ABSTRACT
BACKGROUND: Immunohistochemical assessment of the hormone receptor status of breast carcinoma is a routine investigation. However, there is no worldwide consensus on the scoring system. The Quick Score is claimed to be a reliable scoring system, which assesses both the proportion of stained cells and the intensity of staining. AIMS: To assess the value of Quick Score in terms of accepted clinicopathological parameters and to document the prevalence of hormone receptor-positive breast carcinomas in the study sample. MATERIALS AND METHODS: Clinicopathological parameters of 151 breast cancers were compared with the Quick Scores for estrogen receptor (ER) and progesterone receptor (PR) status. RESULTS AND CONCLUSIONS: The Quick Score for ER was 0 in 54.3% (82/151) and for PR was 0 in 51.7% (75/145), indicating no hormone receptor expression in the majority. The Nottingham grade and the mitotic count had a significant inverse relationship with the Quick Score for hormone receptor status. The Nottingham Prognostic Index (NPI) also had an inverse relationship with the hormone receptor status.
ABSTRACT
BACKGROUND: Immunohistochemical (IHC) assessment of estrogen receptor (ER) and progesterone receptor (PR) status has become a routine practice to predict the likely outcome of Tamoxifen therapy. AIMS: To assess the interobserver variation in scoring hormone receptor status of breast carcinoma, using the Quick Score. MATERIALS AND METHODS: IHC-stained slides of breast carcinomas reported by the two authors during a 28-month period were included in the study. Both authors independently reassessed all the tumors. Both were blinded to each other's assessment. The Quick score with a 0-8 point scale was used to score the hormone receptor status. Weighted Kappa was calculated to assess the interobserver variation. RESULTS: A total of 210 breast carcinomas were included in this study. There was a substantial to almost perfect agreement between the two observers in scoring the hormone receptor status (kappa values; ER=0.856, PR=0.711). Both ER and PR showed an almost perfect agreement in assessing the intensity of staining (kappa value; ER=0.882, PR=0.840), while the scoring of proportion of cells gave lower Kappa values (kappa value; ER=0.778, PR=0.592). Interobserver agreement was less in scoring hormone receptor status of breast carcinomas after mastectomies compared with excision biopsies, wide local excisions and metastatic deposits in lymph nodes. Suboptimal fixation resulting in background staining has contributed to the variation. CONCLUSION: A substantial to almost perfect interobserver agreement was seen in assigning an overall Quick score. Detection of complete negative and strong expression had a moderate to substantial agreement.
Subject(s)
Breast Neoplasms/chemistry , Breast Neoplasms/pathology , Carcinoma/chemistry , Carcinoma/pathology , Humans , Immunohistochemistry , Observer Variation , Receptors, Estrogen/isolation & purification , Receptors, Progesterone/isolation & purification , Reproducibility of Results , Severity of Illness Index , Chickenpox/epidemiology , Chickenpox/immunology , Data Interpretation, Statistical , Humans , Mental Recall , Predictive Value of Tests , Reproducibility of ResultsABSTRACT
BACKGROUND: Fine needle aspiration is a simple technique to obtain material for early diagnosis of tuberculous lymphadenitis. Objective: To assess the value of fine needle aspiration cytology (FNAC) in the diagnosis of tuberculous lymphadenitis. MATERIALS AND METHODS: A total of 43 aspirates from patients who were clinically suspected to have tuberculous lymphadenitis were included in the study. Apart from FNAC, aspirates were smeared for Ziehl Neelsen stain and cultured on Middlebrook 7H9 and 7H10 media. Culture was considered the gold standard. Positive and negative predictive values and agreement between the gold standard and five diagnostic criteria were assessed. Kappa value was used to calculate the agreement. RESULTS: The presence of epithelioid cells either with caseation or positive Ziehl Neelsen had the highest agreement (kappa value 0.84), with high positive and negative predictive values (85.71% and 96.55%). Positive Ziehl Neelsen alone and presence of epithelioid cells with positive Ziehl Neelsen had 100% positive predictive values, but the kappa values were lower (0.62 and 0.52) with lower negative predictive values (83.33% and 81.08%). Epithelioid cells alone had a high negative predictive value (93.35%), but the positive predictive value was lower (84.62%). When epithelioid cells were taken together with caseation, the positive predictive value reduced further (83.33%). CONCLUSION: The presence of epithelioid cells either with caseation or positive Ziehl Neelsen stain appears to be the best diagnostic criteria, with a very good agreement with the gold standard and high positive and negative predictive values.