TY - JOUR
T1 - Quality of Anatomic Staging of Breast Carcinoma in Hospitals in the United States, with Focus on Measurement of Tumor Dimension
AU - Wu, Dolly Y.
AU - Spangler, Ann E.
AU - De Hoyos, Alberto
AU - Vo, Dat T.
AU - Seiler, Stephen J.
N1 - Publisher Copyright:
© 2021 American Society for Clinical Pathology,.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objectives: We investigated the accuracy of clinical breast carcinoma anatomic staging and the greatest tumor dimension measurements. Methods: We compared clinical stage and greatest dimension values with the pathologic reference standard values using 57,747 cases from the 2016 US National Cancer Institute Surveillance, Epidemiology, and End Results program who were treated by surgical resection without prior neoadjuvant therapy. Results: Agreement for clinical vs pathologic anatomic TNM group stage, overall, is 74.3% ± 0.4%. Lymph node N staging overall agrees very well (85.1% ± 0.4%). Based on tumor dimension and location, T staging has an agreement of only 64.2% ± 0.4%, worsening to 55% without carcinoma in situ (Tis) cases. In approximately 25% of cases, pathologic T stage is higher than clinical T stage. The mean difference in the greatest dimension is 1.36 ± 9.59 mm with pathologic values being generally larger than clinical values; pathologic and clinical measurements correlate well. T-stage disagreement is associated with histology, tumor grade, tumor size, N stage, patient age, periodic biases in tumor size measurements, and overuse of family T-stage categories. Pathologic measurement biases include rounding and specimen-slicing intervals. Conclusions: Clinical and pathologic T-staging values agree only moderately. Pathologists face challenges in increasing the precision of gross tumor measurements, with the goal of improving the accuracy of clinical T staging and measurement.
AB - Objectives: We investigated the accuracy of clinical breast carcinoma anatomic staging and the greatest tumor dimension measurements. Methods: We compared clinical stage and greatest dimension values with the pathologic reference standard values using 57,747 cases from the 2016 US National Cancer Institute Surveillance, Epidemiology, and End Results program who were treated by surgical resection without prior neoadjuvant therapy. Results: Agreement for clinical vs pathologic anatomic TNM group stage, overall, is 74.3% ± 0.4%. Lymph node N staging overall agrees very well (85.1% ± 0.4%). Based on tumor dimension and location, T staging has an agreement of only 64.2% ± 0.4%, worsening to 55% without carcinoma in situ (Tis) cases. In approximately 25% of cases, pathologic T stage is higher than clinical T stage. The mean difference in the greatest dimension is 1.36 ± 9.59 mm with pathologic values being generally larger than clinical values; pathologic and clinical measurements correlate well. T-stage disagreement is associated with histology, tumor grade, tumor size, N stage, patient age, periodic biases in tumor size measurements, and overuse of family T-stage categories. Pathologic measurement biases include rounding and specimen-slicing intervals. Conclusions: Clinical and pathologic T-staging values agree only moderately. Pathologists face challenges in increasing the precision of gross tumor measurements, with the goal of improving the accuracy of clinical T staging and measurement.
KW - Anatomic staging accuracy
KW - Breast cancer staging
KW - Concordance
KW - Gross examination
KW - Tumor size measurement accuracy
UR - http://www.scopus.com/inward/record.url?scp=85114055639&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114055639&partnerID=8YFLogxK
U2 - 10.1093/ajcp/aqaa240
DO - 10.1093/ajcp/aqaa240
M3 - Article
C2 - 33899092
AN - SCOPUS:85114055639
SN - 0002-9173
VL - 156
SP - 356
EP - 369
JO - American journal of clinical pathology
JF - American journal of clinical pathology
IS - 3
ER -