Summary
Mitotic rate is an important prognostic predictor in invasive breast carcinoma. Current
guidelines recommend counting mitoses from 10 contiguous high power fields (HPFs)
in the core biopsy. We propose a method to score mitotic activity in 1 HPF at the
most mitotically active area of the tumour edge, or the interface between invasive
tumour and benign breast tissue. We propose a score of 1, 2, or 3, corresponding to
≤1, 2, or ≥3 mitoses in 1 HPF, respectively.
A total of 141 breast core biopsies with corresponding surgical excisions were blindly
examined. We counted the number of mitotic figures in 1 HPF and in 10 contiguous HPFs
in the core biopsy and compared with the mitotic count from 10 contiguous HPFs in
the excision which is considered the gold standard. Concordance rates and interobserver
agreement rates were calculated.
The concordance rate was 82.3%, 78.7% and 82.3% between 1 HPF versus 10 HPFs in the
core biopsy, 1 HPF in the core biopsy versus 10 HPFs in the excision and 10 HPFs in
the core biopsy vs 10 HPFs in the excision, respectively. In the core biopsy, all
three investigators agreed in 73.8% and 83.7% of the cases using the 1 HPF method
and the 10 HPFs method, respectively; in the excision specimen, agreement was reached
in 82.3% of the cases. The 1 HPF method showed similar concordance rate and interobserver
agreement compared to the conventional method in the prediction of the mitotic score
in the excision in all score groups. When stratified by mitotic score, the 1 HPF method
predicted superior correlation with excision in the score 1 group than the 10 HPFs
method, but not in the score 2 or 3 groups. From these findings we conclude that the
proposed 1 HPF method can be used in clinical practice to grade invasive breast carcinomas
in core biopsies, with the possibility of being utilised in small biopsies with less
than 10 HPFs of invasive carcinoma.
Key words
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Article info
Publication history
Published online: December 13, 2021
Accepted:
September 22,
2021
Received in revised form:
September 15,
2021
Received:
June 2,
2021
Identification
Copyright
© 2021 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.
