title: [Training and standardized criteria improve the diagnosis of premalignant breast lesions].
abstract: OBJECTIVE
  to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria.
  
  
  METHODS
  Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed.
  
  
  RESULTS
  There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80).
  
  
  CONCLUSIONS
  interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. ma.salles@terra.com.br
authors.forename: Marcio de Almeida
authors.initials: Mde A
authors.lastname: Salles
authors.forename: Agostinho Pinto
authors.initials: AP
authors.lastname: Gouvêa
authors.forename: Daniela
authors.initials: D
authors.lastname: Savi
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Figueiredo
authors.forename: Ramão
authors.initials: R
authors.lastname: Tavares Neto
authors.forename: Rodrigo Assis de
authors.initials: RA
authors.lastname: Paula
authors.forename: Helenice
authors.initials: H
authors.lastname: Gobbi
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015588:Observer Variation; D010336:Pathology / Q000193:education / Q000592:standards / Q000706:statistics & numerical data; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*