Verkooijen H M, Peterse J L, Schipper M E I, Buskens E, Hendriks J H C L, Pijnappel R M, Peeters P H M, Borel Rinkes I H M, Mali W P Th M, Holland R
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Eur J Cancer. 2003 Oct;39(15):2187-91. doi: 10.1016/s0959-8049(03)00540-9.
The purpose of this study was to assess whether general pathologists are able to make as accurate and reproducible a diagnosis on large-core needle biopsies as on open breast biopsy specimens. A total of 688 patients underwent a stereotactic large-core (14G) needle biopsy and subsequent surgical excision of 718 non-palpable breast lesions. Forty-two pathologists from 10 departments of pathology (generalists) made a diagnosis on both the needle and open biopsy specimens. Afterwards, three pathologists and two radiologists with extensive experience in breast pathology (experts) diagnosed all of the biopsy specimens. The general pathologists made a similar histological diagnosis as the experts in 632 (88%) of the needle biopsies and 649 (90%) of the open biopsy specimens. Accordingly, the interobserver agreement for the diagnosis of large-core needle biopsies between the general and experts pathologists was excellent (kappa 0.83) and not significantly different from the interobserver agreement for the diagnosis of open breast biopsies (kappa 0.86). However, many inconsistencies were observed in the category of borderline lesions: only 24% of the large-core needle biopsies and 43% of the open biopsies with an expert diagnosis of 'borderline' were diagnosed similarly by the general pathologists. Additionally, the risk of benign/malignant inconsistencies between general pathologists and experts was approximately 1 in 55 for both needle and open biopsies.
本研究的目的是评估普通病理学家对粗针活检做出的诊断是否能与对开放性乳腺活检标本做出的诊断一样准确且可重复。共有688例患者接受了立体定位粗针（14G）活检，随后对718个不可触及的乳腺病变进行了手术切除。来自10个病理科的42位病理学家（通科医生）对针吸活检标本和开放性活检标本都做出了诊断。之后，三位病理学家和两位在乳腺病理学方面有丰富经验的放射科医生（专家）对所有活检标本进行了诊断。普通病理学家在632例（88%）针吸活检和649例（90%）开放性活检标本中做出了与专家相似的组织学诊断。因此，普通病理学家和专家病理学家在粗针活检诊断方面的观察者间一致性非常好（kappa值为0.83），与开放性乳腺活检诊断的观察者间一致性（kappa值为0.86）无显著差异。然而，在临界病变类别中观察到许多不一致之处：在专家诊断为“临界”的粗针活检中，只有24%被普通病理学家做出了相似诊断，在开放性活检中这一比例为43%。此外，普通病理学家和专家在针吸活检和开放性活检中，良性/恶性诊断不一致的风险约为1/55。
