Dessauvagie, BF, Lee, AHS, Meehan, K et al. (8 more authors) (2018) Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology. Journal of Clinical Pathology, 71 (8). pp. 672-679. ISSN 0021-9746
Abstract
Aim: Fibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important with FAs managed conservatively while equivocal lesions and PTs are managed with surgery. We sought to audit core biopsy diagnoses of equivocal FELs by digital pathology and to investigate whether digital point counting is useful in clarifying FEL diagnoses.
Method: Scanned slide images from cores and subsequent excisions of 69 equivocal FELs were examined in a multicentre audit by eight pathologists to determine the agreement and accuracy of core needle biopsy (CNB) diagnoses and by digital point counting of stromal cellularity and expansion to determine if classification could be improved.
Results: Interobserver variation was high on CNB with a unanimous diagnosis from all pathologists in only eight cases of FA, diagnoses of both FA and PT on the same CNB in 15 and a ‘weak’ mean kappa agreement between pathologists (k=0.36). ‘Moderate’ agreement was observed on CNBs among breast specialists (k=0.44) and on excision samples (k=0.49). Up to 23% of lesions confidently diagnosed as FA on CNB were PT on excision and up to 30% of lesions confidently diagnosed as PT on CNB were FA on excision. Digital point counting did not aid in the classification of FELs.
Conclusion: Accurate and reproducible diagnosis of equivocal FELs is difficult, particularly on CNB, resulting in poor interobserver agreement and suboptimal accuracy. Given the diagnostic difficulty, and surgical implications, equivocal FELs should be reported in consultation with experienced breast pathologists as a small number of benign FAs can be selected out from equivocal lesions.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. This is an author produced version of a paper published in Journal of Clinical Pathology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | breast pathology; digital pathology; fibroadenoma; fibroepithelial lesions; phyllodes tumour; quality assurance |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cancer and Pathology (LICAP) > Pathology & Tumour Biology (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 22 Feb 2018 11:54 |
Last Modified: | 24 Jul 2018 14:35 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Identification Number: | 10.1136/jclinpath-2017-204977 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:127677 |