Discrepancy between routine and expert pathologists' assessment of non-palpable breast cancer and its impact on locoregional and systemic treatment
Discrepancy between routine and expert pathologists' assessment of non-palpable breast cancer and its impact on locoregional and systemic treatment
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DOI：
10.1016/j.ejphar.2012.12.033
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发表时间：
2013-10-05
影响因子：
5
通讯作者：
van Hillegersberg, Richard
中科院分区：
文献类型：
--
作者：
Postma, Emily L.;Verkooijen, Helena M.;van Hillegersberg, Richard
组织学参数对于决定乳腺癌手术后的辅助治疗至关重要。我们评估了临床淋巴结阴性、不可触及的乳腺癌患者手术治疗策略的观察者间差异性的影响。在一项多中心随机对照试验的背景下，前瞻性收集了310例临床淋巴结阴性不可触及浸润性乳腺癌患者的临床和组织学数据。首先在常规环境中对原发性肿瘤和前哨淋巴结进行组织学评估，随后进行中心审查。如果局部和中心评估之间不一致，我们确定了对局部和全身治疗策略的影响。在13%的患者中观察到当地和中心审查之间的不一致，（kappa 0.60，95% CI 0.50-0.71），12%的等级（k=0.796，95% CI 0.73-0.86），ER状态1%（k=0.898，95% CI 0.80-1.0），PR状态2%（k=0.940，95% CI 0.89-0.99）。在2%的患者中观察到前哨淋巴结评估的不一致性（k=0.954，95% CI 0.92-0.98）。应用现行荷兰指南，中心审查将影响2%（7/310）的局部治疗，5%（16/310）的全身治疗和1%（2/310）的患者。对于中心审查可能导致额外全身治疗的9例（3%）患者，辅助治疗！预测的10年死亡率和复发率将分别下降，中位数为4.6%和15%。在24%的患者中观察到常规组织学评估与中心审查不可触及的乳腺癌标本和前哨淋巴结之间的不一致。这种观察者间差异会影响8%患者的局部和/或全身治疗策略。(C)© 2013 Elsevier B. V.版权所有
Histopathological parameters are essential for deciding on adjuvant treatment following breast cancer surgery. We assessed the impact of inter observer variability on treatment strategy in patients operated for clinically node negative, non palpable breast carcinomas. In the context of a multicenter randomised controlled trial, clinical and histological data of 310 patients with clinically node negative non palpable invasive breast cancer were prospectively collected. Histological assessment of the primary tumour and sentinel nodes was first performed in a routine setting, subsequently central review took place. In case of discordance between local en central assessments, we determined the impact on locoregional and systemic treatment strategy. Discordance between local and central review was observed in 13% of the patients for type (kappa 0.60, 95% CI 0.50-0.71), in 12% for grade (k=0.796, 95% CI 0.73-0.86), in 1% for ER status (k=0.898, 95% CI 0.80-1.0), in 2% for PR status (k=0.940 95% CI 0.89-0.99). Discrepancy in the assessment of the sentinel node(s) was seen in 2% of the patients (k=0.954, 95% CI 0.92-0.98). Applying current Dutch Guidelines, central review would have affected locoregional treatment in 2% (7/310), systemic treatment in 5%(16/310) and both in 1% (2/310) of the patients. For the 9(3%) patients in whom central review would have led to additional systemic treatment, Adjuvant! predicted 10 years mortality and recurrence rate would have decreased with a median of 4.6% and 15%, respectively. Discordance between routine histological assessment and central review of non-palpable breast carcinoma specimens and sentinel nodes was observed in 24% of patients. This inter-observer variation would have impacted locoregional and/or systemic treatment strategies in 8% of the patients. (C) 2013 Elsevier B.V. All rights reserved