Japanese Journal of Clinical Oncology, Vol 29, Issue 2 68-73, Copyright © 1999 by Foundation for Promotion of Cancer Research
H Tsuda, F Akiyama, M Kurosumi, G Sakamoto and T Watanabe
BACKGROUND: The pathology section of the Japan National Surgical Adjuvant
Study of Breast Cancer protocol study was set up to establish histological
criteria for assessing high-risk node-negative breast cancers and
standardize the subjective criteria used by collaborating pathologists for
nuclear grading of cancers. METHODS: In order to standardize the nuclear
atypia criteria, five slide conferences were held. A total of 57 observers
assigned nuclear atypia scores to 119 breast carcinomas that were presented
using a slide projector or a TV monitor and discussed their histological
findings. The percentage interobserver agreements per tumor and per
conference and kappa value per conference were estimated and compared among
the conferences. The percentage intraobserver reproducibility per tumor
between the last two conferences was compared with the percentage
interobserver agreement for 20 tumors. The kappa value was also calculated
for each of 27 observers to evaluate scoring reproducibility. RESULTS: The
percentage interobserver agreement per conference was constant (75-78%)
throughout the five meetings and the rate of tumors with > 80% agreement
per tumor became higher in later conferences. The kappa value was 0.42,
0.25, 0.42, 0.51 and 0.50 for the first, second, third, fourth and fifth
conferences, respectively. The tumors with a lower percentage interobserver
agreement also had a lower percentage intraobserver reproducibility and
such scoring variations were attributed to the intermediate nature of the
degree of tumor atypia. In 26 of 27 observers, intraobserver agreement for
20 tumors was estimated from the kappa value to range from moderate to
almost perfect. CONCLUSION: We concluded that the repeated slide
conferences conducted by the pathology section were an effective means of
standardizing the subjective histopathological criteria used to assess
tumors. However, the achievement of a good scoring agreement would be
difficult for tumors with an intermediate degree of atypia.
ORIGINAL ARTICLE
The efficacy and limitations of repeated slide conferences for improving interobserver agreement when judging nuclear atypia of breast cancer. The Japan National Surgical Adjuvant Study of Breast Cancer (NSAS-BC) Pathology Section
Pathology Division, National Cancer Center Research Institute, Tokyo, Japan. hstsuda@gan2.ncc.go.jp
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