Abstract
BackgroundAs high percentage of mammographic densities complicates the assessment of imaging findings, mammographic density may influence the histopathological evaluation of core-biopsies of the breast. We measured the influence of mammographic density on the inter-observer variability of histopathological findings of breast biopsies.MethodsHistological slides of 695 women who underwent core biopsies of the breast at University of Halle between 2006 and 2008 were evaluated in a blinded fashion by two pathologists using the five levels of the B-categorization scheme (B1-B5). To quantify mammographic density, we used a computer-based threshold method (Madena). We calculated observed and chance-corrected agreements (weighted kappa) and 95% confidence intervals (95% CI) according to four categories of mammographic density (<10%, 10<25%, 25<50%, ≥50%).ResultsThe weighted kappa decreased monotonically from 89.6% (95% CI: 85.8%, 93.3%) among women with less than 10% of mammographic density to 80.4% (95% CI: 69.9%, 90.9%) for women with more than 50% of mammographic density, respectively. Results of a kappa regression analysis showed that agreement of pathologists on clinically relevant categories (B1-B2 versus B3-B5) decreased with mammographic density.ConclusionsMammographic density is a relevant modifier of the agreement between pathologists who assess breast biopsies using the B-categorization scheme. The influence of mammographic density on the inter-observer variability can be explained to some extent by varying prevalences of histological entities across B categories that have typically different inter-observer agreement. Women with high mammographic density are at higher risk of inter-observer variability compared to women with low mammographic density and should possibly undergo a second pathology review.
Highlights
As high percentage of mammographic densities complicates the assessment of imaging findings, mammographic density may influence the histopathological evaluation of core-biopsies of the breast
As high mammographic density complicates the assessment of the imaging findings and the histopathological diagnostic should be performed in correspondence with the mammographic findings, a high mammographic density may be associated with higher inter-observer variability between pathologists who evaluate biopsy material
Our study shows that a higher percentage of mammographic density is associated with lower inter-observer agreement of the histopathological evaluation of core biopsies of the breast using the B-categorization
Summary
As high percentage of mammographic densities complicates the assessment of imaging findings, mammographic density may influence the histopathological evaluation of core-biopsies of the breast. As high mammographic density complicates the assessment of the imaging findings and the histopathological diagnostic should be performed in correspondence with the mammographic findings, a high mammographic density may be associated with higher inter-observer variability between pathologists who evaluate biopsy material. No studies have reported results about the influence of mammographic density on the reliability of histopathological findings of breast biopsies that are currently classified by the Bcategorization according to the National Coordinating Group for Breast Screening Pathology [5]. Categories B1-B2 usually do not require further invasive diagnostic workup unless biopsies classified as B1 were uninterpretable or unrepresentative of the breast lesion according to the imaging and clinical findings. The European guidelines recommend to check that the histological findings correlate with the mammographic findings in order to interpret correctly the histological material of core biopsies of the breast and before to define the diagnosis [6]
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