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Consistency in the observation of features used to classify duct carcinoma in situ (DCIS) of the breast
  1. A G Douglas-Jones1,
  2. J M Morgan1,
  3. M A C Appleton2,
  4. R L Attanoos3,
  5. A Caslin4,
  6. C S Champ5,
  7. M Cotter3,
  8. N S Dallimore3,
  9. A Dawson6,
  10. R W Fortt7,
  11. A P Griffiths6,
  12. M Hughes4,
  13. P A Kitching8,
  14. C O'Brien6,
  15. A M Rashid7,
  16. D Stock5,
  17. A Verghese5,
  18. D W Williams9,
  19. N W Williams10,
  20. S Williams10
  1. 1Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff, CF4 4XN, UK
  2. 2Department of Pathology, Worthing Hospital, Worthing West Sussex, BN11 2DH, UK
  3. 3Department of Pathology, Llandough Hospital, Penarth, CF64 2XX, UK
  4. 4Department of Pathology, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK
  5. 5Department of Pathology, East Glamorgan General Hospital, Church Village, Nr Pontypridd, CF38 1AB, UK
  6. 6Department of Pathology, Morriston Hospital, Swansea, SA6 6NL, UK
  7. 7Department of Pathology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent, NP9 2UB, UK
  8. 8Department of Pathology, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
  9. 9Department of Pathology, Prince Philip Hospital, Llanelli, Dyfed, SA14 8QF, UK
  10. 10Department of Pathology, Singleton Hospital, Swansea, SA2 8QA, UK
  1. Dr Douglas-Jones email:{at}


Aim—To determine interobserver and intra-observer agreement in the assessment of cytological grade and intraduct necrosis in pure duct carcinoma in situ (DCIS) of the breast.

Methods—Sixty unselected cases with illustrated diagnostic criteria were circulated to 19 practising histopathologists.

Results—Overall agreement was moderate for cytological grade in three categories: 71% agreement; weighted κ (κw), 0.36; intraduct necrosis in three categories (absent, present, extensive): 76% agreement; κw, 0.57; and the Van Nuys classification system: 73% agreement; κw, 0.48. Agreement was no better among observers participating in the National External Quality Assurance Programme. Intra-observer agreement for cytological assessment (69.6% agreement; κw, 0.52) and intraduct necrosis (68.3% agreement; κw, 0.48) was moderate, suggesting that individual variation rather than precision of criteria contributes to the lack of agreement.

Conclusions—Moderate agreement on observations can be achieved by non-specialist pathologists, with better agreement on necrosis than cytological grade. There was evidence of consistent individual bias towards over or under scoring cytological grade, which could be corrected with adequate and prompt feedback.

  • classification
  • duct carcinoma in situ
  • breast
  • intraduct necrosis

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