title: Is expert breast pathology assessment necessary for the management of ductal carcinoma in situ ?
abstract: BACKGROUND
  Current guidelines include a recommendation that a pathologist with expertise in breast disease review all ductal carcinoma in situ (DCIS) specimens due to the presence of significant variability in pathologic reporting of DCIS. The objective of this study was to evaluate the completeness and accuracy of pathologic reporting of DCIS over the past decade and to determine the current impact of expert breast pathology assessment on the management of DCIS.
  
  
  METHODS
  All patients with a diagnosis of DCIS referred to a single regional cancer centre between 1982 and 2000 have been reviewed. Inter-observer variability between initial and secondary reports has been evaluated using kappa statistics. For each case, the Van Nuys Prognostic Index (VNPI) using pathologic data obtained from the initial and reviewed pathology reports were compared. The impact of expert breast pathology on risk assessment and treatment was determined.
  
  
  RESULTS
  481 individuals with DCIS were referred and pathology review was performed on 350 patients (73%). Inter-observer agreement was high for the main pathologic features of DCIS. From 1996 to 2000, secondary pathology assessments lead to a change in the assessment of local recurrence risk in 100 cases (29%) and contributed to a change in treatment recommendation in 93 (43%) cases.
  
  
  CONCLUSIONS
  Expert breast pathology assessments continue to be necessary in the management of DCIS.
authors.affiliation: Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Ontario, Canada. eileen.rakovitch@sw.ca
authors.forename: Eileen
authors.initials: E
authors.lastname: Rakovitch
authors.forename: Alina
authors.initials: A
authors.lastname: Mihai
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Pignol
authors.forename: Wedad
authors.initials: W
authors.lastname: Hanna
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kwinter
authors.forename: Carole
authors.initials: C
authors.lastname: Chartier
authors.forename: Ida
authors.initials: I
authors.lastname: Ackerman
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: Kathleen
authors.initials: K
authors.lastname: Pritchard
authors.forename: Lawrence
authors.initials: L
authors.lastname: Paszat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D015588:Observer Variation; D009864:Ontario / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies