Evidence map›Paper›PMID 30980039›Full record

Observational studyModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2019

Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ.

Beth T Harrison, E Shelley Hwang, Ann H Partridge, Alastair M Thompson, Stuart J Schnitt

Open access · bronzeAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed
4.2field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 40 citations in OpenAlex.

  1. Article
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
  8. Review
  9. Article
  10. Review
  11. Article
  12. Review
  13. Low-risk DCIS. What is it? Observe or excise?Virchows Archiv : an international journal of pathology · 2022
    Review
  14. Article
  15. Improving DCIS diagnosis and predictive outcome by applying artificial intelligence.Biochimica et biophysica acta. Reviews on cancer · 2021
    Review
  16. Article
  17. Diagnosis of ductal carcinoma in situ in an era of de-escalation of therapy.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2021
    Review
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 1 country.

Beth T HarrisonDepartment of Pathology, Brigham and Women's Hospital, Boston, MA, USA. bharrison3@bwh.harvard.edu.
E Shelley HwangDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann H PartridgeDepartment of Medicine, Harvard Medical School, Boston, MA, USA.
Alastair M ThompsonDepartment of Surgical Oncology, Baylor College of Medicine, Houston, TX, USA.
Stuart J SchnittDepartment of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Brigham and Women's Hospital · USBaylor College of Medicine · USDuke Medical Center · USHarvard University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Active surveillance trials for low-risk ductal carcinoma in situ (DCIS) are in progress in the United States and Europe. In some of these trials, the presence of comedo necrosis in the DCIS has been an exclusion criterion for trial entry. However, the minimum amount of necrosis required by pathologists for a diagnosis of comedo necrosis is not well-defined. We surveyed 35 experienced breast pathologists to assess their diagnostic threshold for comedo necrosis. Pink circles representing necrosis ranging in extent from 10 to 80% of the duct diameter were superimposed on eight replicate histologic images of a single duct involved by low nuclear grade, solid pattern DCIS. These images were circulated by e-mail to the participating pathologists who were asked to select the image that represents the minimum amount of necrosis that they require for a diagnosis of comedo necrosis. Among the 35 participants, the minimum extent of the duct diameter required for a diagnosis of comedo necrosis was 10% for 4 pathologists, 20% for 5, 30% for 11, 40% for 7, 50% for 6, 60% for 1 and 70% for 1. There was no single threshold about which more than one-third of the pathologists agreed met the minimal criteria for comedo necrosis. We conclude that even among experienced breast pathologists, the threshold for comedo necrosis is highly variable. Our findings highlight the need for a standardized definition of comedo necrosis as a trial criterion, and more generally where it may be used as a marker of increased risk of recurrence for therapeutic decision making.

Indexed as

Pathology, ClinicalPatient SelectionBreast NeoplasmsCarcinoma, Intraductal, NoninfiltratingFemaleHumansNecrosisReproducibility of ResultsWatchful Waiting

Identifiers

PMID30980039
OpenAlexW2935807775

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.