Onega Tracy, Weaver Donald L, Frederick Paul D, Allison Kimberly H, Tosteson Anna N A, Carney Patricia A, Geller Berta M, Longton Gary M, Nelson Heidi D, Oster Natalia V, Pepe Margaret S, Elmore Joann G
Department of Biomedical Data Science, Department of Epidemiology, The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Department of Pathology, University of Vermont and UVM Cancer Center, Burlington, VT, USA.
Eur J Cancer. 2017 Jul;80:39-47. doi: 10.1016/j.ejca.2017.04.013. Epub 2017 May 20.
Diagnostic agreement among pathologists is 84% for ductal carcinoma in situ (DCIS). Studies of interpretive variation according to grade are limited.
A national sample of 115 pathologists interpreted 240 breast pathology test set cases in the Breast Pathology Study and their interpretations were compared to expert consensus interpretations. We assessed agreement of pathologists' interpretations with a consensus reference diagnosis of DCIS dichotomised into low- and high-grade lesions. Generalised estimating equations were used in logistic regression models of rates of under- and over-interpretation of DCIS by grade.
We evaluated 2097 independent interpretations of DCIS (512 low-grade DCIS and 1585 high-grade DCIS). Agreement with reference diagnoses was 46% (95% confidence interval [CI] 42-51) for low-grade DCIS and 83% (95% CI 81-86) for high-grade DCIS. The proportion of reference low-grade DCIS interpretations over-interpreted by pathologists (i.e. categorised as either high-grade DCIS or invasive cancer) was 23% (95% CI 19-28); 30% (95% CI 26-34) were interpreted as a lower diagnostic category (atypia or benign proliferative). Reference high-grade DCIS was under-interpreted in 14% (95% CI 12-16) of observations and only over-interpreted 3% (95% CI 2-4).
Grade is a major factor when examining pathologists' variability in diagnosing DCIS, with much lower agreement for low-grade DCIS cases compared to high-grade. These findings support the hypothesis that low-grade DCIS poses a greater interpretive challenge than high-grade DCIS, which should be considered when developing DCIS management strategies.
导管原位癌（DCIS）的病理学家诊断一致性为84%。关于根据分级进行解释性差异的研究有限。
115名病理学家的全国样本对乳腺病理研究中的240例乳腺病理检测集病例进行了解读，并将他们的解读与专家共识解读进行了比较。我们评估了病理学家的解读与DCIS的共识参考诊断的一致性，DCIS分为低级别和高级别病变。广义估计方程用于DCIS按分级的低解读率和高解读率的逻辑回归模型。
我们评估了2097例DCIS的独立解读（512例低级别DCIS和1585例高级别DCIS）。低级别DCIS与参考诊断的一致性为46%（95%置信区间[CI]42 - 51），高级别DCIS为83%（95%CI 81 - 86）。病理学家将参考低级别DCIS解读为高级别DCIS或浸润性癌（即过度解读）的比例为23%（95%CI 19 - 28）；30%（95%CI 26 - 34）被解读为较低诊断类别（非典型增生或良性增生）。参考高级别DCIS在14%（95%CI 12 - 16）的观察中被低解读，仅3%（95%CI 2 - 4）被过度解读。
分级是检查病理学家诊断DCIS变异性时的一个主要因素，低级别DCIS病例的一致性远低于高级别。这些发现支持了低级别DCIS比高级别DCIS带来更大解释挑战的假设，在制定DCIS管理策略时应予以考虑。
