Comparison of methods for assessing abdominal adipose tissue from magnetic resonance images

Objective: To compare the inter‐rater and intra‐rater reliability and analysis time of two methods for quantifying visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volumes from magnetic resonance (MR) images. Research Methods and Procedures: Ten subjects (BMI, 27.0 ± 2.1 kg/m²; 56 years of age ± 4 years) underwent MR imaging of the abdomen. Ten transverse T1‐weighted images were selected from each scan and analyzed using two software packages that differ in principle. The first method, ANALYZE version 5.0, represents the manual threshold method, and the second, HIPPO version 1.3, is based on the fuzzy clustering approach. Inter‐rater reliability for each method was assessed by comparing the intra‐class correlation coefficients (ICCs) for VAT and SAT results from two evaluators, and intra‐rater reliability for each method was assessed by comparing ICCs for VAT and SAT analyses performed 1 week apart by the same evaluator. The total time for analysis also was compared between methods. Results: The inter‐rater reliability for VAT was greater with HIPPO than with ANALYZE (ICC = 0.996 vs. 0.828), whereas inter‐rater reliability for SAT did not differ between methods (ICC = 0.975 and 0.987). The intra‐rater reliability was equally high with HIPPO and ANALYZE for both VAT (ICC = 0.998 vs. 0.992) and SAT (ICC = 0.996 vs. 0.992). HIPPO required less than one‐half as much analysis time as ANALYZE (15.9 ± 4.4 vs. 36.5 ± 8.2 minutes, p < 0.0001). Discussion: HIPPO software appears advantageous for the quantification of VAT from multislice MR images because inter‐rater results are more reliable, and it is more time‐efficient than less automated methods.     

The development of a method for functional assessment of dentures

Aims: To design and validate a method of assessing complete dentures from a functional standpoint. Subjects: A random sample of 40 complete denture wearers took part in the study. Setting: A university clinical department of prosthetic dentistry. Intervention: We undertook a pilot study to refine the protocol and criteria. All participants and their dentures were examined by two authors independently, with no prior knowledge of the patients'complaints. Design: We defined nine clinical factors of functional quality and applied criteria with binary scoring. We analysed the scores for these factors for inter‐rater reliability. Results: The method proved simple to apply and took less than 5 minutes to complete. The inter‐examiner agreement for all factors was 86% to 100% giving Kappa scores of 0.64 to 1.00 (all Good or Very Good). Conclusions: This study successfully demonstrates that the technique, which we call the Functional Assessment of Dentures (FAD), can give good inter‐examiner reliability. It can therefore be used separately as a routine diagnostic tool and to investigate the relationship between denture qualities and functional ‘outcome’ such as difficulty eating or dietary selection.     

The FAt Spondyloarthritis Spine Score (FASSS): development and validation of a new scoring method for the evaluation of fat lesions in the spine of patients with axial spondyloarthritis

Introduction

Studies have shown that fat lesions follow resolution of inflammation in the spine of patients with axial spondyloarthritis (SpA). Fat lesions at vertebral corners have also been shown to predict development of new syndesmophytes. Therefore, scoring of fat lesions in the spine may constitute both an important measure of treatment efficacy as well as a surrogate marker for new bone formation. The aim of this study was to develop and validate a new scoring method for fat lesions in the spine, the Fat SpA Spine Score (FASSS), which in contrast to the existing scoring method addresses the localization and phenotypic diversity of fat lesions in patients with axial SpA.

Methods

Fat lesions at pre-specified anatomical locations at each vertebral endplate (C2 lower-S1 upper) were assessed dichotomously (present/absent) on spine MRIs. Two readers independently evaluated MRIs obtained at two time points for 58 patients (Exercise 1), followed by optimization of scoring methodology and reader calibration. Thereafter, the same readers read 135 pairs of MRI scans (Exercise 2; including the 58 pairs from exercise 1 randomly mixed with 77 new pairs).

