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KMID : 1039420210550060380
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Journal of Pathology and Translational Medicine
2021 Volume.55 No. 6 p.380 ~ p.387
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A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification
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Kang Hye-Ju
Kwon Sun-Young
Kim Ah-Rong
Kim Woo-Gyeong
Kim Eun-Kyung
Kim Ae-Ree
Kim Chung-Yeul
Min Soo-Kee
Park So-Young
Sung Sun-Hee
Yoon Hye-Kyoung
Lee Ah-Won
Lee Ji-Shin
Lee Hyang-Im
Lee Ho-Chang
Lim Sung-Chul
Jun Sun-Young
Jung Min-Jung
Jung Chang-Won
Cho Soo-Youn
Cho Eun-Yoon
Choi Hye-Jeong
Park So-Yeon
Kim Jee-Yeon
Park In-Ae
Kwon Young-Mee
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Abstract
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Background: Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification.
Methods: Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier).
Results: On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems.
Conclusions: Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.
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KEYWORD
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Papillary breast lesion, Core needle biopsy, Interobserver variability, Agreement rate
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