Discordance in pathology report after central pathology review

Implications for breast cancer adjuvant treatment

Laura Orlando, Giuseppe Viale, Emilio Bria, Eufemia Stefania Lutrino, Isabella Sperduti, Luisa Carbognin, Paola Schiavone, Annamaria Quaranta, Palma Fedele, Chiara Caliolo, Nicola Calvani, Mario Criscuolo, Saverio Cinieri

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Aim Pathological predictive factors are the most important markers when selecting early breast cancer adjuvant therapy. In randomized clinical trials the variability in pathology report after central pathology review is noteworthy. We evaluated the discordance rate (DR) and inter-rater agreement between local and central histopathological report and the clinical implication on treatment decision. Methods A retrospective analysis was conducted in a series of consecutive early breast cancer tumors diagnosed by local pathologists and subsequently reviewed at the Pathology Division of European Institute of Oncology. The inter-rater agreement (k) between local and central pathology was calculated for Ki-67, grading, hormone receptors (ER/PgR) and HER2/neu. The Bland–Altman plots were derived to determine discrepancies in Ki-67, ER and PgR. DR was calculated for ER/PgR and HER2. Results From 2007 to 2013, 187 pathology specimens from 10 Cancer Centers were reviewed. Substantial agreement was observed for ER (k0.612; 95% CI, 0538–0.686), PgR (k0.659; 95% CI, 0580–0.737), Ki-67 (k0.609; 95% CI, 0.534–0.684) and grading (k0.669; 95% CI, 0.569–0.769). Moderate agreement was found for HER2 (k0.546; 95% CI, 0444–0.649). DR was 9.5% (negativity to positivity) and 31.7% (positivity to negativity) for HER2 and 26.2% (negativity to positivity) and 12.5% (positivity to negativity) for ER/PgR. According to changes in Her2 and ER/PgR status, 23 (12.2%) and 33 (17.6%) systemic prescription were respectively modified. Conclusions In our retrospective analysis, central pathological review has a significant impact in the decision-making process in early breast cancer, as shown in clinical trials. Further studies are warranted to confirm these provocative results.

Original languageEnglish
Pages (from-to)151-155
Number of pages5
JournalBreast
Volume30
DOIs
Publication statusPublished - Dec 1 2016

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Pathology
Breast Neoplasms
Therapeutics
Prescriptions
Decision Making
Randomized Controlled Trials
Clinical Trials
Hormones
Neoplasms

Keywords

  • Early breast cancer
  • Pathology report

ASJC Scopus subject areas

  • Surgery

Cite this

Discordance in pathology report after central pathology review : Implications for breast cancer adjuvant treatment. / Orlando, Laura; Viale, Giuseppe; Bria, Emilio; Lutrino, Eufemia Stefania; Sperduti, Isabella; Carbognin, Luisa; Schiavone, Paola; Quaranta, Annamaria; Fedele, Palma; Caliolo, Chiara; Calvani, Nicola; Criscuolo, Mario; Cinieri, Saverio.

In: Breast, Vol. 30, 01.12.2016, p. 151-155.

Research output: Contribution to journalArticle

Orlando, L, Viale, G, Bria, E, Lutrino, ES, Sperduti, I, Carbognin, L, Schiavone, P, Quaranta, A, Fedele, P, Caliolo, C, Calvani, N, Criscuolo, M & Cinieri, S 2016, 'Discordance in pathology report after central pathology review: Implications for breast cancer adjuvant treatment', Breast, vol. 30, pp. 151-155. https://doi.org/10.1016/j.breast.2016.09.015
Orlando, Laura ; Viale, Giuseppe ; Bria, Emilio ; Lutrino, Eufemia Stefania ; Sperduti, Isabella ; Carbognin, Luisa ; Schiavone, Paola ; Quaranta, Annamaria ; Fedele, Palma ; Caliolo, Chiara ; Calvani, Nicola ; Criscuolo, Mario ; Cinieri, Saverio. / Discordance in pathology report after central pathology review : Implications for breast cancer adjuvant treatment. In: Breast. 2016 ; Vol. 30. pp. 151-155.
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abstract = "Aim Pathological predictive factors are the most important markers when selecting early breast cancer adjuvant therapy. In randomized clinical trials the variability in pathology report after central pathology review is noteworthy. We evaluated the discordance rate (DR) and inter-rater agreement between local and central histopathological report and the clinical implication on treatment decision. Methods A retrospective analysis was conducted in a series of consecutive early breast cancer tumors diagnosed by local pathologists and subsequently reviewed at the Pathology Division of European Institute of Oncology. The inter-rater agreement (k) between local and central pathology was calculated for Ki-67, grading, hormone receptors (ER/PgR) and HER2/neu. The Bland–Altman plots were derived to determine discrepancies in Ki-67, ER and PgR. DR was calculated for ER/PgR and HER2. Results From 2007 to 2013, 187 pathology specimens from 10 Cancer Centers were reviewed. Substantial agreement was observed for ER (k0.612; 95{\%} CI, 0538–0.686), PgR (k0.659; 95{\%} CI, 0580–0.737), Ki-67 (k0.609; 95{\%} CI, 0.534–0.684) and grading (k0.669; 95{\%} CI, 0.569–0.769). Moderate agreement was found for HER2 (k0.546; 95{\%} CI, 0444–0.649). DR was 9.5{\%} (negativity to positivity) and 31.7{\%} (positivity to negativity) for HER2 and 26.2{\%} (negativity to positivity) and 12.5{\%} (positivity to negativity) for ER/PgR. According to changes in Her2 and ER/PgR status, 23 (12.2{\%}) and 33 (17.6{\%}) systemic prescription were respectively modified. Conclusions In our retrospective analysis, central pathological review has a significant impact in the decision-making process in early breast cancer, as shown in clinical trials. Further studies are warranted to confirm these provocative results.",
keywords = "Early breast cancer, Pathology report",
author = "Laura Orlando and Giuseppe Viale and Emilio Bria and Lutrino, {Eufemia Stefania} and Isabella Sperduti and Luisa Carbognin and Paola Schiavone and Annamaria Quaranta and Palma Fedele and Chiara Caliolo and Nicola Calvani and Mario Criscuolo and Saverio Cinieri",
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T2 - Implications for breast cancer adjuvant treatment

