title: Histopathological grading of breast ductal carcinoma in situ: validation of a web-based survey through intra-observer reproducibility analysis.
abstract: BACKGROUND
  Histopathological grading diagnosis of ductal carcinoma in situ (DCIS) of the breast may be very difficult even for experts, and it is important for therapeutic decisions. The challenge may be due to the inaccurate and/or subjective application of the diagnosis criteria. The aim of this study was to investigate the intra-observer agreement between a traditional method and a developed web-based questionnaire for scoring breast DCIS.
  
  
  METHODS
  A cross-sectional study was carried out to evaluate the diagnostic agreement of an electronic questionnaire and its point scoring system with the subjective reading of digital images for 3 different DCIS grading systems: Holland, Van Nuys and modified Black nuclear grade system. Three pathologists analyzed the same set of digitized images from 43 DCIS cases using two different web-based programs. In the first phase, they accessed a website with a newly created questionnaire and scoring system developed to allow the determination of the histological grade of the cases. After at least 6 months, the pathologists read again the same images, but without the help of the questionnaire, indicating subjectively the diagnoses. The intra-observer agreement analysis was employed to validate this innovative web-based survey.
  
  
  RESULTS
  Overall, diagnostic reproducibility was similar for all histologic grading classification systems, with kappa values of 0.57 ± 0.10, 0.67 ± 0.09 and 0.67 ± 0.09 for Holland, Van Nuys classification and modified Black nuclear grade system respectively. Only two 2-step diagnostic disagreements were found, one for Holland and another for Van Nuys. Both cases were superestimated by the web-based survey.
  
  
  CONCLUSIONS
  The diagnostic agreement between the web-based questionnaire and a traditional method, both using digital images, is moderate to good for Holland, Van Nuys and modified Black nuclear grade system. The use of a scoring point system does not appear to pose a major risk of presenting large (2-step) diagnostic disagreements. These findings indicate that the use of this point scoring system in this web-based survey to grade objectively DCIS lesions is a useful diagnostic tool.
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. fernandoschuh@hotmail.com.|Breast surgeon, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. fernandoschuh@hotmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Schuh
authors.affiliation: Breast surgeon, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. biazus@portoweb.com.br.
authors.forename: Jorge Villanova
authors.initials: JV
authors.lastname: Biazús
authors.affiliation: Department of Pathology, MD Anderson Cancer Center, Houston, Texas, USA. eresetko@mdanderson.org.
authors.forename: Erika
authors.initials: E
authors.lastname: Resetkova
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. camilazbenfica@gmail.com.
authors.forename: Camila Zanella
authors.initials: CZ
authors.lastname: Benfica
authors.affiliation: Breast surgeon, Hospital São Cristóvão, São Paulo, Brazil. af.ventura@hotmail.com.
authors.forename: Alessandra de Freitas
authors.initials: Ade F
authors.lastname: Ventura
authors.affiliation: Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. dmudmu@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Uchoa
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. marciagra@terra.com.br.|Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. marciagra@terra.com.br.
authors.forename: Márcia
authors.initials: M
authors.lastname: Graudenz
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. mariaisabel.edelweiss@gmail.com.|Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. mariaisabel.edelweiss@gmail.com.
authors.forename: Maria Isabel Albano
authors.initials: MI
authors.lastname: Edelweiss
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D020407:Internet; D060787:Neoplasm Grading / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires