Sloane J P, Amendoeira I, Apostolikas N, Bellocq J P, Bianchi S, Boecker W, Bussolati G, Coleman D, Connolly C E, Dervan P, Eusebi V, De Miguel C, Drijkoningen M, Elston C W, Faverley D, Gad A, Jacquemier J, Lacerda M, Martinez-Penuela J, Munt C, Peterse J L, Rank F, Sylvan M, Tsakraklides V, Zafrani B
University of Liverpool, United Kingdom.
Hum Pathol. 1998 Oct;29(10):1056-62.
The increased detection of ductal carcinoma in situ (DCIS) by mammographic screening, the greater use of breast-conserving surgery, and the recognition that certain histological subtypes are associated with a greater risk of local recurrence has led to the formulation of several new classifications of DCIS in recent years. There are, however, no data concerning the degree of consistency with which these schemes can be applied by reasonable numbers of pathologists. Thirty-three cases of DCIS were thus examined by a working group of 23 European pathologists who categorized them using five recently published classifications: (1) that of the European Pathologists' Working Group based on differentiation (a combination of nuclear grade and cell polarization) with categories of poorly, intermediately, and well differentiated; (2) one based entirely on nuclear grade with categories of high, intermediate, and low, currently in use in the UK national and EC-funded breast screening programs; (3) the same classification in which only two categories, high nuclear grade and other, were used; (4) the Van Nuys system in which lesions are divided into high grade, non-high grade with necrosis and non-high grade without necrosis; and (5) a two-category classification based entirely on the presence or absence of comedo necrosis. Of the three systems with three categories, Van Nuys gave the highest overall kappa statistic of 0.42. Others gave similar values of 0.37 and 0.35 showing that assessing cell polarization in addition to nuclear grade neither improves nor worsens consistency. In all three systems, the middle category was associated with the lowest value for kappa. Of the two systems with two categories, that based on nuclear grade gave the highest overall kappa of 0.46 and that based on comedo necrosis the lowest of 0.34. The most robust histological features were thus high- and low-grade nuclei and necrosis as long as the latter did not involve the recognition of a comedo growth pattern. These values probably represent the maximum achievable, at least by reasonable numbers of pathologists in everyday practice. They are better than those previously reported for classification based entirely on architecture, but further improvement is needed.
乳腺钼靶筛查中导管原位癌（DCIS）检出率的增加、保乳手术的更多应用以及认识到某些组织学亚型与局部复发风险更高相关，导致近年来出现了几种新的DCIS分类方法。然而，尚无关于合理数量的病理学家应用这些分类方案的一致程度的数据。因此，一个由23名欧洲病理学家组成的工作组检查了33例DCIS病例，并使用最近发表的五种分类方法对其进行分类：（1）欧洲病理学家工作组基于分化（核分级和细胞极化的组合）的分类，分为低分化、中分化和高分化类别；（2）一种完全基于核分级的分类，分为高、中、低类别，目前在英国国家和欧盟资助的乳腺筛查项目中使用；（3）同一分类方法，但仅使用高核分级和其他两个类别；（4）范努伊斯系统，其中病变分为高级别、伴有坏死的非高级别和不伴有坏死的非高级别；（5）一种完全基于粉刺样坏死存在与否的两类分类方法。在三种有三个类别的系统中，范努伊斯系统的总体kappa统计值最高，为0.42。其他系统的值相似，分别为0.37和0.35，表明除核分级外评估细胞极化既没有提高也没有降低一致性。在所有三种系统中，中间类别与kappa的最低值相关。在两种有两个类别的系统中，基于核分级的系统总体kappa最高，为0.46，基于粉刺样坏死的系统最低，为0.34。因此，最可靠的组织学特征是高、低级别核以及坏死，只要后者不涉及粉刺样生长模式的识别。这些值可能代表了至少在日常实践中由合理数量的病理学家所能达到的最大值。它们比以前完全基于结构的分类报告的值要好，但仍需要进一步改进。
