{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:45:51Z","timestamp":1788515151242,"version":"build-2803163510"},"reference-count":53,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100015638","name":"Japanese Breast Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015638","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000837","name":"University of Nottingham","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000837","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.fr","clinicalkey.jp","clinicalkey.com.au","clinicalkey.es","clinicalkey.com","pathologyjournal.rcpa.edu.au","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Pathology"],"published-print":{"date-parts":[[2022,2]]},"DOI":"10.1016\/j.pathol.2021.09.008","type":"journal-article","created":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T14:31:09Z","timestamp":1638541869000},"page":"20-31","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":26,"title":["Atypia in breast pathology: what pathologists need to know"],"prefix":"10.1016","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8667-158X","authenticated-orcid":false,"given":"Ayaka","family":"Katayama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Toss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Parkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian O.","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecily","family":"Quinn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emad A.","family":"Rakha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.pathol.2021.09.008_bib1","series-title":"WHO Classification of Tumours. Breast Tumours","year":"2019"},{"key":"10.1016\/j.pathol.2021.09.008_bib2","series-title":"Pathology Reporting of Breast Disease in Surgical Excision Specimens Incorporating the Dataset for Histological Reporting of Breast Cancer","author":"Ellis","year":"2016"},{"key":"10.1016\/j.pathol.2021.09.008_bib3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1365-2559.2010.03568.x","article-title":"Breast cancer precursors revisited: molecular features and progression pathways","volume":"57","author":"Lopez-Garcia","year":"2010","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib4","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1158\/1078-0432.CCR-07-1127","article-title":"Ductal carcinoma in situ and the emergence of diversity during breast cancer evolution","volume":"14","author":"Allred","year":"2008","journal-title":"Clin Cancer Res"},{"key":"10.1016\/j.pathol.2021.09.008_bib5","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1158\/1078-0432.CCR-07-1465","article-title":"Integrated genomic and transcriptomic analysis of ductal carcinoma in situ of the breast","volume":"14","author":"Vincent-Salomon","year":"2008","journal-title":"Clin Cancer Res"},{"key":"10.1016\/j.pathol.2021.09.008_bib6","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/bcr2607","article-title":"Breast cancer prognostic classification in the molecular era: the role of histological grade","volume":"12","author":"Rakha","year":"2010","journal-title":"Breast Cancer Res"},{"key":"10.1016\/j.pathol.2021.09.008_bib7","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1136\/jclinpath-2016-203800","article-title":"Review of the national external quality assessment (EQA) scheme for breast pathology in the UK","volume":"70","author":"Rakha","year":"2017","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib8","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1136\/jclinpath-2017-204977","article-title":"Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology","volume":"71","author":"Dessauvagie","year":"2018","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/978-3-030-41596-9_4","article-title":"Breast cytology and pathology in pregnancy and lactation","volume":"1252","author":"Soleimani","year":"2020","journal-title":"Adv Exp Med Biol"},{"key":"10.1016\/j.pathol.2021.09.008_bib10","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ucl.2013.01.006","article-title":"Diagnostically challenging cases: what are atypia and dysplasia?","volume":"40","author":"Sanfrancesco","year":"2013","journal-title":"Urol Clin North Am"},{"key":"10.1016\/j.pathol.2021.09.008_bib11","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.mpdhp.2011.12.004","article-title":"The low nuclear grade breast neoplasia family","volume":"18","author":"Rakha","year":"2012","journal-title":"Diagn Histopathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib12","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1245\/s10434-011-2053-0","article-title":"Is there a low-grade precursor pathway in breast cancer?","volume":"19","author":"King","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"10.1016\/j.pathol.2021.09.008_bib13","article-title":"Hematoxylin and eosin staining of tissue and cell sections","volume":"2008","author":"Fischer","year":"2008","journal-title":"CSH Protoc"},{"key":"10.1016\/j.pathol.2021.09.008_bib14","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/j.1365-2559.1991.tb00229.x","article-title":"Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up","volume":"19","author":"Elston","year":"1991","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib15","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s12253-019-00760-8","article-title":"Grading ductal carcinoma in situ (DCIS) of the breast - what's wrong with it?","volume":"26","author":"Cserni","year":"2020","journal-title":"Pathol Oncol Res"},{"key":"10.1016\/j.pathol.2021.09.008_bib16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1746-1596-3-33","article-title":"A\u00a0diagnostic dilemma in breast pathology--benign fibroadenoma with multinucleated stromal giant cells","volume":"3","author":"Heneghan","year":"2008","journal-title":"Diagn Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib17","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.5858\/133.10.1515","article-title":"Protocol for the examination of specimens from patients with invasive carcinoma of the breast","volume":"133","author":"Lester","year":"2009","journal-title":"Arch Pathol Lab Med"},{"issue":"Suppl 