Tumor architecture exerts no bias on nuclear grading in breast cancer diagnosisReport as inadecuate

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Virchows Archiv

, Volume 461, Issue 4, pp 399–403

First Online: 31 August 2012Received: 20 June 2012Revised: 14 August 2012Accepted: 16 August 2012


We recently reported that nuclear grading in prostate cancer is subject to a strong confirmation bias induced by the tumor architecture. We now wondered whether a similar bias governs nuclear grading in breast carcinoma. An unannounced test was performed at a pathology conference. Pathologists were asked to grade nuclei in a PowerPoint presentation. Circular high power fields of 27 invasive ductal carcinomas were shown, superimposed over low power background images of either tubule-rich or tubule-poor carcinomas. We found a that diagnostic reproducibility of nuclear grades was poor to moderate weighed kappa values between 0.07 and 0.54, 27 cases, 44 graders, but b that nuclear grades were not affected by the tumor architecture. We speculate that the categorized grading in breast cancer, separating tubule formation, nuclear pleomorphism, and mitotic figure counts in a combined three tier score, prevents the bias that architecture exerts on nuclear grades in less well-controlled situations.

KeywordsConfirmation bias Cancer grading Nuclear pleomorphism Architecture Cognitive psychology  Download fulltext PDF

Author: Braulio Mora - Dario Bombari - Stephan C. Schaefer - Marcus Schmidt - Jean-Francois Delaloye - Fred Mast - Hans-Anton Lehr

Source: https://link.springer.com/

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