Results

In Exercise 2, the mean (SD) baseline FASSS score for the two readers was 22.5(29.6) and 21.1(28.0), respectively, and the FASSS change score was 4.2(10.6) and 6.0(12.2). Inter-reader reliability assessed as intra-class correlation coefficients (ICCs) for status and change scores were excellent (0.96 (95% CI (0.94 to 0.97)) and very good (0.86 (0.80 to 0.90)), respectively. The smallest detectable change (SDC) was 3.7 for the 135 patients. Good reliability of change scores was also observed for MRI scans conducted one year apart (ICC 0.74 (95% CI 0.44 to 0.89) and SDC 4.5). For the 58 MRI-pairs assessed in both exercises, inter-reader reproducibility for the total FASSS status score improved from very good (ICCs: 0.89 (95% CI: 0.81 to 0.93) in exercise 1 to excellent in exercise 2 (0.96 (0.93 to 0.98)), and improved substantially for the total change score (from 0.67 (0.51 to 0.80) to 0.83 (0.73 to 0.90).

Conclusions

FASSS meets essential validation criteria for quantification of a common structural abnormality in clinical trials of axial spondyloarthritis.     

Further observations on absence of palmar triradius d in normal people

An ordinal dental attrition scoring technique for molar teeth involving a quadrant system is applied to three Amerind skeletal samples. Molar teeth are visually divided into four sections and each section scored on a 1–10 scale. The score for the whole tooth is the sum of the quadrant scores and ranges from 4–40. Scores are based on the amount of enamel in each quarter of the tooth. The method's reliability is demonstrated by a paired comparison type of ANOVA, for both intra- and inter-observer repeated measurements. Because the method is reliable, easy to use, and produces data with lower variances than a 1–8 system (such as Molnar's ['71]), it is recommended for use in the principal axis technique for the analysis of wear data presented in the accompanying paper.     

Effect of bone mineral density on masticatory performance and efficiency

doi: 10.1111/j.1741‐2358.2010.00414.x Effect of bone mineral density on masticatory performance and efficiency Objective: To evaluate the effect of bone mineral density (BMD) on masticatory performance and efficiency in dentate subjects. Background data: Osteoporosis is the most common disorder of the bone. It causes reduction in BMD of the all the skeletal tissue including jaw bones. It also promotes bone loss in jaw bones. In osteoporosis, a reduction of maximal bite force and greater electromyography activity of masticatory muscles is documented. This may lead to the development of masticatory dysfunction which can be assessed by a chewing test in the form of change in masticatory performance and efficiency. Materials and methods: Sixty subjects with equal numbers of men and women were selected for the study, in which BMD screening (T‐score) was carried out to identify the normal, osteopenic and osteoporotic subjects. Their masticatory performance and efficiency was evaluated by a chewing test (fractional sieving method). Results: A high ‘T’ score was associated with low masticatory efficiency and a low ‘T’ score with high masticatory efficiency. Masticatory performance and efficiency was significantly higher among males as compared to females with similar range of BMD. Conclusion: In both genders, high BMD groups (low ‘T’ score) had a significantly high percentage of masticatory efficiency compared to the low BMD (high ‘T’ score) group.     

The Use of Global Rating Scales for OSCEs in Veterinary Medicine

OSCEs (Objective Structured Clinical Examinations) are widely used in health professions to assess clinical skills competence. Raters use standardized binary checklists (CL) or multi-dimensional global rating scales (GRS) to score candidates performing specific tasks. This study assessed the reliability of CL and GRS scores in the assessment of veterinary students, and is the first study to demonstrate the reliability of GRS within veterinary medical education. Twelve raters from two different schools (6 from University of Calgary [UCVM] and 6 from Royal (Dick) School of Veterinary Studies [R(D)SVS] were asked to score 12 students (6 from each school). All raters assessed all students (video recordings) during 4 OSCE stations (bovine haltering, gowning and gloving, equine bandaging and skin suturing). Raters scored students using a CL, followed by the GRS. Novice raters (6 R(D)SVS) were assessed independently of expert raters (6 UCVM). Generalizability theory (G theory), analysis of variance (ANOVA) and t-tests were used to determine the reliability of rater scores, assess any between school differences (by student, by rater), and determine if there were differences between CL and GRS scores. There was no significant difference in rater performance with use of the CL or the GRS. Scores from the CL were significantly higher than scores from the GRS. The reliability of checklist scores were .42 and .76 for novice and expert raters respectively. The reliability of the global rating scale scores were .7 and .86 for novice and expert raters respectively. A decision study (D-study) showed that once trained using CL, GRS could be utilized to reliably score clinical skills in veterinary medicine with both novice and experienced raters.     

