Skip to main content

Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ.

Publication ,  Conference
Harrison, BT; Hwang, ES; Partridge, AH; Thompson, AM; Schnitt, SJ
Published in: Mod Pathol
September 2019

Active surveillance trials for low-risk ductal carcinoma in situ (DCIS) are in progress in the United States and Europe. In some of these trials, the presence of comedo necrosis in the DCIS has been an exclusion criterion for trial entry. However, the minimum amount of necrosis required by pathologists for a diagnosis of comedo necrosis is not well-defined. We surveyed 35 experienced breast pathologists to assess their diagnostic threshold for comedo necrosis. Pink circles representing necrosis ranging in extent from 10 to 80% of the duct diameter were superimposed on eight replicate histologic images of a single duct involved by low nuclear grade, solid pattern DCIS. These images were circulated by e-mail to the participating pathologists who were asked to select the image that represents the minimum amount of necrosis that they require for a diagnosis of comedo necrosis. Among the 35 participants, the minimum extent of the duct diameter required for a diagnosis of comedo necrosis was 10% for 4 pathologists, 20% for 5, 30% for 11, 40% for 7, 50% for 6, 60% for 1 and 70% for 1. There was no single threshold about which more than one-third of the pathologists agreed met the minimal criteria for comedo necrosis. We conclude that even among experienced breast pathologists, the threshold for comedo necrosis is highly variable. Our findings highlight the need for a standardized definition of comedo necrosis as a trial criterion, and more generally where it may be used as a marker of increased risk of recurrence for therapeutic decision making.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Mod Pathol

DOI

EISSN

1530-0285

Publication Date

September 2019

Volume

32

Issue

9

Start / End Page

1257 / 1262

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Reproducibility of Results
  • Patient Selection
  • Pathology, Clinical
  • Pathology
  • Necrosis
  • Humans
  • Female
  • Carcinoma, Intraductal, Noninfiltrating
  • Breast Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Harrison, B. T., Hwang, E. S., Partridge, A. H., Thompson, A. M., & Schnitt, S. J. (2019). Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ. In Mod Pathol (Vol. 32, pp. 1257–1262). United States. https://doi.org/10.1038/s41379-019-0262-4
Harrison, Beth T., E Shelley Hwang, Ann H. Partridge, Alastair M. Thompson, and Stuart J. Schnitt. “Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ.” In Mod Pathol, 32:1257–62, 2019. https://doi.org/10.1038/s41379-019-0262-4.
Harrison, Beth T., et al. “Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ.Mod Pathol, vol. 32, no. 9, 2019, pp. 1257–62. Pubmed, doi:10.1038/s41379-019-0262-4.

Published In

Mod Pathol

DOI

EISSN

1530-0285

Publication Date

September 2019

Volume

32

Issue

9

Start / End Page

1257 / 1262

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Reproducibility of Results
  • Patient Selection
  • Pathology, Clinical
  • Pathology
  • Necrosis
  • Humans
  • Female
  • Carcinoma, Intraductal, Noninfiltrating
  • Breast Neoplasms