ArticleBreast cancer research and treatment2020
Prognostic value of histopathological DCIS features in a large-scale international interrater reliability study.
Article in Breast cancer research and treatment, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 32 citations in OpenAlex.
- Enabling DCIS subtyping: leveraging foundation models for robust grading and molecular biomarker scoring.NPJ breast cancer · 2026Article
- Deep learning for predicting invasive recurrence of ductal carcinoma in situ: leveraging histopathology images and clinical features.EBioMedicine · 2025Article
- A morphometric signature to identify ductal carcinoma in situ with a low risk of progression.NPJ precision oncology · 2025Article
- Adherence to guideline recommendations for follow-up in patients with DCIS at a large teaching hospital in the Netherlands.Breast cancer research and treatment · 2024Article
- A Nomogram Using Imaging Features to Predict Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ.Korean journal of radiology · 2024Article
- Characterization of dolomite and calcite microcalcifications in human breast tissue.RSC advances · 2024Article
- Systematic assessment of HER2 status in ductal carcinoma in situ of the breast: a perspective on the potential clinical relevance.Breast cancer research : BCR · 2024Review
- Tools to Guide Radiation Oncologists in the Management of DCIS.Healthcare (Basel, Switzerland) · 2024Review
- Application of deep learning on mammographies to discriminate between low and high-risk DCIS for patient participation in active surveillance trials.Cancer imaging : the official publication of the International Cancer Imaging Society · 2024Article
- Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance.Signal transduction and targeted therapy · 2024Review
- Artificial intelligence-based morphometric signature to identify ductal carcinoma in situ with low risk of progression to invasive breast cancer.Research square · 2023Article
- Active surveillance versus treatment in low-risk DCIS: Women's preferences in the LORD-trial.European journal of cancer (Oxford, England : 1990) · 2023Article
- Positive surgical margins after breast-conserving surgery for ductal carcinoma in-situ: does histologic grade or estrogen receptor status matter?Breast cancer research and treatment · 2023Article
- Inflammatory cytokine-enriched microenvironment plays key roles in the development of breast cancers.Cancer science · 2023Review
- Machine Learning of Raman Spectroscopy Data for Classifying Cancers: A Review of the Recent Literature.Diagnostics (Basel, Switzerland) · 2022Review
- Article
- Ductal Carcinoma in Situ: State-of-the-Art Review.Radiology · 2022Review
- Low-risk DCIS. What is it? Observe or excise?Virchows Archiv : an international journal of pathology · 2022Review
- Morphological intratumor heterogeneity in ductal carcinoma in situ of the breast.Virchows Archiv : an international journal of pathology · 2021Article
- Variability in grading of ductal carcinoma in situ among an international group of pathologists.The journal of pathology. Clinical research · 2021Article
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Authors and funding
32 authors at 20 institutions in 11 countries.
Funding
Abstract
purposeFor optimal management of ductal carcinoma in situ (DCIS), reproducible histopathological assessment is essential to distinguish low-risk from high-risk DCIS. Therefore, we analyzed interrater reliability of histopathological DCIS features and assessed their associations with subsequent ipsilateral invasive breast cancer (iIBC) risk.
methodsUsing a case-cohort design, reliability was assessed in a population-based, nationwide cohort of 2767 women with screen-detected DCIS diagnosed between 1993 and 2004, treated by breast-conserving surgery with/without radiotherapy (BCS ± RT) using Krippendorff's alpha (KA) and Gwet's AC2 (GAC2). Thirty-eight raters scored histopathological DCIS features including grade (2-tiered and 3-tiered), growth pattern, mitotic activity, periductal fibrosis, and lymphocytic infiltrate in 342 women. Using majority opinion-based scores for each feature, their association with subsequent iIBC risk was assessed using Cox regression.
resultsInterrater reliability of grade using various classifications was fair to moderate, and only substantial for grade 1 versus 2 + 3 when using GAC2 (0.78). Reliability for growth pattern (KA 0.44, GAC2 0.78), calcifications (KA 0.49, GAC2 0.70) and necrosis (KA 0.47, GAC2 0.70) was moderate using KA and substantial using GAC2; for (type of) periductal fibrosis and lymphocytic infiltrate fair to moderate estimates were found and for mitotic activity reliability was substantial using GAC2 (0.70). Only in patients treated with BCS-RT, high mitotic activity was associated with a higher iIBC risk in univariable analysis (Hazard Ratio (HR) 2.53, 95% Confidence Interval (95% CI) 1.05-6.11); grade 3 versus 1 + 2 (HR 2.64, 95% CI 1.35-5.14) and a cribriform/solid versus flat epithelial atypia/clinging/(micro)papillary growth pattern (HR 3.70, 95% CI 1.34-10.23) were independently associated with a higher iIBC risk.
conclusionsUsing majority opinion-based scores, DCIS grade, growth pattern, and mitotic activity are associated with iIBC risk in patients treated with BCS-RT, but interrater variability is substantial. Semi-quantitative grading, incorporating and separately evaluating nuclear pleomorphism, growth pattern, and mitotic activity, may improve the reliability and prognostic value of these features.
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