Inter-observer Reproducibility in the Pathologic Diagnosis of Breast Intraductal Proliferative Lesions Using the Same Criteria_Chinese Journal of Evidence-Based Medicine

Authors：

WEI Bing ¹ , ZHANG Hongying ¹ , WANG Yufang ² , BU Hong ¹ , CHEN Huijiao ¹ , GUO Hua ¹ , DAI Qingqing ³ , TANG Xi ³ , LANG Zhiqiang ¹ , LI Xinjun ¹

1. Department of Pathology; West China Hospital; Sichuan University; Chengdu 610041; China2. Department of Gastroenterology; West China Hospital; Sichuan University; Chengdu 610041; China3. West China Clinical Medical School; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Breast intraductal proliferative lesions; Pathologic diagnosis; Diagnostic criteria; Inter-observer reproducibility

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Objective 　To investigate inter-observer reproducibility in the pathologic diagnosis of breast intraductal proliferative lesions (BDPL).
Methods 　Forty three BDPL patients were diagnosed by criterion of Page. Every specimen from each case was sorted randomly. All slides were classified as mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. Inter-observer agreement of the two groups was statistically analyzed using Kappa test. Then we compared all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists to analyze the diagnostic accuracy and undue diagnosis.
Results 　Inter-observer reproducibility of the trial group was higher than that of the control group (The total K value of 6, 3, and 2 diagnoses in the two groups were 0.289 3, 0.337 1, 0.492 8, 0.100 3, 0.150 3 and 0.340 3, respectively). When the categories were simplified, inter-observer reproducibility increased. There were still undue diagnoses of different degrees among pathologists of the trial group.
Conclusion 　Using the same criteria is an important method to increase the diagnostic reproducibility and accuracy. More practice is needed to familiarize with these criteria.

Citation： WEI Bing,ZHANG Hongying,WANG Yufang,BU Hong,CHEN Huijiao,GUO Hua,DAI Qingqing,TANG Xi,LANG Zhiqiang,LI Xinjun. Inter-observer Reproducibility in the Pathologic Diagnosis of Breast Intraductal Proliferative Lesions Using the Same Criteria. Chinese Journal of Evidence-Based Medicine, 2004, 04(11): 766-770. doi: Copy

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15.	［12］Silverberg SG. Misconception About Mammary Intraepithelial Neoplasia (MIN)[J]. Breast J,1999; 5(1): 73-74.
16.	［13］Bu H, Wei B. Evidence-based medicine and pathological practice[J]. Chinese Journal of Pathology, 2003; 32(1): 92-94.
17.	步宏, 魏兵.循证医学与病理学实践.中华病理学杂志[J], 2003; 32(1): 92～94.

1. ［1］Wang JY. Diagnostic test. In: Wang JY. Evidence-based medicine and clinical practice [M]. 1st ed. Beijing: Science Publishing House; 2002.p.122141.
2. 王吉耀.诊断试验. 见:王吉耀,主编.循证医学与临床实践[M].第1版.北京:科学出版社; 2002. p.122～141.
3. ［2］Greenhalgh T. How to read a paper. Papers that report diagnostic or screening tests[J]. BMJ, 1997; 315(7107):540-543.
4. ［3］Wang JS. Research and evaluation of diagnostic test[A]. See: Wang JL. Clinical epidemiology[M]. 2st ed. Shanghai: Shanghai science and Technology Publishing House; 2001. p.258-272.
5. 王觉生.诊断性试验的研究与评价[A]. 见:王家良,主编.临床流行病学[M]. 第2版.上海:上海科学技术出版社; 2001. p.258～272.
6. ［4］Bu H, Wei B. Reproducibility and limitation in pathological diagnosis[J]. Chinese Journal of Clinical and Experimental Pathology, 2003; 19(1): 349-350.
7. 步宏, 魏兵.病理学诊断的重复性与局限性[J]. 临床与实验病理学杂志, 2003; 19(1): 349～350.
8. ［5］Creagh T, Bridger JE, Kupek E, Fish DE, Martin-Bates E, Wilkins MJ. Pathologist variation in reporting cervical borderline epithelial abnormalities and cervical intraepithelial neoplasia[J].J Clin Pathol,1995; 48(1): 59-60.
9. ［6］Bergeron C, Nogales FF, Masseroli M, Abeler V, Duvillard P, Muller-Holzner E, Pickartz H, Wells M. A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens[J]. Am J Surg Pathol,1999; 23(9): 1 102-1 108.
10. ［7］Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnoses of mammary atypical ductal hyperplasia[J]. Hum Pathol, 1992; 23(10): 1 095-1 097.
11. ［8］Schnitt SJ, Connolly JL, Tavassoli FA, Fechner RE, Kempson RL, Gelman R, Page DL. inter-observer reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria[J]. Am J Surg Pathol, 1992; 16(12): 1 133-1 143.
12. ［9］Rosai J. Borderline epithelial lesions of the breast[J]. Am J Surg Pathol, 1991; 15(3): 209-221.
13. ［10］Rosai J. The continuing role of morphology in the molecular age[J]. Mod Pathol, 2001; 14(3): 258-260.
14. ［11］Tavassoli FA,Hoefler H,Rosai J. Intraductal proliferaive lesions.In: Tavassoli FA,eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs[M], Lyron: IARC Press; 2003. p.64.
15. ［12］Silverberg SG. Misconception About Mammary Intraepithelial Neoplasia (MIN)[J]. Breast J,1999; 5(1): 73-74.
16. ［13］Bu H, Wei B. Evidence-based medicine and pathological practice[J]. Chinese Journal of Pathology, 2003; 32(1): 92-94.
17. 步宏, 魏兵.循证医学与病理学实践.中华病理学杂志[J], 2003; 32(1): 92～94.

Chinese Journal of Evidence-Based Medicine

Inter-observer Reproducibility in the Pathologic Diagnosis of Breast Intraductal Proliferative Lesions Using the Same Criteria

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