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Atypical ductal hyperplasia: interobserver and intraobserver variability.

Rohit K Jain¹, Rutika Mehta, Rosen Dimitrov

¹Department of Pathology and Laboratory Science, I U School of Medicine, Indianapolis, IN, USA.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc

|May 3, 2011

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Diagnosing benign breast lesions is challenging. Immunohistochemistry significantly improved pathologist agreement on usual ductal hyperplasia versus atypical ductal hyperplasia, potentially reducing unnecessary surgeries.

Area of Science:

Pathology
Oncology
Breast Cancer Diagnosis

Background:

Interobserver variability in diagnosing benign intraductal proliferative lesions is a significant clinical challenge.
Accurate diagnosis is crucial for appropriate patient management and treatment decisions.

Purpose of the Study:

To assess inter- and intraobserver variability in diagnosing breast proliferative lesions.
To evaluate the impact of immunohistochemistry (IHC) on diagnostic concordance.

Main Methods:

Nine pathologists reviewed 81 breast lesion cases using H&E and IHC (ADH-5 cocktail).
Lesions were classified as usual ductal hyperplasia, atypical ductal hyperplasia, or ductal carcinoma in situ.
Inter- and intraobserver agreement was assessed using kappa values before and after IHC.

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Main Results:

Initial interobserver agreement was fair (κ=0.34), improving to moderate (κ=0.50) after IHC (P=0.015).
Intraobserver agreement ranged from moderate to strong (κ=0.56-0.88).
IHC use led to an 8% decrease in atypical ductal hyperplasia diagnoses, reclassifying them as usual hyperplasia.

Conclusions:

Atypical ductal hyperplasia diagnosis remains challenging, with significant inter- and intraobserver variability.
Immunohistochemistry significantly enhances diagnostic concordance for breast proliferative lesions.
IHC may reduce overtreatment by decreasing the diagnosis of atypical ductal hyperplasia.