Reproducibility in the diagnosis of needle core biopsies of non-palpable breast lesions: an international study using virtual slides published on the world-wide web

Inter-observer agreement in the diagnosis of breast atypical ductal hyperplasia: A systematic review

OBJECTIVE

To review the concordance between pathologists in the diagnosis of atypical ductal hyperplasia of the breast.

METHODS

Systematic review of articles registered in the PubMed database with the terms "pathologists" and "atypical ductal hyperplasia", "atypical ductal hyperplasia" and "interobserver variability", in Embase with "interobserver agreement in atypical ductal hyperplasia" and Lilacs with the terms in Spanish "patólogos" and "hiperplasia ductal atípica", without the use of filters, between 03/16/2022 and 03/26/2022 searching for articles that assess inter-observer agreement in the diagnosis of atypical ductal hyperplasia by using the kappa statistic. Review articles, conference proceedings, and commentaries were excluded.

RESULTS

With the search terms, 507 publications were found. Of these, 491 were excluded from the screening by title and abstract. Of the full reading of the remaining articles, 6 were selected for qualitative analysis. The kappa values ranged from slight agreement, kappa = 0.17, to substantial agreement, 0.69 obtained from pathologists dedicated or experienced in breast pathology and who received a prior tutorial session to review the general criteria for atypia.

CONCLUSIONS

This study reviews the reproducibility in the diagnosis of atypical ductal hyperplasia. A better concordance was obtained with a previous teaching process offered to pathologists dedicated or experienced in breast pathology.

Methodological and statistical issues in developing an External Quality Assessment scheme in laboratory medicine: Focus on biomarker research

External Quality Assessment (EQA) schemes are well-established tools with which to evaluate, monitor and improve the output quality of clinical laboratories, recognising that high quality laboratory medicine is essential for patient care. EQA programs involve the testing of multiple laboratories and the statistical comparison of their results, according to a multistep workflow. New clinical laboratory activities, such as biomarker research, require new EQA schemes. Critical elements in designing EQA programs are choosing the statistical methods and defining reference values and control limits. This article summarizes the key features of an EQA scheme, including designing the study, identifying reference values and control limits for qualitative and quantitative data, and graphically reporting laboratory performance statistics. These steps are illustrated with examples taken from the authors' experience in national and international quality assessment schemes for biomarker research.

External Quality Assessment (EQA) program for the preanalytical and analytical immunohistochemical determination of HER2 in breast cancer: an experience on a regional scale

BACKGROUND

An External Quality Assessment (EQA) program was developed to investigate the state of the art of HER2 immunohistochemical determination in breast cancer (BC) in 16 Pathology Departments in the Lazio Region (Italy). This program was implemented through two specific steps to evaluate HER2 staining (step 1) and interpretation (step 2) reproducibility among participants.

METHODS

The management activities of this EQA program were assigned to the Coordinating Center (CC), the Revising Centers (RCs) and the Participating Centers (PCs). In step 1, 4 BC sections, selected by RCs, were stained by each PC using their own procedures. In step 2, each PC interpreted HER2 score in 10 BC sections stained by the CC. The concordance pattern was evaluated by using the kappa category-specific statistic and/or the weighted kappa statistic with the corresponding 95% Jackknife confidence interval.

RESULTS

In step 1, a substantial/almost perfect agreement was reached between the PCs for scores 0 and 3+ whereas a moderate and fair agreement was observed for scores 1+ and 2+, respectively.In step 2, a fully satisfactory agreement was observed for 6 out of the 16 PCs and a quite satisfactory agreement was obtained for the remaining 10 PCs.

CONCLUSIONS

Our findings highlight that in the whole HER2 evaluation process the two intermediate categories, scores 1+ and 2+, are less reproducible than scores 0 and 3+. These findings are relevant in clinical practice where the choice of treatment is based on HER2 positivity, suggesting the need to share evaluation procedures within laboratories and implement educational programs.

In vivo classification of breast masses using features derived from axial-strain and axial-shear images

Breast cancer is currently the second leading cause of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. In this article, we present classification results for features extracted from ultrasound-based, axial-strain and axial-shear images of breast masses. The breast-mass stiffness contrast, size ratio, and a normalized axial-shear strain area feature are evaluated for the classification of in vivo breast masses using a leave-one-out classifier. Radiofrequency echo data from 123 patients were acquired using Siemens Antares or Elegra clinical ultrasound systems during freehand palpation. Data from four different institutions were analyzed. Axial displacements and strains were estimated using a multilevel, pyramid-based two-dimensional cross-correlation algorithm, with final processing block dimensions of 0.385 mm × 0.507 mm (three A-lines). Since mass boundaries on B-mode images for 21 patients could not be delineated (isoechoic), the combined feature analysis was only performed for 102 patients. Results from receiver operating characteristic (ROC) demonstrate that the area under the curve was 0.90, 0.84, and 0.52 for the normalized axial-shear strain, size ratio, and stiffness contrast, respectively. When these three features were combined using a leave-one-out classifier and support vector machine approach, the overall area under the curve improved to 0.93.

Tumor response assessment by modified Choi criteria in localized high-risk soft tissue sarcoma treated with chemotherapy

BACKGROUND

The objective of this study was to compare the prognostic relevance of Response Evaluation Criteria in Solid Tumors (RECIST) versus Choi criteria for the assessment of response in patients with high-risk soft tissue sarcoma of the extremities or trunk wall who received preoperative chemotherapy with or without radiotherapy in a phase 3 trial.

METHODS

Patients received 3 cycles of preoperative epirubicin + ifosfamide with or without radiotherapy. The diagnostic concordance between RECIST and Choi criteria and their correlation with overall survival (OS) and freedom from progression (FFP) were evaluated in a univariate Cox regression model.

RESULTS

In 243 of 321 eligible patients, RECIST, Choi criteria, and histology were predictive for OS and FFP. In the subgroup of 69 patients who received chemotherapy alone and were evaluable by both RECIST and Choi criteria, Choi criteria were associated significantly with OS and FFP, whereas RECIST predicted only FFP, and the pattern of agreement observed between the 2 criteria was unsatisfactory. On a dichotomous scale, comparing objective response (complete and partial responses) and lack of response (stable and progressive disease) to preoperative chemotherapy according to RECIST and Choi criteria, only Choi criteria were predictive of OS and FFP, and fair agreement between RECIST and Choi criteria was observed. When lack of progression and progression were compared (complete and partial responses + stable disease vs progressive disease), both assessment criteria were significantly predictive of OS and FFP, and there was substantial agreement between the 2 criteria.

CONCLUSIONS

Response to chemotherapy with or without radiotherapy was associated with a better outcome in patients with high-risk soft tissue sarcoma. Choi criteria were better predictors than RECIST in patients who received preoperative chemotherapy alone.