Rakha Emad A, Ahmed Mohamed A, Aleskandarany Mohammed A, Hodi Zsolt, Lee Andrew H S, Pinder Sarah E, Ellis Ian O
Department of Histopathology, Nottingham City Hospital, Nottingham B, UK.
Cancer Studies, King's College London, Guy's Hospital, London, UK.
Histopathology. 2017 Mar;70(4):632-642. doi: 10.1111/his.13117. Epub 2016 Dec 28.
Previous concordance studies examining accuracy of breast diagnosis by pathologists, typically targeting difficult, histologically challenging breast lesions using artificial and restrictive environments, have reported aberrantly high levels of diagnostic discordance. The results of these studies may be misinterpreted by non-pathologists and raise concerns relating to routine practice. This study aims to assess the diagnostic agreement among UK breast pathologists.
Two hundred and forty consecutive breast lesions, submitted by participants from their routine practice, included in the UK National Health Service Breast Screening Programme (NHSBSP) breast pathology EQA scheme during the last 10 years were reviewed. An average of approximately 600 participants viewed each case. Data on diagnostic categories (benign, atypical, in-situ malignant and invasive malignant) were collected. In this study, benign and atypical diagnoses were grouped together.
The overall diagnostic agreement level was in the almost perfect range. Thirty-five cases (14.6%) showed diagnostic concordance of ≤95%. Reasons for discordance included one or more of: (1) scheme methodology limitations such as: (i) miscoding of certain lesions (e.g. phyllodes tumours and lobular neoplasia) (n = 7) and (ii) variable representation of the index lesion on glass slides (n = 18); and (2) diagnostically challenging cases that may be interpreted more easily using immunohistochemistry (n = 28). These latter included benign and malignant papillary lesions (n = 12), complex sclerosing lesions (n = 7), intraductal epithelial proliferative lesions (n = 6) and an unusual special tumour type (n = 1). Further review identified pathologists' misinterpretation in 13 cases (5.4%), with an average discordance rate of only 4.2%.
The performance of breast pathologists is high. Exclusion of the effect of the scheme methodology limitations highlights further the high performance rate and identifies true diagnostically challenging entities. These difficult cases may benefit from additional diagnostic work-up and second opinions.
以往关于病理学家乳腺诊断准确性的一致性研究，通常针对使用人工和受限环境的困难、组织学上具有挑战性的乳腺病变，报告的诊断不一致水平异常高。这些研究结果可能被非病理学家误解，并引发对常规实践的担忧。本研究旨在评估英国乳腺病理学家之间的诊断一致性。
回顾了过去10年英国国家医疗服务体系乳腺筛查计划（NHSBSP）乳腺病理室间质评计划中参与者提交的240例连续乳腺病变。平均约600名参与者查看了每个病例。收集了诊断类别（良性、非典型、原位恶性和浸润性恶性）的数据。在本研究中，良性和非典型诊断归为一组。
总体诊断一致性水平几乎处于完美范围。35例（14.6%）病例的诊断一致性≤95%。不一致的原因包括以下一种或多种：（1）计划方法的局限性，如：（i）某些病变的编码错误（如叶状肿瘤和小叶瘤变）（n = 7）和（ii）玻片上索引病变的不同表现（n = 18）；以及（2）使用免疫组化可能更容易解释的诊断挑战性病例（n = 28）。后者包括良性和恶性乳头状病变（n = 12）、复杂性硬化性病变（n = 7）、导管内上皮增生性病变（n = 6）和一种不寻常的特殊肿瘤类型（n = 1）。进一步审查发现13例（5.4%）存在病理学家的误判，平均不一致率仅为4.2%。
乳腺病理学家的表现很高。排除计划方法局限性的影响进一步凸显了高准确率，并确定了真正具有诊断挑战性的实体。这些困难病例可能受益于额外的诊断检查和二次诊断意见。