AU - Orlando, Laura

AU - Viale, Giuseppe

AU - Bria, Emilio

AU - Lutrino, Eufemia Stefania

AU - Sperduti, Isabella

AU - Carbognin, Luisa

AU - Schiavone, Paola

AU - Quaranta, Annamaria

AU - Fedele, Palma

AU - Caliolo, Chiara

AU - Calvani, Nicola

AU - Criscuolo, Mario

AU - Cinieri, Saverio

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Aim Pathological predictive factors are the most important markers when selecting early breast cancer adjuvant therapy. In randomized clinical trials the variability in pathology report after central pathology review is noteworthy. We evaluated the discordance rate (DR) and inter-rater agreement between local and central histopathological report and the clinical implication on treatment decision. Methods A retrospective analysis was conducted in a series of consecutive early breast cancer tumors diagnosed by local pathologists and subsequently reviewed at the Pathology Division of European Institute of Oncology. The inter-rater agreement (k) between local and central pathology was calculated for Ki-67, grading, hormone receptors (ER/PgR) and HER2/neu. The Bland–Altman plots were derived to determine discrepancies in Ki-67, ER and PgR. DR was calculated for ER/PgR and HER2. Results From 2007 to 2013, 187 pathology specimens from 10 Cancer Centers were reviewed. Substantial agreement was observed for ER (k0.612; 95% CI, 0538–0.686), PgR (k0.659; 95% CI, 0580–0.737), Ki-67 (k0.609; 95% CI, 0.534–0.684) and grading (k0.669; 95% CI, 0.569–0.769). Moderate agreement was found for HER2 (k0.546; 95% CI, 0444–0.649). DR was 9.5% (negativity to positivity) and 31.7% (positivity to negativity) for HER2 and 26.2% (negativity to positivity) and 12.5% (positivity to negativity) for ER/PgR. According to changes in Her2 and ER/PgR status, 23 (12.2%) and 33 (17.6%) systemic prescription were respectively modified. Conclusions In our retrospective analysis, central pathological review has a significant impact in the decision-making process in early breast cancer, as shown in clinical trials. Further studies are warranted to confirm these provocative results.

AB - Aim Pathological predictive factors are the most important markers when selecting early breast cancer adjuvant therapy. In randomized clinical trials the variability in pathology report after central pathology review is noteworthy. We evaluated the discordance rate (DR) and inter-rater agreement between local and central histopathological report and the clinical implication on treatment decision. Methods A retrospective analysis was conducted in a series of consecutive early breast cancer tumors diagnosed by local pathologists and subsequently reviewed at the Pathology Division of European Institute of Oncology. The inter-rater agreement (k) between local and central pathology was calculated for Ki-67, grading, hormone receptors (ER/PgR) and HER2/neu. The Bland–Altman plots were derived to determine discrepancies in Ki-67, ER and PgR. DR was calculated for ER/PgR and HER2. Results From 2007 to 2013, 187 pathology specimens from 10 Cancer Centers were reviewed. Substantial agreement was observed for ER (k0.612; 95% CI, 0538–0.686), PgR (k0.659; 95% CI, 0580–0.737), Ki-67 (k0.609; 95% CI, 0.534–0.684) and grading (k0.669; 95% CI, 0.569–0.769). Moderate agreement was found for HER2 (k0.546; 95% CI, 0444–0.649). DR was 9.5% (negativity to positivity) and 31.7% (positivity to negativity) for HER2 and 26.2% (negativity to positivity) and 12.5% (positivity to negativity) for ER/PgR. According to changes in Her2 and ER/PgR status, 23 (12.2%) and 33 (17.6%) systemic prescription were respectively modified. Conclusions In our retrospective analysis, central pathological review has a significant impact in the decision-making process in early breast cancer, as shown in clinical trials. Further studies are warranted to confirm these provocative results.

KW - Early breast cancer

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