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Diagnostic concordance of reporting lymphovascular invasion in breast cancer
  1. Emad A Rakha1,2,
  2. Areeg Abbas1,
  3. Pablo Pinto Ahumada3,
  4. Maysa E ElSayed4,
  5. Derek Colman1,
  6. Sarah E Pinder5,
  7. Ian O Ellis1
  1. 1 Department of Histopathology, School of Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
  2. 2 Histopathology Department, Faculty of Medicine, Menoufia University, Shabeen El Kom, Egypt
  3. 3 Hospital Clínico Magallanes, Punta Arenas, Chile
  4. 4 Public Health Department, Faculty of Medicine, Menoufia University, Shebeen El Kom, Egypt
  5. 5 Cancer Studies, Guy’s Hospital, King’s College London, London, UK
  1. Correspondence to Prof Emad A Rakha, Department of Histopathology, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK; emadrakha{at}


Aims This study aims to assess the diagnostic agreement of lymphovascular invasion (LVI) in invasive breast cancer (BC).

Methods Data on LVI were collected from the UK National Health Service Breast Screening Programme pathology external quality assurance scheme database. 101 BCs assessed over a 10-year period (2004–2014) were included. Cases were scored by an average of 600 pathologists. Three H&E stained slides from each case were reviewed by three pathologists and additional variables were evaluated.

Results In the whole series, the overall κ value was 0.4 (range 0.26–0.53). On review, LVI was detected in all three slides in 20 cases (20%), in two slides in 12 cases and in one of the three slides in 9 cases and was not seen in 60 cases. For concordance analysis, the first and last groups were used to represent cases with definite (LVI+) and absent LVI (LVI–), respectively. In the LVI+group (n=20), the level of agreement ranged from 0.54 to 0.99 (median 0.86). In the LVI– group (n=60), the level of agreement ranged from 0.52 to 1.00 (median 0.93), with 44% of cases showing interobserver concordance of >95%. There was a correlation between increasing number of involved lymphovascular spaces in the section and higher LVI reporting concordance. Some degree of retraction/fixation artefacts was observed in 35% of cases; this was associated with a lower concordance rate.

Conclusions The concordance of reporting LVI is variable. Cases without LVI and those with multiple involved vessels are likely to have the highest concordance and the highest detection rates.

  • interobserver agreement
  • lymphovascular invasion
  • breast cancer

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  • Handling editor Cheok Soon Lee.

  • Contributors All authors contributed to this study and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request and at the discretion of the authors.