Difference between revisions of "Sign-Out Tools: Breast"

Latest revision as of 15:26, November 29, 2021

Coded Comments

Code	Comment
IDC	Invasive ductal carcinoma
ILC	Invasive lobular carcinoma
DCIS	Ductal carcinoma in‐situ
DCIS1	Ductal carcinoma in‐situ, grade 1
DCIS2	Ductal carcinoma in‐situ, grade 2
DCIS3	Ductal carcinoma in‐situ, grade 2
ADH	Atypical ductal hyperplasia
FEA	Flat epithelial atypia
LCIS	Lobular neoplasia (lobular carcinoma in‐situ)
ALH	Lobular neoplasia (atypical lobular hyperplasia)
FBA	Fibroadenoma
PASH	Pseudoangiomatous stromal hyperplasia
FCC	Fibrocystic changes
UDH	Usual ductal hyperplasia
SCA	Sclerosing adenosis
BDA	Blunt duct adenosis
RADS	Radial scar
HBX	Healing biopsy site
XRT	Changes consistent with prior irradiation
CALC	Calcifications
CALC	Calcifications
ITC	Isolated tumor cells
KER1	Immunostained slides for cytokeratin AE1.3/Cam5.2, cytokeratin 7, and cytokeratin MNF116 were examined on tissue levels.
KER2	Immunostained slides for cytokeratin AE1.3/Cam5.2, cytokeratin 7, and cytokeratin MNF116 were examined on tissue levels from each of 2 blocks.
KER3	Immunostained slides for cytokeratin AE1.3/Cam5.2, cytokeratin 7, and cytokeratin MNF116 were examined on tissue levels from each of 3 blocks.
GRDNR	The tumor grade in this limited sample may not be representative of the entire lesion.
BRADS	The results of immunohistochemical staining for estrogen receptor, progesterone receptor, and Her2/neu protein expression and of fluorescence in‐situ hybridization studies for Her2/neu gene amplification will be reported in an addendum.
ERPR	Note: The results of immunohistochemical staining for estrogen and progesterone receptors will be reported in an addendum.
MARG	NOTE: The resection margins of the specimen(s) were inked and microscopically evaluated; see individual gross descriptions.
MARG1	NOTE: The resection margins of the specimen were inked and microscopically evaluated.
MARG2	NOTE: The resection margins of the specimens were inked and microscopically evaluated.
MULTI	The patient’s chart and available radiographs were reviewed at the MGH Breast Center multidisciplinary conference.
EEEEE	This case does not contain all the coding components for CMS PQRI measure #99.

Grading Chart: Ductal Carcinoma In-situ Grading

	Pleomorphic nuclei
Abundant central necrosis	Present	Absent
Present	Grade 3	Grade 2
Absent	Grade 3	Grade 1

^[1]

Rauramo et al.: The effect of castration and peroral estrogen therapy on some psychological functions. Front Horm Res 1975;3:94-104. PMID: 1234567

Grading Chart: Invasive Carcinoma Grading

Score	Tubule Formation	Nuclear Pleomorphism	Mitotic Count*
1	More than 75 %	Slight	0 - 8
2	10% - 75%	Moderate	9 - 17
3	Less than 10%	Marked	18 or greater

* per 10 high power field with 40X objective and 10X ocular with a Field Diameter = 0.55 mm. A field diameter of 0.55 mm is assumed for this table and is compatable with sign-out booth Olympus microscopes. Please confirm that the field diameter of your microscope is 0.55 mm before using the above chart. For other field diameters, please see the conversion chart below.

