Identification of potentially misleading terminology in the fifth edition WHO Classification of Tumours digestive and breast tumours blue books

Abstract

Background: Terminology with misleading potential is a problem with recognised impact in all medical specialties, including training and research. The WHO Classification of Tumours (WCT) is not excluded. Aims: To identify and describe the frequency of use of a set of potentially misleading terms in the 5th edition WCT Digestive System and Breast Tumours blue books. Methods: The project had two parts. Firstly, four independent pathologists of the WCT group identified a set of 26 potentially misleading pathology-related terms, including prefixes and suffixes through consensus. The main investigator reviewed 15 relevant information sources, including dictionaries, for definitions of these terms and compared these with each other. Secondly, a descriptive analysis was performed on the frequency of use of potentially misleading terms in the two recently published 5th edition WCT. Results and conclusions: Twenty-six terms were identified. No sources provided definitions for all terms. Eight of 15 sources used the terms or described them without providing a true definition. The Digestive System Tumours book used misleading terms 1477 times. The six terms most frequently observed were ‘dysplasia’, ‘high-grade dysplasia’, ‘epithelioid’, ‘pseudo’, ‘oid’ and ‘-like’. The Breast Tumours book used misleading terms 574 times. The six terms most frequently observed were ‘microinvasion and microinvasive’, ‘Paget disease’, ‘epithelioid’, ‘-pseudo’, ‘oid’ and ‘-like’. The Digestive System Tumours book showed a more even distribution of potentially misleading terms across chapters than the Breast Tumours book, which had more than half (57%) confined to one chapter. The suffix ‘-oid’ was the most frequently used term in both books (38% in Digestive System Tumours and 46% in Breast Tumours). In conclusion, terminologies were defined inconsistently and use of selected terms was frequent. Uniform definitions for commonly misused terms are required to enhance clarity of communication in medical writing and improve medical education.