title: Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast.
abstract: BACKGROUND
  This study aimed to assess inter-observer variability between the original diagnostic reports and later review by a specialist in breast pathology considering lobular neoplasias (LN), columnar cell lesions (CCL), atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS) of the breast.
  
  
  METHODS
  A retrospective, observational, cross-sectional study was conducted. A total of 610 breast specimens that had been formally sent for consultation and/or second opinions to the Breast Pathology Laboratory of Federal University of Minas Gerais were analysed between January 2005 and December 2010. The inter-observer variability between the original report and later review was compared regarding the diagnoses of LN, CCL, ADH, and DCIS. Statistical analyses were conducted using the Kappa index.
  
  
  RESULTS
  Weak correlations were observed for the diagnoses of columnar cell change (CCC; Kappa=0.38), columnar cell hyperplasia (CCH; Kappa=0.32), while a moderate agreement (Kappa=0.47) was observed for the diagnoses of flat epithelial atypia (FEA). Good agreement was observed in the diagnoses of atypical lobular hyperplasia (ALH; Kappa=0.62) and lobular carcinoma in situ (LCIS; Kappa=0.66). However, poor agreement was observed for the diagnoses of pleomorphic LCIS (Kappa=0.22). Moderate agreement was observed for the diagnoses of ADH (Kappa=0.44), low-grade DCIS (Kappa=0.47), intermediate-grade DCIS (Kappa=0.45), and DCIS with microinvasion (Kappa=0.56). Good agreement was observed between the diagnoses of high-grade DCIS (Kappa=0.68).
  
  
  CONCLUSIONS
  According to our data, the best diagnostic agreements were observed for high-grade DCIS, ALH, and LCIS. CCL without atypia and pleomorphic LCIS had the worst agreement indices.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1640072350119725.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Gomes
authors.forename: Simone S
authors.initials: SS
authors.lastname: Porto
authors.forename: Débora
authors.initials: D
authors.lastname: Balabram
authors.affiliation: Breast Pathology Laboratory, School of Medicine, Federal University of Minas Gerais (UFMG), Av, Professor Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil. hgobbi@medicina.ufmg.br.
authors.forename: Helenice
authors.initials: H
authors.lastname: Gobbi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001938:Brazil; D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006965:Hyperplasia; D042361:Mammary Glands, Human / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D010338:Pathology, Clinical; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013038:Specialization; D055815:Young Adult