Prognostic value of histopathological DCIS features in a large-scale international interrater reliability study.

Autor: Groen EJ; Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands., Hudecek J; Department of Research IT, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Mulder L; Department of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van Seijen M; Department of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Almekinders MM; Department of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Alexov S; Department of Pathology, Oncology Hospital, Sofia, Bulgaria., Kovács A; Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden., Ryska A; The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic., Varga Z; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland., Andreu Navarro FJ; Atryshealth Co, S.L., Barcelona, Spain., Bianchi S; Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy., Vreuls W; Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Balslev E; Department of Pathology, Herlev University Hospital, Herlev, Denmark., Boot MV; Department of Pathology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands., Kulka J; 2nd Department of Pathology, Semmelweis University, Budapest, Hungary., Chmielik E; Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland., Barbé E; Department of Pathology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands., de Rooij MJ; Symbiant Pathology Expert Centre, Location ZMC, Zaandam, The Netherlands., Vos W; Department of Pathology, Zuyderland Medical Center, Location Sittard-Geleen, Sittard-Geleen, The Netherlands., Farkas A; Department of Pathology, Gävle Hospital, Gävle, Sweden., Leeuwis-Fedorovich NE; Department of Pathology, Deventer Hospital, Deventer, The Netherlands., Regitnig P; Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria., Westenend PJ; Laboratory for Pathology Dordrecht, Dordrecht, The Netherlands., Kooreman LFS; Department of Pathology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands., Quinn C; Department of Pathology and Laboratory Medicine, St. Vincent's University Hospital, Dublin, Ireland., Floris G; Laboratory of Translational Cell & Tissue Research, Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium.; Department of Pathology, University Hospitals Leuven, Leuven, Belgium., Cserni G; Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary.; Department of Pathology, University of Szeged, Szeged, Hungary., van Diest PJ; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands., Lips EH; Department of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Schaapveld M; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Wesseling J; Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. j.wesseling@nki.nl.; Department of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands. j.wesseling@nki.nl.
Jazyk: angličtina
Zdroj: Breast cancer research and treatment [Breast Cancer Res Treat] 2020 Oct; Vol. 183 (3), pp. 759-770. Date of Electronic Publication: 2020 Jul 30.
DOI: 10.1007/s10549-020-05816-x
Abstrakt: Purpose: For optimal management of ductal carcinoma in situ (DCIS), reproducible histopathological assessment is essential to distinguish low-risk from high-risk DCIS. Therefore, we analyzed interrater reliability of histopathological DCIS features and assessed their associations with subsequent ipsilateral invasive breast cancer (iIBC) risk.
Methods: Using a case-cohort design, reliability was assessed in a population-based, nationwide cohort of 2767 women with screen-detected DCIS diagnosed between 1993 and 2004, treated by breast-conserving surgery with/without radiotherapy (BCS ± RT) using Krippendorff's alpha (KA) and Gwet's AC2 (GAC2). Thirty-eight raters scored histopathological DCIS features including grade (2-tiered and 3-tiered), growth pattern, mitotic activity, periductal fibrosis, and lymphocytic infiltrate in 342 women. Using majority opinion-based scores for each feature, their association with subsequent iIBC risk was assessed using Cox regression.
Results: Interrater reliability of grade using various classifications was fair to moderate, and only substantial for grade 1 versus 2 + 3 when using GAC2 (0.78). Reliability for growth pattern (KA 0.44, GAC2 0.78), calcifications (KA 0.49, GAC2 0.70) and necrosis (KA 0.47, GAC2 0.70) was moderate using KA and substantial using GAC2; for (type of) periductal fibrosis and lymphocytic infiltrate fair to moderate estimates were found and for mitotic activity reliability was substantial using GAC2 (0.70). Only in patients treated with BCS-RT, high mitotic activity was associated with a higher iIBC risk in univariable analysis (Hazard Ratio (HR) 2.53, 95% Confidence Interval (95% CI) 1.05-6.11); grade 3 versus 1 + 2 (HR 2.64, 95% CI 1.35-5.14) and a cribriform/solid versus flat epithelial atypia/clinging/(micro)papillary growth pattern (HR 3.70, 95% CI 1.34-10.23) were independently associated with a higher iIBC risk.
Conclusions: Using majority opinion-based scores, DCIS grade, growth pattern, and mitotic activity are associated with iIBC risk in patients treated with BCS-RT, but interrater variability is substantial. Semi-quantitative grading, incorporating and separately evaluating nuclear pleomorphism, growth pattern, and mitotic activity, may improve the reliability and prognostic value of these features.
Databáze: MEDLINE
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