The impact of inter-observer variation in pathological assessment of node-negative breast cancer on clinical risk assessment and patient selection for adjuvant systemic treatment
The impact of inter-observer variation in pathological assessment of node-negative breast cancer on clinical risk assessment and patient selection for adjuvant systemic treatment
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DOI：
10.1093/annonc/mdp273
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发表时间：
2010-01-01
影响因子：
50.5
通讯作者：
van de Vijver, M. J.
中科院分区：
文献类型：
--
作者：
Bueno-de-Mesquita, J. M.;Nuyten, D. S. A.;van de Vijver, M. J.
方法：分析694例<61岁原发性单侧T1-4N0M0乳腺癌患者的临床和病理资料。首先在当地评估等级、雌激素受体（ER）状态和人表皮生长因子受体2（HER2）状态；随后对这些参数进行了集中重新评估。使用荷兰国家指南和佐剂评估临床病理学低风险或高风险！在线（www.adjuvantonline.com）。 结果：局部病理检查与中央审查的分级、ER 和 HER2 不一致的患者分别为 28%（kappa 0.56；2 级肿瘤 35% 不一致）、5%（kappa 0.85）和 4%（kappa 0.81）。如果根据荷兰指南或佐剂评估临床风险！在网上，分别有 15%（7 名患者之一；kappa 0.70）或 8%（kappa 0.83）的患者被分配到不同的临床风险组。 结论：乳腺癌病理检查的观察者间差异导致分级、ER 状态、HER2 状态、临床病理风险以及随后的辅助全身治疗建议存在显着差异。
Methods: Clinical and pathological data of 694 patients < 61 years with primary unilateral T1-4N0M0 breast cancer were analysed. Grade, estrogen receptor (ER) status and human epidermal growth factor receptor 2 (HER2) status were first assessed locally; subsequent central re-evaluation of these parameters was carried out. Clinicopathological low or high risk was assessed using national Dutch guidelines and the Adjuvant! Online (www.adjuvantonline.com).Results: The local pathological examination was discordant with central review for grade, ER and HER2 in 28% (kappa 0.56; grade 2 tumours 35% discordant), 5% (kappa 0.85) and 4% (kappa 0.81) of patients, respectively. If clinical risk were assessed based on Dutch guidelines or Adjuvant! Online, respectively, 15% (one of seven patients; kappa 0.70) or 8% (kappa 0.83) of patients would have been assigned to a different clinical risk group.Conclusion: Inter-observer variation in pathological examination of breast carcinomas results in significant differences in grade, ER status, HER2 status, clinicopathological risk and subsequently in adjuvant systemic treatment advice.