Histological Grading in Breast Cancer: Interobserver Agreement, and Relation to Other Prognostic Factors Including Ploidy

Summary Sections of neoplasms from 76 female patients with primary operable carcinoma of the breast were independently assessed by 2 pathologists for histological features and assigned a grade score. Relative disagreement rates between pathologists were estimated by use of a log‐linear model and found to be similar to those reported by many other groups, but higher than that reported by acknowledged experts. Tumor grade was related to nuclear DNA content as measured by static cytometry, inversely related to oestrogen receptor status and provided some additional prognostic information but, in this small series of patients, did not correlate with short‐term survival as closely as other prognostic indicators such as ploidy, tumor size or the extent of lymph node involvement. Patients with Grade III tumors had a particularly poor prognosis, however, there were few patients allotted to Grade III (poorly differentiated tumors), and survival differences between Grades I and II were small; in short‐term followup, used alone, grading separated out only a small proportion of patients into useful prognostic groups. This preliminary study emphasizes the need for a careful approach to the use of grading of breast carcinomas in the routine histopathology laboratory. Demonstration of higher levels of interobserver agreement, or concordance with experts in the field, will be necessary before our grading can be incorporated into a prognostic index useful for patient management.

[1]  J. Warwick,et al.  The West Midlands epithelial ovarian cancer adjuvant therapy trial. , 1993, Clinical oncology (Royal College of Radiologists (Great Britain)).

[2]  K. Kunze,et al.  Histological grading of breast cancer. Interobserver, reproducibility and prognostic significance. , 1990, Pathology, research and practice.

[3]  A. James,et al.  Comparison of chest radiograph reading methods for assessing progress of pneumoconiosis over 10 years in Wittenoom crocidolite workers. , 1990, British journal of industrial medicine.

[4]  A. Clayden,et al.  Histological grading of breast cancer; significance of grade on recurrence and mortality. , 1989, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[5]  A. Clayden,et al.  Observer variation in histological grading of breast cancer. , 1989, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[6]  David L. Page,et al.  Diagnostic Histopathology of the Breast , 1988 .

[7]  O. Kallioniemi,et al.  Tumour DNA ploidy as an independent prognostic factor in breast cancer. , 1987, British Journal of Cancer.

[8]  I. O. Ellis,et al.  Confirmation of a prognostic index in primary breast cancer. , 1987, British Journal of Cancer.

[9]  S Friedman,et al.  The importance of histologic grade in long-term prognosis of breast cancer: a study of 1,010 patients, uniformly treated at the Institut Gustave-Roussy. , 1987, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  R. Gelber,et al.  Association of DNA index and S-phase fraction with prognosis of nodes positive early breast cancer. , 1987, Cancer research.

[11]  C. Cornelisse,et al.  DNA ploidy and survival in breast cancer patients. , 1987, Cytometry.

[12]  R. Gelber,et al.  Prognostic significance of tumor grade in clinical trials of adjuvant therapy for breast cancer with axillary lymph node metastasis , 1986, Cancer.

[13]  M. Tanner,et al.  Modeling ordinal scale disagreement. , 1985, Psychological bulletin.

[14]  C. Elston,et al.  The assessment of histological differentiation in breast cancer. , 1985, The Australian and New Zealand journal of surgery.

[15]  D. Killander,et al.  Flow‐Cytometric DNA analysis in primary breast carcinomas and clinicopthological correlations , 1984 .

[16]  C. Elston,et al.  THE ASSESSMENT OF HISTOLOGICAL DIFFERENTIATION IN BREAST CANCER , 1984 .

[17]  B. Fisher,et al.  Pathologic findings from the national surgical adjuvant project for breast cancers (protocol no. 4) X. Discriminants for tenth year treatment failure , 1984, Cancer.

[18]  C. Holman,et al.  Inter‐observer variation in the histopathological reporting of Hodgkin's disease: an analysis of diagnostic subcomponents using kappa statistics , 1983, Histopathology.

[19]  W. Dupont,et al.  A retrospective cohort study of histologic risk factors in breast cancer patients , 1982, Cancer.

[20]  J. Haybittle,et al.  The cancer research campaign (King's/Cambridge trial for early breast cancer: clinico-pathological aspects. , 1982, British Journal of Cancer.

[21]  G. Garas,et al.  Intralaboratory variations in the grading of breast carcinoma. , 1982, Archives of pathology & laboratory medicine.

