Concordance in breast cancer grading by artificial intelligence on whole slide images compares with a multi-institutional cohort of breast pathologists Journal Article

Authors: Mantrala, S.; Ginter, P. S.; Mitkari, A.; Joshi, S.; Prabhala, H.; Ramachandra, V.; Kini, L.; Idress, R.; D'Alfonso, T. M.; Fineberg, S.; Jaffer, S.; Sattar, A. K.; Chagpar, A. B.; Wilson, P.; Singh, K.; Harigopal, M.; Koka, D.
Article Title: Concordance in breast cancer grading by artificial intelligence on whole slide images compares with a multi-institutional cohort of breast pathologists
Abstract: * Context.--Breast carcinoma grade, as determined by the Nottingham Grading System (NGS), is an important criterion for determining prognosis. The NGS is based on 3 parameters: tubule formation (TF), nuclear pleomorphism (NP), and mitotic count (MC). The advent of digital pathology and artificial intelligence (AI) have increased interest in virtual microscopy using digital whole slide imaging (WSI) more broadly. Objective.--To compare concordance in breast carcinoma grading between AI and a multi-institutional group of breast pathologists using digital WSI. Design.--We have developed an automated NGS framework using deep learning. Six pathologists and AI independently reviewed a digitally scanned slide from 137 invasive carcinomas and assigned a grade based on scoring of the TF, NP, and MC. Results.--Interobserver agreement for the pathologists and AI for overall grade was moderate (κ = 0.471). Agreement was good (κ = 0.681), moderate (κ = 0.442), and fair (κ = 0.368) for grades 1, 3, and 2, respectively. Observer pair concordance for AI and individual pathologists ranged from fair to good (j = 0.313-0.606). Perfect agreement was observed in 25 cases (27.4%). Interobserver agreement for the individual components was best for TF (κ = 0.471 each) followed by NP (κ = 0.342) and was worst for MC (κ = 0.233). There were no observed differences in concordance amongst pathologists alone versus pathologists + AI. Conclusions.--Ours is the first study comparing concordance in breast carcinoma grading between a multi-institutional group of pathologists using virtual microscopy to a newly developed WSI AI methodology. Using explainable methods, AI demonstrated similar concordance to pathologists alone.
Keywords: microscopy; prospective studies; algorithms; artificial intelligence; pathology, clinical; descriptive statistics; breast neoplasms -- diagnosis; cancer patients; multicenter studies; microscopy, virtual; comparative studies; pathologists; neoplasm grading; human; female; deep learning
Journal Title: Archives of Pathology & Laboratory Medicine
Volume: 146
Issue: 11
ISSN: 0003-9985
Publisher: College of American Pathologists  
Date Published: 2022-11-01
Start Page: 1369
End Page: 1377
Language: English
DOI: 10.5858/arpa.2021-0299-OA
PROVIDER: cinahl
PUBMED: 35271701
Notes: Accession Number: 159889122 -- Entry Date: 20221102 -- Revision Date: 20221102 -- Publication Type: Article; pictorial; research; tables/charts -- Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA -- NLM UID: 7607091. -- Source: Cinahl
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