Prognostic value of histopathological DCIS features in a large-scale international interrater reliability study.
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Groen Emma J, Hudecek Jan, Mulder Lennart, van Seijen Maartje, Almekinders Mathilde M, Alexov Stoyan, Kovács Anikó, Ryska Ales, Varga Zsuzsanna, Andreu Navarro Francisco-Javier, Bianchi Simonetta, Vreuls Willem, Balslev Eva, Boot Max V, Kulka Janina, Chmielik Ewa, Barbé Ellis, de Rooij Mathilda J, Vos Winand, Farkas Andrea, Leeuwis-Fedorovich Natalja E, Regitnig Peter, Westenend Pieter J, Kooreman Loes F S, Quinn Cecily, Floris Giuseppe, Cserni Gábor, van Diest Paul J, Lips Esther H, Schaapveld Michael, Wesseling Jelle, Grand Challenge PRECISION consortium
Аннотация
METHODS: Using a case-cohort design, reliability was assessed in a population-based, nationwide cohort of 2767 women with screen-detected DCIS diagnosed between 1993 and 2004, treated by breast-conserving surgery with/without radiotherapy (BCS ± RT) using Krippendorff's alpha (KA) and Gwet's AC2 (GAC2). Thirty-eight raters scored histopathological DCIS features including grade (2-tiered and 3-tiered), growth pattern, mitotic activity, periductal fibrosis, and lymphocytic infiltrate in 342 women. Using majority opinion-based scores for each feature, their association with subsequent iIBC risk was assessed using Cox regression.
RESULTS: Interrater reliability of grade using various classifications was fair to moderate, and only substantial for grade 1 versus 2 + 3 when using GAC2 (0.78). Reliability for growth pattern (KA 0.44, GAC2 0.78), calcifications (KA 0.49, GAC2 0.70) and necrosis (KA 0.47, GAC2 0.70) was moderate using KA and substantial using GAC2; for (type of) periductal fibrosis and lymphocytic infiltrate fair to moderate estimates were found and for mitotic activity reliability was substantial using GAC2 (0.70). Only in patients treated with BCS-RT, high mitotic activity was associated with a higher iIBC risk in univariable analysis (Hazard Ratio (HR) 2.53, 95% Confidence Interval (95% CI) 1.05-6.11); grade 3 versus 1 + 2 (HR 2.64, 95% CI 1.35-5.14) and a cribriform/solid versus flat epithelial atypia/clinging/(micro)papillary growth pattern (HR 3.70, 95% CI 1.34-10.23) were independently associated with a higher iIBC risk.
CONCLUSIONS: Using majority opinion-based scores, DCIS grade, growth pattern, and mitotic activity are associated with iIBC risk in patients treated with BCS-RT, but interrater variability is substantial. Semi-quantitative grading, incorporating and separately evaluating nuclear pleomorphism, growth pattern, and mitotic activity, may improve the reliability and prognostic value of these features.