Significant inter- and intra-laboratory variation in grading of invasive breast cancer : A nationwide study of 33,043 patients in the Netherlands
© 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC..
Accurate, consistent and reproducible grading by pathologists is of key-importance for identification of individual patients with invasive breast cancer (IBC) that will or will not benefit from adjuvant systemic treatment. We studied the laboratory-specific grading variation using nationwide real-life data to create insight and awareness in grading variation. Synoptic pathology reports of all IBC resection-specimens, obtained between 2013 and 2016, were retrieved from the nationwide Dutch Pathology Registry (PALGA). Absolute differences in laboratory-proportions of Grades I-III were compared to the national reference. Multivariable logistic regression provided laboratory-specific odds ratios (ORs) for high- vs. low-grade IBC. 33,792 IBC pathology reports of 33,043 patients from 39 laboratories were included, of which 28.1% were reported as Grade I (range between laboratories 16.3-43.3%), 47.6% as Grade II (38.4-57.8%), and 24.3% as Grade III (15.5-34.3%). Based on national guidelines, the indication for adjuvant chemotherapy was dependent on histologic grade in 29.9% of patients. After case-mix correction, 20 laboratories (51.3%) showed a significantly deviant OR. Significant grading differences were also observed among pathologists within laboratories. In this cohort of 33,043 breast cancer patients, we observed substantial inter- and intra-laboratory variation in histologic grading. It can be anticipated that this has influenced outcome including exposure to unnecessary toxicity, since choice of adjuvant chemotherapy was dependent on grade in nearly a third of patients. Better standardization and training seems warranted.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:146 |
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| Enthalten in: |
International journal of cancer - 146(2020), 3 vom: 01. Feb., Seite 769-780 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van Dooijeweert, Carmen [VerfasserIn] |
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| Links: |
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| Themen: |
Histologic grade |
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| Anmerkungen: |
Date Completed 11.02.2020 Date Revised 11.02.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/ijc.32330 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM295980990 |
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| 245 | 1 | 0 | |a Significant inter- and intra-laboratory variation in grading of invasive breast cancer |b A nationwide study of 33,043 patients in the Netherlands |
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| 500 | |a Date Revised 11.02.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. | ||
| 520 | |a Accurate, consistent and reproducible grading by pathologists is of key-importance for identification of individual patients with invasive breast cancer (IBC) that will or will not benefit from adjuvant systemic treatment. We studied the laboratory-specific grading variation using nationwide real-life data to create insight and awareness in grading variation. Synoptic pathology reports of all IBC resection-specimens, obtained between 2013 and 2016, were retrieved from the nationwide Dutch Pathology Registry (PALGA). Absolute differences in laboratory-proportions of Grades I-III were compared to the national reference. Multivariable logistic regression provided laboratory-specific odds ratios (ORs) for high- vs. low-grade IBC. 33,792 IBC pathology reports of 33,043 patients from 39 laboratories were included, of which 28.1% were reported as Grade I (range between laboratories 16.3-43.3%), 47.6% as Grade II (38.4-57.8%), and 24.3% as Grade III (15.5-34.3%). Based on national guidelines, the indication for adjuvant chemotherapy was dependent on histologic grade in 29.9% of patients. After case-mix correction, 20 laboratories (51.3%) showed a significantly deviant OR. Significant grading differences were also observed among pathologists within laboratories. In this cohort of 33,043 breast cancer patients, we observed substantial inter- and intra-laboratory variation in histologic grading. It can be anticipated that this has influenced outcome including exposure to unnecessary toxicity, since choice of adjuvant chemotherapy was dependent on grade in nearly a third of patients. Better standardization and training seems warranted | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a histologic grade | |
| 650 | 4 | |a invasive breast cancer | |
| 650 | 4 | |a pathology | |
| 650 | 4 | |a patient management | |
| 650 | 4 | |a prognostic factor | |
| 700 | 1 | |a van Diest, Paul J |e verfasserin |4 aut | |
| 700 | 1 | |a Willems, Stefan M |e verfasserin |4 aut | |
| 700 | 1 | |a Kuijpers, Chantal C H J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Wall, Elsken |e verfasserin |4 aut | |
| 700 | 1 | |a Overbeek, Lucy I H |e verfasserin |4 aut | |
| 700 | 1 | |a Deckers, Ivette A G |e verfasserin |4 aut | |
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