Please, read this carefully.
In this study we have two series of cases so TWO circulations.
In the FIRST series/first circulation we have cases from 1 to 50. Each case has 5 jpg H&E slides named: a, b, c and d (which are at magnifications 5X, 10X, 20X, 40X, respectively) and e (which is also at 40X and this is the slide in which we should assess the DCIS nuclear grade if the diagnosis is "DCIS" or "DCIS with microinvasion" – these are the e labelled images following the a, b, c and d ones). You can access the slides at: You can also download the materials (slides, instructions and spreadsheet) at: 
You should fill in the accompanying spreadsheet, excel file and you should send it back to me, i.e. Gabor ( Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát. and Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát.). Deadline for this agreed in Neubrandenburg is 15 November. Those of you, who did the test in 2007, please ignore your previous results, and redo the series again; sorry for this (I did it myself). It would be nice, if you could record the time required for completing the 50 cases (if you do this in multiple sessions, make the addition of the session lengths), so please do it.
Because of previous experience with similar studies, may I just quote to you a text by our group about the definition. (This is at the end of this text – try to adhere to it as much as possible) 
We will start with the second series/second circulation two months after the end of the first circulation. You will receive the relevant information in due time.
The aim of the study is not only to assess the diagnostic reproducibility of microinvasion in H&E sections but also to see if IHC improves the diagnostic accuracy. 
In the First Circulation you should reply to the following questions (one column each in the excel file):
1. Diagnostic categories for non invasive carcinoma: DCIS or LCIS 
2. Nuclear grade for the DCIS component, when present, on the basis of the jpg image labelled “e”: H, I or L for High or Intermediate and Low, respectively 
3. DCIS growth pattern: CRI (cribriform) or PAP (papillary/micropapillary) or COM (comedo) or APO (apocrine) or MIX ( mixed) or OTH (other).
4. Presence or absence of necrosis in DCIS: Y (present) or N (absent).
5. Presence or absence of microinvasive carcinoma on the basis of H&E slides: Y (present) or N (absent). Please, note that there is no scale bar on the images so each case with definite invasion should be interpreted as a MICROINVASIVE CARCINOMA. 
6. Overall diagnosis on the basis of H&E slides: DCIS or LCIS or MIC (microinvasive carcinoma).
7. Certainty of diagnosis on the basis of H&E: please give Y (yes) if you are confident on its reporting or N (no) if you think that the case needs IHC.
A tumour in which the dominant lesion is in-situ carcinoma (usually extensive high nuclear grade DCIS, rarely other types of DCIS or lobular intraepithelial neoplasia) but in which there are one or more clearly separate foci of infiltration of non specialized interlobular or interductal fibrous or adipose tissue, none measuring more than 1 mm (about 2 hpf) in maximum diameter. (27,28,29). This definition has been officially reported in the TNM system as pT1mic since 1997 (fifth edition)(30). It is very restrictive and tumours fulfilling the criteria are consequently rare.
The tumour focus/foci must invade into nonspecialized interlobular or interductal stroma (extension of the lesion beyond the confines of a ductolobular unit, development of a desmoplastic stroma). The cells deemed to be invasive must be distributed in a fashion (non-organoid pattern) that does not represent tangential sectioning of a duct or a lobular structure with in-situ carcinoma. Tangentially sectioned in-situ carcinoma foci that simulate microinvasion are distributed in the specialized periductal and intralobular stroma and usually occur as compact groups of tumour cells that have a smooth border surrounded by a circumferential layer of myoepithelial cells and stroma or a thickened basement membrane (29). At sites of microinvasive foci, tumour cells are distributed singly or as small groups that have irregular shapes reminiscent of conventional invasive carcinoma with no particular orientation (29). There is complete absence of surrounding basement membrane and myoepithelial cells: immunostains are helpful in demonstrating the presence or absence of basement membrane components (laminin and collagen type IV) or myoepithelial cells (smooth-muscle actin, calponin, smooth-muscle myosin heavy chain). Detecting microinvasion can be difficult when there is a marked periductal fibrosis or inflammation because the true boundary of the specialized periductal or lobular stroma is not clear, but immunostaining for cytokeratin may be useful to confirm the presence of separate foci of neoplastic cells embedded in periductal fibrosis or inflammation.”
E(C)WGBSP: Quality assurance guidelines for pathology. Wells CA (ed)
Download the whole package (ZIP)