A Simplified Method to Measure Choroidal Thickness Using Adaptive Compensation in Enhanced Depth Imaging Optical Coherence Tomography

Purpose

To evaluate a simplified method to measure choroidal thickness (CT) using commercially available enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT).

Methods

We measured CT in 31 subjects without ocular diseases using Spectralis EDI SD-OCT. The choroid-scleral interface of the acquired images was first enhanced using a post-processing compensation algorithm. The enhanced images were then analysed using Photoshop. Two graders independently graded the images to assess inter-grader reliability. One grader re-graded the images after 2 weeks to determine intra-grader reliability. Statistical analysis was performed using intra-class correlation coefficient (ICC) and Bland-Altman plot analyses.

Results

Using adaptive compensation both the intra-grader reliability (ICC: 0.95 to 0.97) and inter-grader reliability (ICC: 0.93 to 0.97) were perfect for all five locations of CT. However, with the conventional technique of manual CT measurements using built-in callipers provided with the Heidelberg explorer software, the intra- (ICC: 0.87 to 0.94) and inter-grader reliability (ICC: 0.90 to 0.93) for all the measured locations is lower. Using adaptive compensation, the mean differences (95% limits of agreement) for intra- and inter-grader sub-foveal CT measurements were −1.3 (−3.33 to 30.8) µm and −1.2 (−36.6 to 34.2) µm, respectively.

Conclusions

The measurement of CT obtained from EDI SD-OCT using our simplified method was highly reliable and efficient. Our method is an easy and practical approach to improve the quality of choroidal images and the precision of CT measurement.     

Masticatory performance in 80-year-old individuals

Objective: To evaluate the masticatory performance of elderly people at the age of 80 years. Subjects: A total of 283 individuals of 80 years of age took part in a general and dental health survey. Main outcome measures: A dental examination including the number of remaining teeth, occlusion, prostheses, bite force recording, and a questionnaire regarding masticatory performance were recorded. Setting: Five municipalities (Okazaki city, Tokoname city, Tahara town, Atsumi town and Minami‐chita town) in Aichi prefecture, Japan. Results: There were 20 or more teeth in 7.4% subjects, and 44.5% were edentulous. Subjects with no occlusion accounted for 77.4% of the total. Subjects with prostheses accounted for 90.8%. Maximum bite force and masticatory ability score for patients with 20 or more teeth or not wearing prostheses were higher than other groups. The non‐wearing prostheses group had a low masticatory ability score. Conclusion: Most of the 80‐year‐old individuals recovered their masticatory ability with the assistance of prostheses. Several individuals with 20 or more remaining teeth or without removable dentures present in both jaws had a high score for bite forces and masticatory abilities.     

Reliability of electromyographic normalization methods for evaluating the hip musculature.

The purpose of this study was to determine the reliability of three normalization methods for analyzing hip abductor activation during rehabilitation exercises. Thirteen healthy subjects performed three open kinetic chain and three closed kinetic chain hip abductor exercises. Surface EMG activity for the gluteus medius was collected during each exercise and normalized based on a maximum voluntary isometric contraction (MVIC), mean dynamic (m-DYN), and peak dynamic activity (pk-DYN). Intraclass coefficient correlations (ICCs), intersubject coefficients of variation (CVs), and intrasubject CVs were then calculated for each normalization method. MVIC ICCs exceeded 0.93 for all exercises. M-DYN and pk-DYN ICCs exceeded 0.85 for all exercises except for the sidelying abduction exercise. Intersubject CVs ranged from 55% to 77% and 19% to 61% for the MVIC and dynamic methods, respectively. Intrasubject CVs ranged from 11% to 22% for all exercises under all normalization methods. The MVIC method provided the highest measurement reliability for determining differences in activation amplitudes between hip abductor exercises in healthy subjects. Future research should determine if these same results would apply to a symptomatic patient population.     

Dental wear estimation using a digital intra-oral optical scanner and an automated 3D computer vision method

The objective of this work was to propose an automated and direct process to grade tooth wear intra-orally. Eight extracted teeth were etched with acid for different times to produce wear and scanned with an intra-oral optical scanner. Computer vision algorithms were used for alignment and comparison among models. Wear volume was estimated and visual scoring was achieved to determine reliability. Results demonstrated that it is possible to directly detect submillimeter differences in teeth surfaces with an automated method with results similar to those obtained by direct visual inspection. The investigated method proved to be reliable for comparison of measurements over time.     