[22]  R. Blamey,et al.  A prognostic index in primary breast cancer. , 1982, British Journal of Cancer.

[23]  W. Grove Statistical Methods for Rates and Proportions, 2nd ed , 1981 .

[24]  H. Johansen,et al.  Selection of High Risk Groups Among Prognostically Favorable Patients with Breast Cancer: An Analysis of the Value of Prospective Grading of Tumor Anaplasia in 1,048 Patients , 1981, Annals of surgery.

[25]  T. Caspersson,et al.  DNA content and survival in mammary carcinoma. , 1980, Analytical and quantitative cytology.

[26]  J. Vegelius,et al.  Analysis of reproducibility of subjective grading systems for breast carcinoma. , 1979, Journal of clinical pathology.

[27]  R W Blamey,et al.  Prognostic factors in breast cancer -- the formation of a prognostic index. , 1979, Clinical oncology.

[28]  J. Nelder,et al.  The GLIM System Release 3. , 1979 .

[29]  Gresham Ga Grading of mammary carcinoma. , 1976 .

[30]  G. Gresham Grading of mammary carcinoma. , 1976, Clinical oncology.

[31]  M. Black,et al.  Prognosis in breast cancer utilizing histologic characteristics of the primary tumor , 1975, Cancer.

[32]  B. Fisher,et al.  The pathology of invasive breast cancer A Syllabus Derived from Findings of the National Surgical Adjuvant Breast Project (Protocol No. 4) , 1975, Cancer.

[33]  J. Fleiss,et al.  Statistical methods for rates and proportions , 1973 .

[34]  C. Berry,et al.  A comparison of two methods of prognostic typing in breast cancer , 1972, Journal of clinical pathology.

[35]  R. Prescott,et al.  Histology in Breast Cancer Prognosis , 1972, British Journal of Cancer.

[36]  F. Hartveit Prognostic Typing in Breast Cancer , 1971, British medical journal.

[37]  G. Friedell,et al.  Tumor grade in the prognosis of breast cancer. , 1970, The Nebraska state medical journal.

[38]  D. C. Carter,et al.  Histological grading in breast cancer. , 1969, British Journal of Cancer.

[39]  I. Hamlin Possible host resistance in carcinoma of the breast: a histological study. , 1968, British Journal of Cancer.

[40]  B. Wolff Histological grading in carcinoma of the breast. , 1966, British Journal of Cancer.

[41]  M. Black,et al.  Prognostic factors in cancer of the female breast. II. Reproducibility of histopathologic classification , 1966, Cancer.

[42]  Yasargil Ec HOMOGRAFT REPLACEMENT OF THE AORTIC VALVE. , 1964, Lancet.

[43]  M. Black,et al.  Prognostic factors in cancer of the female breast. I. An investigation of some interrelations , 1963, Cancer.

[44]  H. Bloom,et al.  Histological Grading and Prognosis in Breast Cancer , 1957, British Journal of Cancer.

[45]  M. Black,et al.  Survival in breast cancer cases in relation to the structure of the primary tumor and regional lymph nodes. , 1955, Surgery, gynecology & obstetrics.

[46]  H. Bloom Further Studies on Prognosis of Breast Carcinoma , 1950, British Journal of Cancer.

[47]  H. Bloom Prognosis in Carcinoma of the Breast , 1950, British Journal of Cancer.

[48]  R. W. Scarff,et al.  THE POSITION OF HISTOLOGY IN THE PROGNOSIS OF CARCINOMA OF THE BREAST. , 1928 .

[49]  Robert B. Greenough,et al.  Varying Degrees of Malignancy in Cancer of the Breast , 1925 .

[50]  W. Sistrunk,et al.  LIFE EXPECTANCY FOLLOWING RADICAL AMPUTATION FOR CARCINOMA OF THE BREAST: A CLINICAL AND PATHOLOGIC STUDY OF 218 CASES , 1922, Annals of surgery.

[51]  A. C. Broders SQUAMOUS‐CELL EPITHELIOMA OF THE SKIN A STUDY OF 256 CASES , 1921, Annals of surgery.

[52]  A. C. Broders Squamous-Cell Epithelioma of the Skin. A Study of Two Hundred and Fifty-Six Cases , 1920 .

[53]  A. C. Broders SQUAMOUS-CELL EPITHELIOMA OF THE LIP: A STUDY OF FIVE HUNDRED AND THIRTY-SEVEN CASES , 1920 .