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Quality of Anatomic Staging of Breast Carcinoma in Hospitals in the United States, With Focus on Measurement of Tumor Dimension

Wu, Dolly Y. and Spangler, Ann E. and de Hoyos, Alberto and Vo, Dat T. and Seiler, Stephen J. (2021) Quality of Anatomic Staging of Breast Carcinoma in Hospitals in the United States, With Focus on Measurement of Tumor Dimension. American Journal of Clinical Pathology, 156 (3). pp. 356-369. ISSN 0002-9173. doi:10.1093/ajcp/aqaa240.

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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.

Item Type:Article
Related URLs:
URLURL TypeDescription
Spangler, Ann E.0000-0002-0982-1855
Vo, Dat T.0000-0001-9088-7132
Seiler, Stephen J.0000-0002-7501-9844
Additional Information:© 2021 American Society for Clinical Pathology. This work is written by (a) US Government employee(s) and is in the public domain in the US. Published: 26 April 2021. We thank the US National Cancer Institute SEER Program, the University of Texas Southwestern Medical Center Tumor Registry, Heather Blakley, PA, Yasmeen Butt, MD, H. Michael Crowson, PhD, Helena Hwang, MD, Joerg Luedicke, PhD, Hollis Notgrass, MS, PA, and Rachel Wooldridge, MD.
Funding AgencyGrant Number
National Cancer InstituteUNSPECIFIED
University of TexasUNSPECIFIED
Subject Keywords:Breast cancer staging; Anatomic staging accuracy; Tumor size measurement accuracy; Gross examination; Concordance
Issue or Number:3
Record Number:CaltechAUTHORS:20210512-075705885
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Official Citation:Dolly Y Wu, PhD, JD, Ann E Spangler, MD, MACM, Alberto de Hoyos, MD, Dat T Vo, MD, PhD, Stephen J Seiler, MD, Quality of Anatomic Staging of Breast Carcinoma in Hospitals in the United States, With Focus on Measurement of Tumor Dimension, American Journal of Clinical Pathology, Volume 156, Issue 3, September 2021, Pages 356–369,
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:109087
Deposited By: Tony Diaz
Deposited On:12 May 2021 16:26
Last Modified:11 Aug 2021 22:21

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