Histologic grading of breast carcinoma: a multi-institution study of interobserver variation using virtual microscopy.
Histologic grading of breast carcinoma: a multi-institution study of interobserver variation using virtual microscopy.
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DOI：
10.1038/s41379-020-00698-2
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Harigopal M
中科院分区：
文献类型：
--
作者：
Ginter PS;Idress R;D'Alfonso TM;Fineberg S;Jaffer S;Sattar AK;Chagpar A;Wilson P;Harigopal M
乳腺癌分级是最近纳入AJCC癌症分期手册的一个重要预后特征。越来越多的人对使用更广泛的数字全载玻片成像(WSI)的虚拟显微镜(VM)产生兴趣。关于使用Vm进行分级的一致性以及这种变异性如何影响AJCC预后分期(PS)，我们知之甚少。我们使用数字WSI评估了多机构乳腺病理学家之间的观察者间变异性，以及分级的差异将如何影响PS。来自143例浸润性癌的数字扫描切片由6位病理学家独立评审，并根据已建立的小管形成(Tf)、核多形性(NP)和有丝分裂计数(MC)的标准进行分级。进行统计学分析。观察者间对评分的一致性为中等(κ=0.497)。2、3和1年级的一致性分别为一般(κ=0.375)、一般(κ=0.491)和良好(κ=0.705)。观察者对的一致性从一般到良好(κ=0.354~0.684)，完全一致43例(30%)。观察者间对单个成分的一致性最好的是Tf(κ=0.503)，最差的是MC(κ=0.281)。在86例不一致病例中，17例(19.8%)会导致PS改变，其中最常见的是PS由IA变为IB(n=9)。对于这九个病例中的两个，无论年级如何，Oncotype DX结果都会导致PS为1A。使用Vm，一个多机构的病理学家队列显示乳腺癌分级的中度一致性，类似于使用光学显微镜的研究。在等级和Tf的评估中，一致性是最好的。MC的高变异性是否是VM分级的结果，值得进一步研究。分级的不一致很少导致预后阶段的临床有意义的变化。
Breast carcinoma grading is an important prognostic feature recently incorporated into the AJCC Cancer Staging Manual. There is increased interest in applying virtual microscopy (VM) using digital whole slide imaging (WSI) more broadly. Little is known regarding concordance in grading using VM and how such variability might affect AJCC prognostic staging (PS). We evaluated interobserver variability amongst a multi-institutional group of breast pathologists using digital WSI and how discrepancies in grading would affect PS. A digitally scanned slide from 143 invasive carcinomas was independently reviewed by 6 pathologists and assigned grades based on established criteria for tubule formation (TF), nuclear pleomorphism (NP), and mitotic count (MC). Statistical analysis was performed. Interobserver agreement for grade was moderate (κ=0.497). Agreement was fair (κ=0.375), moderate (κ=0.491), and good (κ=0.705) for grades 2, 3, and 1, respectively. Observer pair concordance ranged from fair to good (κ=0.354 to 0.684) Perfect agreement was observed in 43 cases (30%). Interobserver agreement for the individual components was best for TF (κ=0.503) and worst for MC (κ=0.281). 17 of 86 (19.8%) discrepant cases would have resulted in changes in PS and discrepancies most frequently resulted in a PS change from IA to IB (n=9). For two of these nine cases, Oncotype DX results would have led to a PS of 1A regardless of grade. Using VM, a multi-institutional cohort of pathologists showed moderate concordance for breast cancer grading, similar to studies using light microscopy. Agreement was the best at the extremes of grade and for evaluation of TF. Whether the higher variability noted for MC is a consequence of VM grading warrants further investigation. Discordance in grading infrequently leads to clinically meaningful changes in the prognostic stage.
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影响因子：
4.5
作者：
HARVEY, JM;DEKLERK, NH;STERRETT, GF
通讯作者：
STERRETT, GF
影响因子：
8.8
作者：
BLOOM, HJG
通讯作者：
BLOOM, HJG
影响因子：
2.8
作者：
Chowdhury, Nilotpal;Pal, Muktha R.;Varghese, Rebecca
通讯作者：
Varghese, Rebecca
DOI：
10.1097/00000421-200102000-00002
发表时间：
2001-02-01
影响因子：
2.6
作者：
Page, DL;Gray, R;Wood, WC
通讯作者：
Wood, WC
影响因子：
5
作者：
Balkenhol, Maschenka C. A.;Tellez, David;van der Laak, Jeroen A. W. M.
通讯作者：
van der Laak, Jeroen A. W. M.