EVALUATION OF WINE QUALITY USING A SMALL-PANEL HEDONIC SCALING METHOD

A hedonic scoring method for evaluating wines with a small panel was examined for reliability, effects of training level and agreement with a traditional 20-point scoring technique. The method was found to differentiate among qualities of 14 domestic Sauvignon Blanc wines with good reliability. Four panels were tested, three with a high degree of experience in wine judging and a fourth consisting of fine wine consumers with no special training. The three experienced panels agreed well about the wines' quality scores. Mean panel scores were less highly correlated (although still positive) with the untrained panel, which showed higher variability and lower reliability. Mean scores from the hedonic method were correlated at r =+0.94 with mean scores from a 20-point quality judging procedure. The small panel hedonic method is suitable for generating quality scores for consumer guidance in large scale wine surveys, as are commonly found in popular wine periodicals.     

Development and validation of the Vitiligo Extent Score for a Target Area (VESTA) to assess the treatment response of a target lesion

Since localized treatment for vitiligo is as essential as systemic treatment, a reliable instrument for target evaluation is needed besides those for whole body evaluation. We developed the Vitiligo Extent Score for a Target Area (VESTA) using reference images of both marginal and perifollicular repigmentation to measure the repigmentation rate (%) in a target lesion. In the validation study, a total of 65 dermatologists in 10 institutes evaluated 17 pairs of vitiligo images (pre‐ and post‐treatment) using both a rough estimate and the VESTA. The VESTA (concordance correlation coefficient: 0.949, 95% confidence interval [CI] 0.942–0.955) was significantly more accurate than the rough estimate (0.896, 95% CI: 0.883–0.908). It was also associated with better inter‐rater reliability over the rough estimate, albeit not significant. The VESTA can afford intuitive, convenient, and reliable assessment of the treatment response in a target area, and would be useful in clinical practice as well as retrospective studies.     

The Mouse Grimace Scale: A Clinically Useful Tool?

Medical research has a heavy and continuing demand for rodent models across a range of disciplines. Behavioural assessment of pain in such models is highly time consuming, thus limiting the number of models and analgesics that can be studied. Facial expressions are widely used to assess pain in human infants. Recently the mouse grimace scale (MGS) has been developed and shown to be accurate and reliable, requiring only a short amount of training for the observer. This system therefore has the potential to become a highly useful tool both in pain research and clinical assessment of mouse pain. To date, the MGS has only been used as a research tool, however there is increasing interest in its use in cage-side clinical assessment. It is often wrongly assumed that MGS scores of animals not in pain (i.e. at baseline) are zero. Here, we aimed to assess the variability in baseline MGS scores between cohorts, sexes and strains of mice. Establishing the presence of a consistent baseline MGS score could lead to a valuable clinical pain assessment tool for mice when baseline information from the individual mouse may not be available as a comparator. Results demonstrated a significant difference in baseline MGS scores between both sexes (males > females) and strains of mice. The method used to score the facial action units (Live vs. retrospectively from still images) demonstrated significant differences in scores with live scores being significantly lower than retrospective scoring from images. The level of variation shown demonstrates the need for further research to be undertaken with regard to establishing baseline MGS scores for specific strains and sexes of mice, taking into account the method of scoring, prior to considering clinical implementation of this method in pain assessment.     

Validity and reliability of the Myotest accelerometric system for the assessment of vertical jump height

The aim of the present study was to verify the validity and reliability of the Myotest accelerometric system (Myotest SA, Sion, Switzerland) for the assessment of vertical jump height. Forty-four male basketball players (age range: 9-25 years) performed series of squat, countermovement and repeated jumps during 2 identical test sessions separated by 2-15 days. Flight height was simultaneously quantified with the Myotest system and validated photoelectric cells (Optojump). Two calculation methods were used to estimate the jump height from Myotest recordings: flight time (Myotest-T) and vertical takeoff velocity (Myotest-V). Concurrent validity was investigated comparing Myotest-T and Myotest-V to the criterion method (Optojump), and test-retest reliability was also examined. As regards validity, Myotest-T overestimated jumping height compared to Optojump (p < 0.001) with a systematic bias of approximately 7 cm, even though random errors were low (2.7 cm) and intraclass correlation coefficients (ICCs) where high (>0.98), that is, excellent validity. Myotest-V overestimated jumping height compared to Optojump (p < 0.001), with high random errors (>12 cm), high limits of agreement ratios (>36%), and low ICCs (<0.75), that is, poor validity. As regards reliability, Myotest-T showed high ICCs (range: 0.92-0.96), whereas Myotest-V showed low ICCs (range: 0.56-0.89), and high random errors (>9 cm). In conclusion, Myotest-T is a valid and reliable method for the assessment of vertical jump height, and its use is legitimate for field-based evaluations, whereas Myotest-V is neither valid nor reliable.     

