Cytologic grading of fine needle aspirates of breast carcinoma by private practice pathologists

OBJECTIVE: To determine the reproducibility of two clinically proven grading systems for breast carcinoma assessed by private practice pathologists. STUDY DESIGN: Twenty fine needle aspiration (FNA) slides of histologically proven breast carcinoma were submitted to 15 private practice pathologists practicing in 11 separate groups who interpret cytology as part of their daily practice. The pathologists received the same set of slides. They graded the FNAs using the modified Black (MB) (grades 1-3) and simplified Black (SB) (low grade, high grade) grading systems. Specified criteria and guidelines as well as case samples were provided. RESULTS: There was complete agreement among the 15 pathologists on only one case using the MB grading system as compared to five using the SB grading system. In MB, greater than or equal to 10 pathologists were in agreement on 14 cases as compared to 19 cases using SB. There were three cases in MB where the grades ranged from 1 to 3. Also noted in MB was the high number of cases graded 2 (intermediate grade). The predominant comment made by the pathologists was the easier, more objective and practical application of the SB. CONCLUSION: High reproducibility in the cytologic grading of FNA of breast carcinoma can be more readily attained among private practice pathologists using the two-tier SB grading system.