic breast cancer

“…The comparison of these results with those from other institutions is difficult to determine. It is well known that there is a wide variation of results from different institutions (Stenkvist et al, 1983;Gilchrist et al, 1985). In his review, Clayton (1991) found the proportion of well-differentiated tumours to be between 3% and 33% and the proportion of poorly differentiated tumours to be between 25% and 67%.…”

Breast carcinoma malignancy grading by Bloom–Richardson system vs proliferation index: reproducibility of grade and advantages of proliferation index

“…Rationale for an unweighted combined scoring of these three correlated variables has never been put forth, but a relationship between grade of invasive ductal carcinoma (IDC) of the breast and outcome has been recognized consistently. 3,4,[7][8][9] Strength of the prognostic relationship has fallen short of levels necessary for critical therapeutic decisions, and reproducibility of grading has remained a matter of concern [10][11][12][13][14][15][16][17][18][19] (Table 1). The Cooperative Breast Cancer Tissue Resource (CBCTR) has collected and categorized 9000 breast cancer specimens available as formalin-fixed blocks in paraffin.…”