Total Score	Interpretation
3-5	Grade 1 (Low Grade)
6-7	Grade 2 (Intermediate Grade)
8-9	Grade 3 (High Grade)

^[2]

Score Categories According to Field Diameter and Mitotic Count

Table of mitosis score thresholds by Field Diameter (mm)
Field Diameter (mm)	Field Area (mm²	Number of Mitoses per 10 Fields
		Score 1	Score 2	Score 3
0.50	0.196	≤7	8 to 14	≥15
0.51	0.204	≤7	8 to 14	≥15
0.52	0.212	≤7	8 to 15	≥16
0.53	0.221	≤8	9 to 16	≥17
0.54	0.229	≤8	9 to 16	≥17
0.55	0.238	≤8	9 to 17	≥18
0.56	0.246	≤8	9 to 17	≥18
0.57	0.255	≤9	10 to 18	≥19
0.58	0.264	≤9	10 to 19	≥20
0.59	0.273	≤9	10 to 19	≥20
0.60	0.283	≤10	11 to 20	≥21

References

↑ Citation: Silverstein et al.: Prognostic classification of breast ductal carcinoma-in-situ. Lancet 1995;345:1154-7. PMID: 7723550
We present a new prognostic classification designated the Van Nuys classification for ductal carcinoma-in-situ (DCIS). The classification combines high nuclear grade and comedo-type necrosis to predict clinical recurrence. Three groups of DCIS patients were defined by the presence or absence of high nuclear grade and comedo-type necrosis: 1--non-high-grade DCIS without comedo-type necrosis, 2--non-high-grade DCIS with comedo-type necrosis, 3--high-grade DCIS with or without comedo-type necrosis. There were 31 local recurrences in 238 patients after breast-conservation surgery 3.8% (3/80) in group 1, 11.1% (10/90) in group 2, and 26.5% (18/68) in group 3. The 8-year actuarial disease-free survivals were 93%, 84%, and 61%, respectively (all p < or = 0.05). The Van Nuys classification defines three distinct and easily recognisable groups, each of which has a different likelihood of local recurrence if treated with breast conservation.
↑ Citation: Robbins et al.: Histological grading of breast carcinomas: a study of interobserver agreement. Hum. Pathol. 1995;26:873-9. PMID: 7635449
Interobserver variation in the histological grading of breast carcinoma was investigated using the hypothesis that optimal fixation, more precise grading guidelines, some experience, the use of training and test sets, and a comparison of results with an expert group might allow higher levels of agreement. For the training sets sections from 50 consecutive cases of breast carcinoma received at the Sir Charles Gairdner Hospital (SCGH) and fixed in both B5 and buffered formal saline (BFS) were graded by consensus of three pathologists at the SCGH and independently by consensus of two pathologists at the Nottingham City Hospital (NCH) using a modified Scarff-Bloom-Richardson histological grading system with guidelines as suggested by NCH pathologists. The section quality and degree of preservation of nuclear morphology were judged by NCH pathologists to be superior for B5-fixed material. Complete agreement in grade between SCGH and NCH results was achieved for 83.3% of B5-fixed cases and 73.5% of BFS-fixed cases (P = .05) with relative disagreement rates (RDRs) of 0.15 and 0.29 and kappa statistic values of 0.73 and 0.58, respectively. Approximately 80% complete agreement was achieved for tubule formation, nuclear score, and mitotic count, with RDRs ranging from 0.19 to 0.27 and kappa values from 0.46 to 0.69. There was a consistent bias in the SCGH results toward a higher tubule score in both B5- and BFS-fixed material because of a difference in interpretation of cribriform or complex gland patterns and a consistent bias in SCGH results toward a lower nuclear size/pleomorphism score for B5 and BFS material. For the test set sections from 50 further consecutive cases of breast cancer fixed in B5 were examined using similar criteria but taking into account the sources of error shown by the training set. Approximately 80% complete agreement was again achieved for grade components and grade (RDRs, 0.18 and 0.72). Systematic bias was reduced in the test set, but no other improvement was observed. Of the tumors designated as grade I by NCH, 87.5% were called grade I tumors by SCGH in the B5 training set, 84.6% in the B5 test set, and 66.6% in the BFS training set. The levels of agreement shown in both the training and test sets were satisfactory and represented a significant improvement over our previous study, suggesting that experience and precise grading guidelines are of value. The similar levels of agreement in training and test sets suggest that reasonable results can be achieved without direct training by expert groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Breast Service