2","key":"10.1016\/j.pathol.2021.09.008_bib18","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1038\/modpathol.2010.40","article-title":"Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation","volume":"23","author":"Pinder","year":"2010","journal-title":"Mod Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib19","doi-asserted-by":"crossref","first-page":"686","DOI":"10.5858\/arpa.2015-0238-OA","article-title":"Estrogen receptor and cytokeratin 5 are reliable markers to separate usual ductal hyperplasia from atypical ductal hyperplasia and low-grade ductal carcinoma in situ","volume":"140","author":"Martinez","year":"2016","journal-title":"Arch Pathol Lab Med"},{"key":"10.1016\/j.pathol.2021.09.008_bib20","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1046\/j.1365-2559.2000.00882.x","article-title":"Cytokeratin 5\/6 immunohistochemistry assists the differential diagnosis of atypical proliferations of the breast","volume":"37","author":"Otterbach","year":"2000","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib21","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1038\/modpathol.3800678","article-title":"Basal phenotype of ductal carcinoma in situ: recognition and immunohistologic profile","volume":"19","author":"Dabbs","year":"2006","journal-title":"Mod Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib22","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1097\/01.pas.0000157295.93914.3b","article-title":"Columnar cell lesions of the breast: the missing link in breast cancer progression? A morphological and molecular analysis","volume":"29","author":"Simpson","year":"2005","journal-title":"Am J Surg Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib23","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1038\/s41379-018-0099-2","article-title":"Role of columnar cell lesions in breast carcinogenesis: analysis of chromosome 16 copy number changes by multiplex ligation-dependent probe amplification","volume":"31","author":"de Boer","year":"2018","journal-title":"Mod Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib24","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1097\/PAS.0000000000001191","article-title":"Pleomorphic and florid lobular carcinoma in situ variants of the breast: a clinicopathologic study of 85 cases with and without invasive carcinoma from a single academic center","volume":"43","author":"Shamir","year":"2019","journal-title":"Am J Surg Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib25","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1097\/PAS.0000000000001493","article-title":"Apocrine variant of pleomorphic lobular carcinoma in situ: further clinical, histopathologic, immunohistochemical, and molecular characterization of an emerging entity","volume":"44","author":"Zhong","year":"2020","journal-title":"Am J Surg Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib26","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s10549-007-9768-4","article-title":"Histologic grading is an independent prognostic factor in invasive lobular carcinoma of the breast","volume":"111","author":"Rakha","year":"2008","journal-title":"Breast Cancer Res Treat"},{"key":"10.1016\/j.pathol.2021.09.008_bib27","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1111\/his.13709","article-title":"Impact of breast cancer grade discordance on prediction of outcome","volume":"73","author":"Rakha","year":"2018","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib28","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/his.13117","article-title":"Diagnostic concordance of breast pathologists: lessons from the national Health service breast screening programme pathology external quality assurance scheme","volume":"70","author":"Rakha","year":"2017","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib29","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1111\/his.14199","article-title":"Visual histological assessment of morphological features reflects the underlying molecular profile in invasive breast cancer: a morphomolecular study","volume":"77","author":"Rakha","year":"2020","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib30","doi-asserted-by":"crossref","first-page":"3153","DOI":"10.1200\/JCO.2007.15.5986","article-title":"Prognostic significance of Nottingham histologic grade in invasive breast carcinoma","volume":"26","author":"Rakha","year":"2008","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.pathol.2021.09.008_bib31","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1136\/jcp.55.2.88","article-title":"Long term prognostic value of Nottingham histological grade and its components in early (pT1N0M0) breast carcinoma","volume":"55","author":"Frkovic-Grazio","year":"2002","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib32","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1136\/jcp.43.2.152","article-title":"Radiation and other pathological changes in breast tissue after conservation treatment for carcinoma","volume":"43","author":"Girling","year":"1990","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib33","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/0046-8177(90)90128-R","article-title":"The effects of hormonal and chemotherapy on tumoral and nonneoplastic breast tissue","volume":"21","author":"Kennedy","year":"1990","journal-title":"Hum Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib34","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/00000478-200401000-00004","article-title":"Radiation-induced histopathologic changes of the breast: the effects of time","volume":"28","author":"Moore","year":"2004","journal-title":"Am J Surg Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib35","first-page":"103","article-title":"The effect of chemotherapy on the morphology of human breast carcinoma","volume":"72","author":"Close","year":"1987","journal-title":"S\u00a0Afr Med J"},{"key":"10.1016\/j.pathol.2021.09.008_bib36","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1038\/bjc.1994.303","article-title":"The effects of chemotherapy on morphology, cellular proliferation, apoptosis and oncoprotein expression in primary breast carcinoma","volume":"70","author":"Rasbridge","year":"1994","journal-title":"Br J Cancer"},{"key":"10.1016\/j.pathol.2021.09.008_bib37","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.5858\/arpa.2016-0238-RA","article-title":"Atypical apocrine adenosis: diagnostic challenges and pitfalls","volume":"140","author":"Asirvatham","year":"2016","journal-title":"Arch Pathol Lab Med"},{"key":"10.1016\/j.pathol.2021.09.008_bib38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/jclinpath-2018-205484","article-title":"Apocrine lesions of the breast: part 1 of a two-part review: benign, atypical and in situ apocrine proliferations of the breast","volume":"72","author":"D'Arcy","year":"2019","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib39","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1136\/jclinpath-2018-205485","article-title":"Apocrine lesions of the breast: part 2 of a two-part review. Invasive apocrine carcinoma, the molecular apocrine signature and utility of immunohistochemistry in the diagnosis of apocrine lesions of the breast","volume":"72","author":"D'Arcy","year":"2019","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib40","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1038\/nature11412","article-title":"Comprehensive molecular portraits of human breast tumours","volume":"490","year":"2012","journal-title":"Nature"},{"key":"10.1016\/j.pathol.2021.09.008_bib41","doi-asserted-by":"crossref","first-page":"632","DOI":"10.5858\/2000-124-0632-MAOTBW","article-title":"Malignant adenomyoepithelioma of the breast with malignant proliferation of epithelial and myoepithelial elements: a case report and review of the literature","volume":"124","author":"Ahmed","year":"2000","journal-title":"Arch Pathol Lab Med"},{"key":"10.1016\/j.pathol.2021.09.008_bib42","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.prp.2015.09.008","article-title":"Adenomyoepithelioma with carcinoma of the breast: a report of two cases and a review of the literature","volume":"212","author":"Xu","year":"2016","journal-title":"Pathol Res Pract"},{"key":"10.1016\/j.pathol.2021.09.008_bib43","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/his.12876","article-title":"Phyllodes tumours of the breast: a consensus review","volume":"68","author":"Tan","year":"2016","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib44","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1365-2559.2007.02892.x","article-title":"Vascular proliferations of the breast","volume":"52","author":"Brodie","year":"2008","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib45","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1046\/j.1524-4741.1998.440230.x","article-title":"Hyperplastic ductal and lobular lesions and carcinomas in situ of the breast: reproducibility of current diagnostic criteria among community- and academic-based pathologists","volume":"4","author":"Palazzo","year":"1998","journal-title":"Breast J"},{"key":"10.1016\/j.pathol.2021.09.008_bib46","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1038\/modpathol.3800514","article-title":"Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast","volume":"19","author":"O'Malley","year":"2006","journal-title":"Mod Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib47","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/his.13403","article-title":"Digital pathology for the primary diagnosis of breast histopathological specimens: an innovative validation and concordance study on digital pathology validation and training","volume":"72","author":"Williams","year":"2018","journal-title":"Histopathology"},{"key":"10.1016\/j.pathol.2021.09.008_bib48","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/PAS.0000000000000948","article-title":"Whole slide imaging versus microscopy for primary diagnosis in surgical pathology: a multicenter blinded randomized noninferiority study of 1992 cases (pivotal study)","volume":"42","author":"Mukhopadhyay","year":"2018","journal-title":"Am J Surg Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib49","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1038\/s41379-019-0205-0","article-title":"Whole slide imaging equivalency and efficiency study: experience at a large academic center","volume":"32","author":"Hanna","year":"2019","journal-title":"Mod Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib50","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/jpi.jpi_48_20","article-title":"(Re) defining the high-power field for digital pathology","volume":"11","author":"Kim","year":"2020","journal-title":"J\u00a0Pathol Inform"},{"key":"10.1016\/j.pathol.2021.09.008_bib51","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1136\/jclinpath-2014-202526","article-title":"Quantification of histochemical stains using whole slide imaging: development of a method and demonstration of its usefulness in laboratory quality control","volume":"68","author":"Gray","year":"2015","journal-title":"J\u00a0Clin Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib52","doi-asserted-by":"crossref","DOI":"10.15761\/CDP.1000139","article-title":"Color standardization and optimization in whole slide imaging","volume":"4","author":"Inoue","year":"2020","journal-title":"Clin Diagn Pathol"},{"key":"10.1016\/j.pathol.2021.09.008_bib53","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.csbj.2018.01.001","article-title":"Machine learning methods for histopathological image analysis","volume":"16","author":"Komura","year":"2018","journal-title":"Comput Struct Biotechnol J"}],"container-title":["Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0031302521005171?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0031302521005171?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T15:03:18Z","timestamp":1656082998000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0031302521005171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":53,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["S0031302521005171"],"URL":"https:\/\/doi.org\/10.1016\/j.pathol.2021.09.008","relation":{},"ISSN":["0031-3025"],"issn-type":[{"value":"0031-3025","type":"print"}],"subject":[],"published":{"date-parts":[[2022,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Atypia in breast pathology: what pathologists need to know","name":"articletitle","label":"Article Title"},{"value":"Pathology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pathol.2021.09.008","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.","name":"copyright","label":"Copyright"}]}}