Region of interest identification and diagnostic agreement in breast pathology

Dilip B. Nagarkar, Ezgi Mercan, Donald L. Weaver, Tad T. Brunyé, Patricia (Patty) Carney, Mara H. Rendi, Andrew H. Beck, Paul D. Frederick, Linda G. Shapiro, Joann G. Elmore

Research output: Contribution to journalArticle

5 Scopus citations


A pathologist’s accurate interpretation relies on identifying relevant histopathological features. Little is known about the precise relationship between feature identification and diagnostic decision making. We hypothesized that greater overlap between a pathologist’s selected diagnostic region of interest (ROI) and a consensus derived ROI is associated with higher diagnostic accuracy. We developed breast biopsy test cases that included atypical ductal hyperplasia (n=80); ductal carcinoma in situ (n=78); and invasive breast cancer (n=22). Benign cases were excluded due to the absence of specific abnormalities. Three experienced breast pathologists conducted an independent review of the 180 digital whole slide images, established a reference consensus diagnosis and marked one or more diagnostic ROIs for each case. Forty-four participating pathologists independently diagnosed and marked ROIs on the images. Participant diagnoses and ROI were compared with consensus reference diagnoses and ROI. Regression models tested whether percent overlap between participant ROI and consensus reference ROI predicted diagnostic accuracy. Each of the 44 participants interpreted 39–50 cases for a total of 1972 individual diagnoses. Percent ROI overlap with the expert reference ROI was higher in pathologists who self-reported academic affiliation (69 vs 65%, P=0.002). Percent overlap between participants’ ROI and consensus reference ROI was then classified into ordinal categories: 0, 1–33, 34–65, 66–99 and 100% overlap. For each incremental change in the ordinal percent ROI overlap, diagnostic agreement increased by 60% (OR 1.6, 95% CI (1.5–1.7), P

Original languageEnglish (US)
JournalModern Pathology
StateAccepted/In press - May 20 2016


ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Nagarkar, D. B., Mercan, E., Weaver, D. L., Brunyé, T. T., Carney, P. P., Rendi, M. H., Beck, A. H., Frederick, P. D., Shapiro, L. G., & Elmore, J. G. (Accepted/In press). Region of interest identification and diagnostic agreement in breast pathology. Modern Pathology.