© 1998 by Oxford University Press
Journal Of The National Cancer Institute, Vol 90, 142-145, Copyright © 1998 by Oxford University Press
WA Wells, PA Carney, MS Eliassen, AN Tosteson and ER Greenberg
BACKGROUND: This study assessed the degree of diagnostic agreement among
community-based general pathologists reading slides of representative
breast tissue specimens and tested whether diagnostic variability is
associated with type of breast specimen (e.g., core needle or excisional
biopsy) or slide quality. METHODS: Twenty-six of the 44 eligible
pathologists working at community-based pathology practices in New
Hampshire participated. Each pathologist evaluated slides of breast tissue
obtained from 30 case subjects randomly selected from a statewide breast
pathology database. The diagnostic categories used were benign, benign with
atypia, noninvasive malignant, and invasive malignant. The levels of
agreement (i.e., kappa coefficients) for the diagnoses were assessed.
RESULTS: Agreement was high among pathologists for assignment of diagnostic
category (kappa coefficient = 0.71) and was nearly perfect for their
selection of benign versus malignant categories (kappa coefficient = 0.95).
There was less agreement for the categories of noninvasive malignant and
benign with atypia (kappa coefficients of 0.59 and 0.22, respectively).
There was no apparent relationship between levels of diagnostic agreement
and specimen type or perceived slide quality. CONCLUSIONS: Diagnostic
agreement for breast tissue specimens is high overall among community-based
pathologists, but clinically relevant disagreements may occur in the
assessment of noninvasive malignant diagnoses. The establishment of reread
policies for certain diagnostic categories may reduce the possibility that
diagnostic misclassification will lead to overtreatment or undertreatment.
The high degree of diagnostic reproducibility for invasive cancerous
lesions of the breast suggests that it is unnecessary for a central review
of these lesions in national cancer trials.
ARTICLES
Statewide study of diagnostic agreement in breast pathology
Department of Pathology, Dartmouth Medical School, Hanover, NH 03756, USA. Wendy.Wells@dartmouth.edu
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