Case 10a

Case 10b

Case 10c

Case 10d

Case 10e

Case 11a

Case 11b

Case 11c

Case 11d

Case 11e

Case 12a

Case 12b

Case 12c

Case 12d

Case 12e

Case 13a

Case 13b

Case 13c

Case 13d

Case 13e

Case 14a

Case 14b

Case 14c

Case 14d

Case 14e

Case 15a

Case 15b

Case 15c

Case 15d

Case 15e

Case 16a

Case 16b

Case 16c

Case 16d

Case 16e

Case 17a

Case 17b

Case 17c

Case 17d

Case 17e

Case 18a

Case 18b

Case 18c

Case 18d

Case 18e

Case 19a

Case 19b

Case 19c

Case 19d

Case 19e

Case 1a

Case 1b

Case 1c

Case 1d

Case 1e

Case 20a

Case 20b

Case 20c

Case 20d

Case 20e

Case 21a

Case 21b

Case 21c

Case 21d

Case 21e

Case 22a

Case 22b

Case 22c

Case 22d

Case 22e

Case 23a

Case 23b

Case 23c

Case 23d

Case 23e

Case 24a

Case 24b

Case 24c

Case 24d

Case 24e

Case 25a

Case 25b

Case 25c

Case 25d

Case 25e

Case 26a

Case 26b

Case 26c

Case 26d

Case 26e

Case 27a

Case 27b

Case 27c

Case 27d

Case 27e

Case 28a

Case 28b

Case 28c

Case 28d

Case 28e

Case 29a

Case 29b

Case 29c

Case 29d

Case 29e

Case 2a

Case 2b

Case 2c

Case 2d

Case 2e

Case 30a

Case 30b

Case 30c

Case 30d

Case 30e

Case 31a

Case 31b

Case 31c

Case 31d

Case 31e

Case 32a

Case 32b

Case 32c

Case 32d

Case 32e

Case 33a

Case 33b

Case 33c

Case 33d

Case 33e

Case 34a

Case 34b

Case 34c

Case 34d

Case 34e

Case 35a

Case 35b

Case 35c

Case 35d

Case 35e

Case 36a

Case 36b

Case 36c

Case 36d

Case 36e

Case 37a

Case 37b

Case 37c

Case 37d

Case 37e

Case 38a

Case 38b

Case 38c

Case 38d

Case 38e

Case 39a

Case 39b

Case 39c

Case 39d

Case 39e

Case 3a

Case 3b

Case 3c

Case 3d

Case 3e

Case 40a

Case 40b

Case 40c

Case 40d

Case 40e

Case 41a

Case 41b

Case 41c

Case 41d

Case 41e

Case 42a

Case 42b

Case 42c

Case 42d

Case 42e

Case 43a

Case 43b

Case 43c

Case 43d

Case 43e

Case 44a

Case 44b

Case 44c

Case 44d

Case 44e

Case 45a

Case 45b

Case 45c

Case 45d

Case 45e

Case 46a

Case 46b

Case 46c

Case 46d

Case 46e

Case 47a

Case 47b

Case 47c

Case 47d

Case 47e

Case 48a

Case 48b

Case 48c

Case 48d

Case 48e

Case 49a

Case 49b

Case 49c

Case 49d

Case 49e

Case 4a

Case 4b

Case 4c

Case 4d

Case 4e

Case 50a

Case 50b

Case 50c

Case 50d

Case 50e

Case 5a

Case 5b

Case 5c

Case 5d

Case 5e

Case 6a

Case 6b

Case 6c

Case 6d

Case 6e

Case 7a

Case 7b

Case 7c

Case 7d

Case 7e

Case 8a

Case 8b

Case 8c

Case 8d

Case 8e

Case 9a

Case 9b

Case 9c

Case 9d

Case 9e