Test-retest reliability and construct validity of the ENERGY-parent questionnaire on parenting practices, energy balance-related behaviours and their potential behavioural determinants: the ENERGY-project

ABSTRACT: BACKGROUND: Insight in parental energy balance-related behaviours, their determinants and parenting practices are important to inform childhood obesity prevention. Therefore, reliable and valid tools to measure these variables in large-scale population research are needed. The objective of the current study was to examine the test-retest reliability and construct validity of the parent questionnaire used in the ENERGY-project, assessing parental energy balance-related behaviours, their determinants, and parenting practices among parents of 10-12 year old children. FINDINGS: We collected data among parents (n = 316 in the test-retest reliability study; n = 109 in the construct validity study) of 10-12 year-old children in six European countries, i.e. Belgium, Greece, Hungary, the Netherlands, Norway, and Spain. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC) and percentage agreement comparing scores from two measurements, administered one week apart. To assess construct validity, the agreement between questionnaire responses and a subsequent interview was assessed using ICC and percentage agreement. All but one item showed good to excellent test-retest reliability as indicated by ICCs > .60 or percentage agreement [greater than or equal to] 75%. Construct validity appeared to be good to excellent for 92 out of 121 items, as indicated by ICCs > .60 or percentage agreement [greater than or equal to] 75%. From the other 29 items, construct validity was moderate for 24 and poor for 5 items. CONCLUSIONS: The reliability and construct validity of the items of the ENERGY-parent questionnaire on multiple energy balance-related behaviours, their potential determinants, and parenting practices appears to be good. Based on the results of the validity study, we strongly recommend adapting parts of the ENERGY-parent questionnaire if used in future research.     

Interobserver reliability of methods for paleopathological diagnosis of dental caries

There is disagreement as to whether clinical methods of caries diagnosis will produce reliable results in skeletal material, and studies vary greatly in the extent to which such methods are employed. The purpose of this study is, therefore, to evaluate the interobserver reliability of visual, tactile, and radiographic methods of scoring dental caries in ancient populations. Thirty-three individuals from a Mogollon skeletal sample were scored on three occasions by pairs of examiners. The first exam employed visual criteria alone. In the second exam, visual methods were supplemented with the dental explorer. For the third exam, mesial and distal surfaces were scored from “intraoral” radiographs. Examiners worked independently, but did calibrate on material from clinical populations prior to the second and third exams. Exams were conducted on a “blind” basis, and analysis was delayed until all exams were completed. Caries scores were expressed as a percentage of total surfaces present per individual. Repeat-measures ANOVA and intraclass correlation coefficients (ICC) were used to estimate interobserver reliabilities. For visual scores, ICC = 0.97, and there is no significant difference between examiners (P = 0.897). For visual plus explorer scores, ICC drops to 0.90, and there is a significant difference between examiners (P = 0.003). For the radiographs, ICC = 0.86, and there is no significant difference between observers (P = 0.117). These results suggest that clinical methods are less reliable in skeletal populations. Probable sources of error include postmortem dehydration of carious dentin, confusing radiolucencies engendered by worn or fractured enamel, and inadequate radiologic standards for root caries. These problems can be avoided through reliance on visual criteria.     

Reliability and intermethod agreement for body fat assessment among two field and two laboratory methods in adolescents

