Nodal stage classification for breast carcinoma

Improving interobserver reproducibility through standardized histologic criteria and image-based training

Roderick R. Turner, Donald L. Weaver, Gabor Cserni, Susan C. Lester, Karen Hirsch, David A. Elashoff, Patrick L. Fitzgibbons, Giuseppe Viale, Giovanni Mazzarol, Julio A. Ibarra, Stuart J. Schnitt, Armando E. Giuliano

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Purpose: Reliable pathologic stage classification of axillary lymph nodes is an important determinant of prognosis and therapeutic decision making for patients with invasive breast cancer. Pathologists' distinction between micrometastasis (pN1mi) and isolated tumor cells [ITC; pN0(i+)] is variable using the American Joint Committee on Cancer (AJCC) Staging Manual (Sixth Edition). We sought to determine whether a set of clearly defined histologic criteria could lead to reproducible nodal classification by pathologists. Patients and Methods: Digital images of sentinel lymph node biopsies from 56 patients with small-volume nodal metastases were examined by six experienced breast pathologists (MDs), first as a pre-test, and again as a post-test after studying a training program that outlined and illustrated the classification criteria. Results: Post-test results, after study of the training program, were significantly improved. Compared with the reference MD, agreement improved from 76.2% (pre-test κ = 0.575; standard deviation [SD], 0.25) to 97.3% (post-test κ = 0.947; SD, 0.049). Multirater analysis of agreement among the six MDs improved from 71.5% (pre-test κ = 0.487; ASE, 0.039) to 95.7% (post-test κ = 0.915; ASE, 0.037). Agreement on lobular carcinoma metastasis classification improved from 55% (23 of 42; pre-test) to 100% (42 of 42; post-test) (P <.001), and agreement on ITC classification in nodal parenchyma improved from 67.6% (69 of 102; pre-test) to 98.0% (100 of 102; post-test; P <.001). Conclusion: Application of current definitions for classification of small-volume nodal metastases are inconsistent, leading to variable classification of ITC and micrometastases. Reproducibility of pathologic nodal stage classification is achievable through study of a training set to clarify the AJCC criteria.

Original languageEnglish
Pages (from-to)258-263
Number of pages6
JournalJournal of Clinical Oncology
Volume26
Issue number2
DOIs
Publication statusPublished - Jan 10 2008

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Breast Neoplasms
Neoplasm Micrometastasis
Neoplasm Metastasis
Lobular Carcinoma
Education
Sentinel Lymph Node Biopsy
Neoplasm Staging
Neoplasms
Decision Making
Breast
Lymph Nodes
Pathologists

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Nodal stage classification for breast carcinoma : Improving interobserver reproducibility through standardized histologic criteria and image-based training. / Turner, Roderick R.; Weaver, Donald L.; Cserni, Gabor; Lester, Susan C.; Hirsch, Karen; Elashoff, David A.; Fitzgibbons, Patrick L.; Viale, Giuseppe; Mazzarol, Giovanni; Ibarra, Julio A.; Schnitt, Stuart J.; Giuliano, Armando E.

In: Journal of Clinical Oncology, Vol. 26, No. 2, 10.01.2008, p. 258-263.

