title: Interobserver variability in the classification of proliferative breast lesions by fine-needle aspiration: results of the Papanicolaou Society of Cytopathology Study.
abstract: This study evaluates the applicability of the published cytologic criteria in the categorization of proliferative breast lesions by assessing the diagnostic accuracy and interobserver reproducibility of a panel of experts. Twelve breast fine-needle aspiration (FNA) specimens of biopsy-proven nonproliferative breast lesion (NPL) (1 case), proliferative lesions without atypia (PL) (7 cases), proliferative lesion with atypia (PLA) (1 case), and low-nuclear grade ductal carcinoma in situ (DCIS) (3 cases) were selected. Six FNAs were Papanicolaou (PAP) and 6 were Diff-Quik-stained (DQ). Six expert cytopathologists classified the smears using a summary of published criteria as a guideline. All 6 participants rendered the same cytologic diagnosis in 2/12 (16%) cases. The agreement among the 6 raters was low (Kappa = 0.35). Cytohistologic correlation was achieved in 26/72 (36%) FNA diagnoses. The correlation of the PAP-stained cases was better than the DQ: 17/36 (47%) PAP and 9/36 (25%) DQ correlated. Improving the correlation was achieved by amalgamation of NPL and PL into "low risk" and PLA and DCIS into "high risk" categories: 47/72 (65%) FNA diagnoses then correlated with histology [29/36 (81%) PAP and 18/36 (50%) DQ]. We conclude that the cytologic criteria of proliferative breast lesions need to be further defined and assessed. Consideration should be given to minimizing the number of diagnostic categories and adopting a terminology that has a direct effect on patient management.
authors.affiliation: Department of Pathology, The George Washington University Medical Center, Washington, DC 20037, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Sidawy
authors.forename: M H
authors.initials: MH
authors.lastname: Stoler
authors.forename: W J
authors.initials: WJ
authors.lastname: Frable
authors.forename: A R
authors.initials: AR
authors.lastname: Frost
authors.forename: S
authors.initials: S
authors.lastname: Masood
authors.forename: T R
authors.initials: TR
authors.lastname: Miller
authors.forename: S G
authors.initials: SG
authors.lastname: Silverberg
authors.forename: N
authors.initials: N
authors.lastname: Sneige
authors.forename: H H
authors.initials: HH
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000145:classification* / Q000473:pathology; D002278:Carcinoma in Situ / Q000145:classification* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000145:classification* / Q000473:pathology; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000145:classification* / Q000473:pathology; D015203:Reproducibility of Results; D012955:Societies, Medical