Wells W A, Carney P A, Eliassen M S, Grove M R, Tosteson A N
Department of Pathology, Dartmouth Medical School, Hanover, New Hampshire, USA.
Am J Surg Pathol. 2000 May;24(5):651-9. doi: 10.1097/00000478-200005000-00003.
Several histologic classifications for breast ductal carcinoma in situ (DCIS) have been proposed. This study assessed the diagnostic agreement and reproducibility of three DCIS classifications (Holland [HL], modified Lagios [LA], and Van Nuys [VN]) by comparing the interpretations of pathologists without expertise in breast pathology with those of three breast pathology experts, each a proponent of one classification. Seven nonexpert pathologists in New Hampshire and three experts evaluated 40 slides of DCIS according to the three classifications. Twenty slides were reinterpreted by each nonexpert pathologist. Diagnostic accuracy (nonexperts compared with experts) and reproducibility were evaluated using inter- and intrarater techniques (kappa statistic). Final DCIS grade and nuclear grade were reported most accurately among nonexpert pathologists using HL (kappa = 0.53 and 0.49, respectively) compared with LA and VN (kappa = 0.29 and 0.35, respectively, for both classifications). An intermediate DCIS grade was assessed most accurately using HL and LA, and a high grade (group 3) was assessed most accurately using VN. Diagnostic reproducibility was highest using HL (kappa = 0.49). The VN interpretation of necrosis (present or absent) was reported more accurately than the LA criteria (extensive, focal, or absent; kappa = 0.59 and 0.45, respectively), but reproducibility of each was comparable (kappa = 0.48 and 0.46, respectively). Intrarater agreement was high overall. Comparing all three classifications, final DCIS grade was reported best using HL. Nuclear grade (cytodifferentiation) using HL and the presence or absence of necrosis were the criteria diagnosed most accurately and reproducibly. Establishing one internationally approved set of interpretive definitions, with acceptable accuracy and reproducibility among both pathologists with and without expertise in breast pathology interpretation, will assist researchers in evaluating treatment effectiveness and characterizing the natural history of DCIS breast lesions.
已经提出了几种乳腺导管原位癌（DCIS）的组织学分类方法。本研究通过比较非乳腺病理专业的病理学家与三位乳腺病理专家（分别支持一种分类方法）的解读，评估了三种DCIS分类方法（荷兰分类法[HL]、改良拉吉奥斯分类法[LA]和范努伊斯分类法[VN]）的诊断一致性和可重复性。新罕布什尔州的七位非专家病理学家和三位专家根据这三种分类方法对40张DCIS切片进行了评估。每位非专家病理学家对20张切片进行了重新解读。使用评分者间和评分者内技术（kappa统计量）评估诊断准确性（非专家与专家比较）和可重复性。与LA和VN相比（两种分类方法的kappa分别为0.29和0.35），非专家病理学家使用HL时最终DCIS分级和核分级报告得最准确（kappa分别为0.53和0.49）。使用HL和LA时，中间DCIS分级评估得最准确，使用VN时，高级别（3组）评估得最准确。使用HL时诊断可重复性最高（kappa = 0.49）。VN对坏死（存在或不存在）的解读比LA标准（广泛、局灶或不存在；kappa分别为0.59和0.45）报告得更准确，但每种方法的可重复性相当（kappa分别为0.48和0.46）。评分者内一致性总体较高。比较所有三种分类方法，使用HL时最终DCIS分级报告得最好。使用HL的核分级（细胞分化）以及坏死的存在与否是诊断最准确且可重复的标准。建立一套国际认可的解释性定义，在有和没有乳腺病理解读专业知识的病理学家中都具有可接受的准确性和可重复性，将有助于研究人员评估治疗效果并描述DCIS乳腺病变的自然史。