Research output: Contribution to journalArticle

Turner, RR, Weaver, DL, Cserni, G, Lester, SC, Hirsch, K, Elashoff, DA, Fitzgibbons, PL, Viale, G, Mazzarol, G, Ibarra, JA, Schnitt, SJ & Giuliano, AE 2008, 'Nodal stage classification for breast carcinoma: Improving interobserver reproducibility through standardized histologic criteria and image-based training', Journal of Clinical Oncology, vol. 26, no. 2, pp. 258-263. https://doi.org/10.1200/JCO.2007.13.0179
Turner, Roderick R. ; Weaver, Donald L. ; Cserni, Gabor ; Lester, Susan C. ; Hirsch, Karen ; Elashoff, David A. ; Fitzgibbons, Patrick L. ; Viale, Giuseppe ; Mazzarol, Giovanni ; Ibarra, Julio A. ; Schnitt, Stuart J. ; Giuliano, Armando E. / Nodal stage classification for breast carcinoma : Improving interobserver reproducibility through standardized histologic criteria and image-based training. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 2. pp. 258-263.
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abstract = "Purpose: Reliable pathologic stage classification of axillary lymph nodes is an important determinant of prognosis and therapeutic decision making for patients with invasive breast cancer. Pathologists' distinction between micrometastasis (pN1mi) and isolated tumor cells [ITC; pN0(i+)] is variable using the American Joint Committee on Cancer (AJCC) Staging Manual (Sixth Edition). We sought to determine whether a set of clearly defined histologic criteria could lead to reproducible nodal classification by pathologists. Patients and Methods: Digital images of sentinel lymph node biopsies from 56 patients with small-volume nodal metastases were examined by six experienced breast pathologists (MDs), first as a pre-test, and again as a post-test after studying a training program that outlined and illustrated the classification criteria. Results: Post-test results, after study of the training program, were significantly improved. Compared with the reference MD, agreement improved from 76.2{\%} (pre-test κ = 0.575; standard deviation [SD], 0.25) to 97.3{\%} (post-test κ = 0.947; SD, 0.049). Multirater analysis of agreement among the six MDs improved from 71.5{\%} (pre-test κ = 0.487; ASE, 0.039) to 95.7{\%} (post-test κ = 0.915; ASE, 0.037). Agreement on lobular carcinoma metastasis classification improved from 55{\%} (23 of 42; pre-test) to 100{\%} (42 of 42; post-test) (P <.001), and agreement on ITC classification in nodal parenchyma improved from 67.6{\%} (69 of 102; pre-test) to 98.0{\%} (100 of 102; post-test; P <.001). Conclusion: Application of current definitions for classification of small-volume nodal metastases are inconsistent, leading to variable classification of ITC and micrometastases. Reproducibility of pathologic nodal stage classification is achievable through study of a training set to clarify the AJCC criteria.",
author = "Turner, {Roderick R.} and Weaver, {Donald L.} and Gabor Cserni and Lester, {Susan C.} and Karen Hirsch and Elashoff, {David A.} and Fitzgibbons, {Patrick L.} and Giuseppe Viale and Giovanni Mazzarol and Ibarra, {Julio A.} and Schnitt, {Stuart J.} and Giuliano, {Armando E.}",
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T2 - Improving interobserver reproducibility through standardized histologic criteria and image-based training

AU - Turner, Roderick R.

AU - Weaver, Donald L.

AU - Cserni, Gabor

AU - Lester, Susan C.

AU - Hirsch, Karen

AU - Elashoff, David A.

AU - Fitzgibbons, Patrick L.

AU - Viale, Giuseppe

AU - Mazzarol, Giovanni

AU - Ibarra, Julio A.

AU - Schnitt, Stuart J.

AU - Giuliano, Armando E.

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N2 - Purpose: Reliable pathologic stage classification of axillary lymph nodes is an important determinant of prognosis and therapeutic decision making for patients with invasive breast cancer. Pathologists' distinction between micrometastasis (pN1mi) and isolated tumor cells [ITC; pN0(i+)] is variable using the American Joint Committee on Cancer (AJCC) Staging Manual (Sixth Edition). We sought to determine whether a set of clearly defined histologic criteria could lead to reproducible nodal classification by pathologists. Patients and Methods: Digital images of sentinel lymph node biopsies from 56 patients with small-volume nodal metastases were examined by six experienced breast pathologists (MDs), first as a pre-test, and again as a post-test after studying a training program that outlined and illustrated the classification criteria. Results: Post-test results, after study of the training program, were significantly improved. Compared with the reference MD, agreement improved from 76.2% (pre-test κ = 0.575; standard deviation [SD], 0.25) to 97.3% (post-test κ = 0.947; SD, 0.049). Multirater analysis of agreement among the six MDs improved from 71.5% (pre-test κ = 0.487; ASE, 0.039) to 95.7% (post-test κ = 0.915; ASE, 0.037). Agreement on lobular carcinoma metastasis classification improved from 55% (23 of 42; pre-test) to 100% (42 of 42; post-test) (P <.001), and agreement on ITC classification in nodal parenchyma improved from 67.6% (69 of 102; pre-test) to 98.0% (100 of 102; post-test; P <.001). Conclusion: Application of current definitions for classification of small-volume nodal metastases are inconsistent, leading to variable classification of ITC and micrometastases. Reproducibility of pathologic nodal stage classification is achievable through study of a training set to clarify the AJCC criteria.

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