Institute of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
Pathology Institute, Cantonal Hospital Aarau, Aarau, Switzerland.
J Cancer Res Clin Oncol. 2020 Jun;146(6):1473-1478. doi: 10.1007/s00432-020-03195-w. Epub 2020 Mar 30.
Classical type of lobular neoplasia (LN) spans a spectrum of disease, including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), classical lobular neoplasia (LN), and the three-tiered classification of lobular intraepithelial neoplasia (LIN-1, -2, -3). This study addressed inter-observer variability of classical lobular neoplasias (LN) (B3 lesions) in preoperative breast biopsies among breast and gynecopathologists METHODS: A retrospective, observational, cross-sectional study was conducted. 40 preoperative digital images of breast core/vacuum biopsies were analyzed by eight experienced breast- and gynecopathologists. Evaluation criteria were ALH, LCIS, LN classic, LIN-1, LIN-2, LIN-3, focal B3 (one focus), extensive B3 (> one focus). Kappa-index and Chi-square tests were used for statistics. Digital scanned slides were provided to each participant. Agreement between the categories was defined as at least six of eight (cut-off 75%) concordant diagnoses.
The highest agreement between eight pathologists was reached using the category lobular neoplasia (LN, classical), 26/40 (65%) cases were diagnosed as such. Agreements in other categories was low or poor: 12/40 (30%) (ALH), 9/40 (22%) (LCIS), 8/40 (20%) (LIN-1), 8/40 (20%) (focal B3), 3/40 (7.5%) (LIN-2), and 2/40 (5%) (extensive B3). Chi-square-test (classical LN versus the other nomenclatures) was significant (p = 0.001137).
Our data suggest that among Swiss breast pathologists, the most reproducible diagnosis for B3 lobular lesions is the category of classical LN. These data further support lack of consistent data in retrospective studies using different terminologies. Validation of reproducible nomenclature is warranted in further studies. This information is useful especially in view of retro- and prospective data analysis with different diagnostic categories.
经典型小叶肿瘤（LN）包括一系列疾病，包括不典型小叶增生（ALH）和小叶原位癌（LCIS）、经典型 LN 以及三级小叶上皮内肿瘤（LIN-1、-2、-3）。本研究旨在探讨术前乳腺活检中乳腺和妇科病理学家对经典型 LN（B3 病变）的观察者间变异性。
本研究为回顾性、观察性、横断面研究。对 8 名经验丰富的乳腺和妇科病理学家进行了 40 例术前乳腺芯/真空活检的数字图像分析。评估标准为 ALH、LCIS、经典型 LN、LIN-1、LIN-2、LIN-3、局灶性 B3（一个病灶）、广泛性 B3（多个病灶）。采用 Kappa 指数和卡方检验进行统计学分析。每位参与者均提供数字扫描幻灯片。将类别间的一致性定义为至少 8 个中的 6 个（截止值为 75%）一致诊断。
8 位病理学家之间使用小叶肿瘤（LN，经典型）这一类别达到了最高的一致性，40 例中有 26 例（65%）被诊断为该类疾病。其他类别的一致性较低或较差：12 例（30%）（ALH）、9 例（22%）（LCIS）、8 例（20%）（LIN-1）、8 例（20%）（局灶性 B3）、3 例（7.5%）（LIN-2）和 2 例（5%）（广泛性 B3）。卡方检验（经典型 LN 与其他命名法）差异有统计学意义（p=0.001137）。
本研究数据表明，在瑞士乳腺病理学家中，对 B3 小叶病变最具可重复性的诊断是经典型 LN 类别。这些数据进一步支持了使用不同术语的回顾性研究中缺乏一致数据的情况。在进一步的研究中，需要验证可重复的命名法。鉴于使用不同诊断类别进行回顾性和前瞻性数据分析，这些信息非常有用。