To increase knowledge about reliability and intermethods agreement for body fat (BF) is of interest for assessment, interpretation, and comparison purposes. It was aimed to examine intra- and inter-rater reliability, interday variability, and degree of agreement for BF using air-displacement plethysmography (Bod-Pod), dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfold measurements in European adolescents. Fifty-four adolescents (25 females) from Zaragoza and 30 (14 females) from Stockholm, aged 13-17 years participated in this study. Two trained raters in each center assessed BF with Bod-Pod, DXA, BIA, and anthropometry (DXA only in Zaragoza). Intermethod agreement and reliability were studied using a 4-way ANOVA for the same rater on the first day and two additional measurements on a second day, one each rater. Technical error of measurement (TEM) and percentage coefficient of reliability (%R) were also reported. No significant intrarater, inter-rater, or interday effect was observed for %BF for any method in either of the cities. In Zaragoza, %BF was significantly different when measured by Bod-Pod and BIA in comparison with anthropometry and DXA (all P < 0.001). The same result was observed in Stockholm (P < 0.001), except that DXA was not measured. Bod-Pod, DXA, BIA, and anthropometry are reliable for %BF repeated assessment within the same day by the same or different raters or in consecutive days by the same rater. Bod-Pod showed close agreement with BIA as did DXA with anthropometry; however, Bod-Pod and BIA presented higher values of %BF than anthropometry and DXA.     

The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers

doi: 10.1111/j.1741‐2358.2011.00610.x The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers Aim: To compare masticatory performance, masticatory efficiency and residual ridge resorption (RRR) in osteoporotic and non‐osteoporotic edentulous subjects after rehabilitation with complete dentures. Method: Thirty subjects fulfilling the inclusion criteria were enrolled from the patients visiting the Department of Prosthodontics for complete denture fabrication. Two groups consisting of control subjects (group I; N = 15) and osteoporotic subjects (group II; N = 15) were formed. Complete dentures satisfying certain criteria were fabricated for both groups. Masticatory performance and efficiency were measured 6 months after denture insertion. Areal measurements were taken on lateral cephalograms before and 6 months after denture fabrication. The data were then computed to analyse differences between groups I and II using SPSS statistical software version 15.0. Results: Six months after denture fabrication, the masticatory performance and efficiency were significantly higher (p < 0.001) for group I, with a significant decrease in maxillary and mandibular sagittal area seen in both groups. The rate of bone loss was more in group II compared with group I. Conclusion: Greater masticatory function was demonstrated by the non‐osteoporotic group, and the rate of RRR was more in the osteoporotic group compared with the normal group. In this pilot study, osteoporosis leads to greater RRR, decreased masticatory performance and efficiency in edentulous subjects 6 months after denture insertion. Screening for osteoporosis is suggested as a routine procedure for all edentulous subjects undergoing rehabilitation. Recall check‐ups for osteoporotic patients should be more frequent, and these patients may require more frequent denture remakes.     

The role of micronucleus scoring in fine needle aspirates of ductal carcinoma of the breast

S. Samanta, P. Dey and R. Nijhawan The role of micronucleus scoring in fine needle aspirates of ductal carcinoma of the breast Aims and objectives: Micronucleus (MN) scoring was carried out in benign (fibroadenoma) and malignant (infiltrating ductal carcinoma) breast lesions to evaluate the role of MN as a biomarker in breast carcinomas. We also compared MN scores among different cytological grades of breast carcinoma. Materials and methods: A total of 31 archival cases of fibroadenoma (FA) and 40 cases of infiltrating ductal carcinoma (IDC) were selected. The best May‐Grünwald–Giemsa (MGG) stained fine needle aspiration cytology (FNAC) smear of each case was selected. The MN scoring was carried out independently by two observers on 1000 epithelial cells in oil immersion magnification (100× objective). The MN scores in FA and IDC were compared. The IDC cases were graded and the MN scores in different cytological grades of IDC were compared. Results: The mean MN scores (± standard deviation) in FA and IDC were 0.6 (± 1.1) and 13.6 (± 12.8), respectively, which were significantly different (P < 0.0001). There were seven grade 1, 13 grade 2, and 20 grade 3 IDCs. The mean MN scores (± standard deviation) of grade 1, 2 and 3 IDC were 4.3 (± 2.3), 11.95 (± 9.2) and 21.1 (± 16.7), respectively. An analysis of variance (anova ) test showed a significant difference in MN score between all the grades of IDC (P < 0.05). However, there was no significant difference between fibroadenoma and grade 1 IDC. The Pearson’s correlation coefficient showed positive correlations between MN scoring in the different grades of IDC. Conclusions: MN scoring on routinely stained smears of IDCs was significantly higher than in fibroadenoma and was relatively easy, reliable and reproducible. As MN scoring of grade 1 IDC was similar to fibroadenoma, a larger study should be conducted to compare grade 1 IDC with other benign breast lesions.