[1] Citation: Silverstein et al.: Prognostic classification of breast ductal carcinoma-in-situ. Lancet 1995;345:1154-7. PMID: 7723550
We present a new prognostic classification designated the Van Nuys classification for ductal carcinoma-in-situ (DCIS). The classification combines high nuclear grade and comedo-type necrosis to predict clinical recurrence. Three groups of DCIS patients were defined by the presence or absence of high nuclear grade and comedo-type necrosis: 1--non-high-grade DCIS without comedo-type necrosis, 2--non-high-grade DCIS with comedo-type necrosis, 3--high-grade DCIS with or without comedo-type necrosis. There were 31 local recurrences in 238 patients after breast-conservation surgery 3.8% (3/80) in group 1, 11.1% (10/90) in group 2, and 26.5% (18/68) in group 3. The 8-year actuarial disease-free survivals were 93%, 84%, and 61%, respectively (all p < or = 0.05). The Van Nuys classification defines three distinct and easily recognisable groups, each of which has a different likelihood of local recurrence if treated with breast conservation.

[2] Citation: Robbins et al.: Histological grading of breast carcinomas: a study of interobserver agreement. Hum. Pathol. 1995;26:873-9. PMID: 7635449
Interobserver variation in the histological grading of breast carcinoma was investigated using the hypothesis that optimal fixation, more precise grading guidelines, some experience, the use of training and test sets, and a comparison of results with an expert group might allow higher levels of agreement. For the training sets sections from 50 consecutive cases of breast carcinoma received at the Sir Charles Gairdner Hospital (SCGH) and fixed in both B5 and buffered formal saline (BFS) were graded by consensus of three pathologists at the SCGH and independently by consensus of two pathologists at the Nottingham City Hospital (NCH) using a modified Scarff-Bloom-Richardson histological grading system with guidelines as suggested by NCH pathologists. The section quality and degree of preservation of nuclear morphology were judged by NCH pathologists to be superior for B5-fixed material. Complete agreement in grade between SCGH and NCH results was achieved for 83.3% of B5-fixed cases and 73.5% of BFS-fixed cases (P = .05) with relative disagreement rates (RDRs) of 0.15 and 0.29 and kappa statistic values of 0.73 and 0.58, respectively. Approximately 80% complete agreement was achieved for tubule formation, nuclear score, and mitotic count, with RDRs ranging from 0.19 to 0.27 and kappa values from 0.46 to 0.69. There was a consistent bias in the SCGH results toward a higher tubule score in both B5- and BFS-fixed material because of a difference in interpretation of cribriform or complex gland patterns and a consistent bias in SCGH results toward a lower nuclear size/pleomorphism score for B5 and BFS material. For the test set sections from 50 further consecutive cases of breast cancer fixed in B5 were examined using similar criteria but taking into account the sources of error shown by the training set. Approximately 80% complete agreement was again achieved for grade components and grade (RDRs, 0.18 and 0.72). Systematic bias was reduced in the test set, but no other improvement was observed. Of the tumors designated as grade I by NCH, 87.5% were called grade I tumors by SCGH in the B5 training set, 84.6% in the B5 test set, and 66.6% in the BFS training set. The levels of agreement shown in both the training and test sets were satisfactory and represented a significant improvement over our previous study, suggesting that experience and precise grading guidelines are of value. The similar levels of agreement in training and test sets suggest that reasonable results can be achieved without direct training by expert groups.(ABSTRACT TRUNCATED AT 400 WORDS)

[1]

[2]

@@ Line 99: / Line 99: @@
 ! Score !! Tubule Formation !! Nuclear Pleomorphism !! Mitotic Count*
 |-
-| style="background-color:#ffeeab;" | 1 || style="background-color:#ffeeab;" | More than 75 % || style="background-color:#ffeeab;" | Slight || style="background-color:#ffeeab;" | 0 - 18
+| style="background-color:#ffeeab;" | 1 || style="background-color:#ffeeab;" | More than 75 % || style="background-color:#ffeeab;" | Slight || style="background-color:#ffeeab;" | 0 - 8
 |-
 | style="background-color:#fcd432;" | 2 || style="background-color:#fcd432;" | 10% - 75% || style="background-color:#fcd432;" | Moderate || style="background-color:#fcd432;" | 9 - 17