Department of Histopathology, School of Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
Histopathology Department, Faculty of Medicine, Menoufia University, Shabeen El Kom, Egypt.
J Clin Pathol. 2018 Sep;71(9):802-805. doi: 10.1136/jclinpath-2017-204981. Epub 2018 Mar 29.
This study aims to assess the diagnostic agreement of lymphovascular invasion (LVI) in invasive breast cancer (BC).
Data on LVI were collected from the UK National Health Service Breast Screening Programme pathology external quality assurance scheme database. 101 BCs assessed over a 10-year period (2004-2014) were included. Cases were scored by an average of 600 pathologists. Three H&E stained slides from each case were reviewed by three pathologists and additional variables were evaluated.
In the whole series, the overall κ value was 0.4 (range 0.26-0.53). On review, LVI was detected in all three slides in 20 cases (20%), in two slides in 12 cases and in one of the three slides in 9 cases and was not seen in 60 cases. For concordance analysis, the first and last groups were used to represent cases with definite (LVI+) and absent LVI (LVI-), respectively. In the LVI+group (n=20), the level of agreement ranged from 0.54 to 0.99 (median 0.86). In the LVI- group (n=60), the level of agreement ranged from 0.52 to 1.00 (median 0.93), with 44% of cases showing interobserver concordance of >95%. There was a correlation between increasing number of involved lymphovascular spaces in the section and higher LVI reporting concordance. Some degree of retraction/fixation artefacts was observed in 35% of cases; this was associated with a lower concordance rate.
The concordance of reporting LVI is variable. Cases without LVI and those with multiple involved vessels are likely to have the highest concordance and the highest detection rates.
本研究旨在评估浸润性乳腺癌（BC）中淋巴血管侵犯（LVI）的诊断一致性。
从英国国家医疗服务体系乳腺筛查计划病理学外部质量保证计划数据库中收集 LVI 数据。纳入了在 10 年期间（2004-2014 年）评估的 101 例 BC 病例。由平均 600 位病理学家对这些病例进行评分。每位病理学家对每个病例的三张 H&E 染色切片进行了审查，并评估了其他变量。
在整个系列中，整体 κ 值为 0.4（范围 0.26-0.53）。在复查中，20 例（20%）在所有三张切片中均检测到 LVI，12 例中有 2 张切片中检测到 LVI，9 例中有 1 张切片中检测到 LVI，60 例中未检测到 LVI。为了进行一致性分析，将第一组和最后一组分别代表明确存在 LVI（LVI+）和不存在 LVI（LVI-）的病例。在 LVI+组（n=20）中，一致性水平范围为 0.54 至 0.99（中位数 0.86）。在 LVI-组（n=60）中，一致性水平范围为 0.52 至 1.00（中位数 0.93），其中 44%的病例具有>95%的观察者间一致性。切片中受累的淋巴管和血管数量增加与 LVI 报告一致性提高有关。35%的病例观察到某种程度的回缩/固定伪影，这与较低的一致性率相关。
报告 LVI 的一致性是可变的。无 LVI 且有多个受累血管的病例可能具有最高的一致性和最高的检出率。
