Diagnostic concordance among pathologists interpreting breast biopsy specimens.
Diagnostic concordance among pathologists interpreting breast biopsy specimens.
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DOI：
10.1001/jama.2015.1405
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发表时间：
2015-03-17
期刊：
影响因子：
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通讯作者：
Weaver DL
中科院分区：
文献类型：
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作者：
Elmore JG;Longton GM;Carney PA;Geller BM;Onega T;Tosteson AN;Nelson HD;Pepe MS;Allison KH;Schnitt SJ;O'Malley FP;Weaver DL
乳腺病理学诊断为临床治疗和管理决策提供了依据，然而，其准确性还没有得到充分的理解。量化病理学家与共识小组参考诊断相比的诊断分歧程度，并评价相关患者和病理学家特征。对美国8个州临床实践中解释乳腺活检的病理学家的研究。参与者在2011年11月至2014年5月期间独立解读了60份乳腺活检测试集（总共240例病例，每例1张切片）的切片，其中包括23例浸润性乳腺癌、73例导管原位癌（DCIS）、72例非典型增生（非典型性）和72例无非典型性的良性病例。参与者对其他研究病理学家和共识小组成员的解释不知情。在3名共识专家组成员中，其独立诊断的一致性为75%，与共识参考诊断的一致性为90.3%。评估了相对于共识参考诊断的过度解释和解释不足的诊断比例。65%的受邀病理学家符合条件并同意参与。其中，91%（N = 115）完成了研究，提供了6900例个体病例诊断。与共识参考诊断相比，参与病理学家诊断解释的总体一致率为75.3%（95%CI，73.4%-77.0%; 6900例解释中有5194例）。与参考诊断的不一致性在既往乳房X线片上乳腺密度较高（n = 122）与较低（n = 118）的女性活检中有统计学意义（总体一致率，较高者为73% [95%CI，71%-75%]，较低者为77% [95%CI，75%-80%]，P < .001），而在解释较低的每周病例量（P <0.001）或在较小的实践（P = 0.034）或非学术环境（P = 0.007）工作的病理学家中。在这项病理学家的研究中，诊断解释基于单个乳腺活检载玻片，个体病理学家的解释与专家共识衍生的参考诊断之间的总体一致性为75.3%，浸润性癌的一致性最高，DCIS和乳腺癌的一致性较低。需要进一步的研究来了解这些发现与患者管理的关系。
A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%–77.0%; 5194 of 6900 interpretations). Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%–75%] for higher vs 77% [95% CI, 75%–80%] for lower, P < .001), and among pathologists who interpreted lower weekly case volumes (P < .001) or worked in smaller practices (P = .034) or nonacademic settings (P = .007). In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists’ interpretations and the expert consensus–derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management.