Artikel
Histopathology of Core Biopsies of the Female Breast: Interobserver Variability and its Determinants. Preliminary Results of the DIOS Study
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Veröffentlicht: | 2. September 2009 |
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Introduction: According to European guidelines, the histology of breast core biopsies is categorized by the B-categorization (B1-B5). If histologies are categorized as B3-B5, women usually undergo open surgery of the breast. The aim of this study is to estimate the interobserver variability of the B-categorization and to study potential determinants.
Methods: We recruited consecutive women undergoing core biopsies of the breast at University of Halle. We documented radiological findings including BIRDAS-assessment categories (BIRADS: 0=incomplete, 1=negative, 2=benign finding(s), 3=probably benign, 4=suspicious abnormality, 5=highly suggestive of malignancy, 6=known biopsy-provden malignancy), clinical findings and gynecological histories in a standardized way. Histological slides of the biopsies were assessed by two independent experienced pathologists in a blinded fashion. We calculated observed and chance-corrected agreements (unweighted kappa) and 95% confidence intervals (95%CI).
Results: From April 2006 through July 2008, 765 consecutive women were included. 112 women (15%) had a history of breast cancer, 142 women (19%) without a history of breast cancer had breast symptoms, 83 women (11%) had pathological breast images in the organized screening program, and 428 women(56%) without a history of breast cancer and without symptoms had pathological images (either ultrasound, MRT, or mammography) detected outside of the screening program. The observed agreement of B-categorization (B1-B5) between pathologists was 0.86 (95%CI: 0.83-0.88). The kappa was 0.76 (95%CI: 0.72-0.80). Kappa depended on the BIRADS assessment: BIRADS 2-3: kappa=0.49 (95%CI: 0.34-0.65), BIRADS 4: 0.71 (95%CI: 0.65-0.76), and BIRADS 5: 0.84 (95%CI: 0.64-1.00).
Discussion: Overall, the reliability of the histopathological assessment of breast core biopsies is high. We provide evidence that this agreement is substantially influenced by the pre-biopsy BIRADS-based ratings of the images. Agreement is especially low for lesions rated as benign or probably benign according to BIRADS. The distinction between B1 and B2 was especially problematic when MRT-based biopsies were rated.