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patients in the Netherlands Carmen van Dooijeweert European - - PowerPoint PPT Presentation

Sep 10, 2023 244 likes •381 views

Inter- and intra-laboratory variation in grading of invasive breast cancer: a nationwide study of 33,043 patients in the Netherlands Carmen van Dooijeweert European Congress of Pathology MD, PhD-student September 7-11, 2019 Nice

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Inter- and intra-laboratory variation in grading of invasive breast cancer: a nationwide study of 33,043 patients in the Netherlands

Carmen van Dooijeweert European Congress of Pathology MD, PhD-student September 7-11, 2019 Nice

c.vandooijeweert-3@umcutrecht.nl

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I hereby declare that I have no conflict of interest

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Breast cancer: background

  • Most common type of cancer in European women1
  • Breast cancer management: it all starts with pathology

– Subtype: PATHOLOGY – Prognosis: PATHOLOGY – Treatment: PATHOLOGY

  • 1. International Agency for Research on Cancer (WHO), source: GLOBOCON 2018
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  • Histologic grade

– B&R (modified) – Clinical decisions

  • Chemotherapy
  • Radiotherapy
  • Gene-expression profiling

Breast cancer biomarkers

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Reproducibility histologic grading

  • No more than moderate1-4

But how are we doing in daily clinical practice?

1. Boiesen et al. Acta Oncol 2000: 39(1):41-45 2. Frierson et al. Am J Clin Pathol 1995:103(2):195-198 3. Italian Network for Quality Assurance of Tumour Biomarkers (INQAT group). Pathologica 2005:97(1):1-6 4. Meyer et al. Mod Pathol 2005:18(8):1067-1078

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Real-life data on a Dutch nationwide level

the nationwide network and registry of histo- and cytopathology in the Netherlands

  • Synoptic reporting

▪ Increased overall completeness of reports1 ▪ Easy data extraction ▪ Breast cancer resection specimens: 80% via synoptic protocol2

1. Sluijter et al. Virchows Archiv 2016:468(4):639-649. 2. PALGA Foundation, Annual Report 2018

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Grading in the Netherlands; 2013-2016 (n=33,792)

Laboratory-level (n=39)

0% 10% 20% 30% 40% 50% 60% 500 1000 1500 2000 2500

Proportion (%) grade I Number of IBC reports per laboratory

Grade I

Mean: 28.1% Range: 16.3-43.3%

Case-mix: age, tumour size, type of surgery, histologic subtype, ER/PR- and, HER2-receptor status

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Grading in the Netherlands; 2013-2016 (n=33,792)

Laboratory-level (n=39)

0% 10% 20% 30% 40% 50% 60% 500 1000 1500 2000 2500

Proportion (%) grade II Number of IBC reports per laboratory

Grade II

0% 10% 20% 30% 40% 50% 60% 500 1000 1500 2000 2500

Proportion (%) grade III Number of IBC reports per laboratory

Grade III

Mean: 47.6% Range: 38.4-57.8% Mean: 24.3% Range: 15.5-34.3%

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Grading in the Netherlands; 2013-2016

Pathologist-level (n=68, 8 laboratories)

0% 10% 20% 30% 40% 50% 60% 50 100 150 200 250 300

Proportion (%) grade I Number of IBC reports per pathologist

Grade I

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0% 10% 20% 30% 40% 50% 60% 50 100 150 200 250 300

Proportion (%) grade III Number of IBC reports per pathologist

Grade III

20% 30% 40% 50% 60% 70% 80% 50 100 150 200 250 300

Proportion (%) grade II Number of IBC reports per pathologist

Grade II

Grading in the Netherlands; 2013-2016

Pathologist-level (n=68, 8 laboratories)

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Grading variation; does it really matter?

Chemotherapy (n=19,461)

Invasive breast cancer reports with complete information on all relevant variables (i.e. lymph node status (N), age, tumor size, histologic grade) n = 19,461 According to the Dutch breast cancer guideline, adjuvant chemotherapy (aCT) is advised for patients with a positive lymph node status (N+) and for patients with a negative lymph node status (N0) with the following characteristics: · Age <35 years, except for a grade I tumor <1cm · Age ≥35 years with a tumor of 1.1-2cm and ≥grade II, or a tumor >2cm · HER2 overexpression in a tumor ≥0.5cm N0 n = 13,077 N+ n = 6,384 HER2 + n = 1,119 HER2 - n = 11,958 <0.5 cm n = 43 ≥ 0.5 cm n = 1,076 <35 years n = 3 ≥ 35 years n = 40 Grade I: no aCT Grade II-III: aCT > 2.0 cm n = 2,605 ≤ 2.0 cm n = 9,353 <35 years n = 72 ≥ 35 years n = 9,281 ≤ 1 cm n = 27 > 1 cm n = 45 Grade I: no aCT Grade II-III: aCT aCT aCT aCT aCT no aCT ≤ 1 cm n = 3,490 no aCT 1.1-2 cm n = 5,791 Grade I: no aCT Grade II-III: aCT

n = 5,821

  • All patients:

29.9%

  • N0-patients:

44.5%

Curigliano et al. Ann Oncol 2017: 28(8):1700-1712

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Conclusion: histologic grading

  • Synoptic pathology reports of >33,000 patients
  • Substantial inter- and intra-laboratory variation in grading of invasive breast cancer in

daily clinical practice

– Not explained by differences in case-mix

  • Biomarker of major clinical importance

– Indication chemotherapy

  • 1 in 3 breast cancer patients
  • 1 in 2 lymph-node negative breast cancer patients
  • Decrease in variation warranted!
  • Interventions

– Feedback reports – E-learning

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Acknowledgements

Paul van Diest Carolien van Deurzen Elsken van der Wall Henk-Jan van Slooten Stefan Willems Jelle Wesseling Chantal Kuijpers Pieter Westenend Inge Baas Ivette Deckers Lucy Overbeek