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Rossi C, Fraticelli S, Fanizza M, Ferrari A, Ferraris E, Messina A, Della Valle A, Anghelone CAP, Lasagna A, Rizzo G, Perrone L, Sommaruga MG, Meloni G, Dallavalle S, Bonzano E, Paulli M, Di Giulio G, Sgarella A, Lucioni M. Concordance of immunohistochemistry for predictive and prognostic factors in breast cancer between biopsy and surgical excision: a single-centre experience and review of the literature. Breast Cancer Res Treat 2023; 198:573-582. [PMID: 36802316 PMCID: PMC10036406 DOI: 10.1007/s10549-023-06872-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Accurate evaluation of breast cancer on bioptic samples is of fundamental importance to guide therapeutic decisions, especially in the neoadjuvant or metastatic setting. We aimed to assess concordance for oestrogen receptor (ER), progesterone receptor (PR), c-erbB2/HER2 and Ki-67. We also reviewed the current literature to evaluate our results in the context of the data available at present. METHODS We included patients who underwent both biopsy and surgical resection for breast cancer at San Matteo Hospital, Pavia, Italy, between January 2014 and December 2020. ER, PR, c-erbB2, and Ki-67 immunohistochemistry concordance between biopsy and surgical specimen was evaluated. ER was further analysed to include the recently defined ER-low-positive in our analysis. RESULTS We evaluated 923 patients. Concordance between biopsy and surgical specimen for ER, ER-low-positive, PR, c-erbB2 and Ki-67 was, respectively, 97.83, 47.8, 94.26, 68 and 86.13%. Cohen's κ for interobserver agreement was very good for ER and good for PR, c-erbB2 and Ki-67. Concordance was especially low (37%) in the c-erbB2 1 + category. CONCLUSION Oestrogen and progesterone receptor status can be safely assessed on preoperative samples. The results of this study advise caution in interpreting biopsy results regarding ER-low-positive, c-erbB2/HER and Ki-67 results due to a still suboptimal concordance. The low concordance for c-erbB2 1 + cases underlines the importance of further training in this area, in the light of the future therapeutic perspectives.
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Affiliation(s)
- Chiara Rossi
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
| | - Sara Fraticelli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marianna Fanizza
- Unit of Breast Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery 3-Breast Surgery, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Elisa Ferraris
- Unit of Medical Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessia Messina
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Angelica Della Valle
- Department of Surgical Sciences, General Surgery 3-Breast Surgery, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | | | - Angioletta Lasagna
- Unit of Medical Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Gianpiero Rizzo
- Unit of Medical Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Lorenzo Perrone
- Unit of Medical Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | | | - Giulia Meloni
- Unit of Breast Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Silvia Dallavalle
- Unit of Breast Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Elisabetta Bonzano
- School in Experimental Medicine, Unit of Radiational Oncology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Paulli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Giuseppe Di Giulio
- Unit of Breast Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Adele Sgarella
- Department of Surgical Sciences, General Surgery 3-Breast Surgery, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Lucioni
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
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2
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Same day estrogen, progesterone and HER2neu receptor assessment in breast cancer diagnosis using Core Wash Cytology. Surg Oncol 2023; 47:101919. [PMID: 36863065 DOI: 10.1016/j.suronc.2023.101919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/01/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
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3
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He Y, Zhang J, Chen H, Zhou Y, Hong L, Ma Y, Chen N, Zhao W, Tong Z. Clinical significance and prognostic value of receptor conversion after neoadjuvant chemotherapy in breast cancer patients. Front Surg 2023; 9:1037215. [PMID: 36684294 PMCID: PMC9852345 DOI: 10.3389/fsurg.2022.1037215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023] Open
Abstract
The hormone receptor (HR) status and human epidermal growth hormone receptor 2 (HER2) status of patients with breast cancer may change following neoadjuvant chemotherapy (NAC). We retrospectively analyzed the clinical data of 294 patients with stage II/III breast cancer to evaluate the clinical significance and prognostic value of receptor transformation after NAC in breast cancer patients. Pathological complete response after NAC was achieved in 10.7% of patients. HR, estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 conversion rates were 9.2%, 6.5%, 13.0%, 4.4%, and 33.7%, respectively. Patients with stable HR (P = 0.01) and HER2 (P = 0.048) expression had more favorable overall survival (OS). Low or reduced Ki-67 expression was associated with better disease-free survival (DFS) (P < 0.001) and OS (P < 0.01). Multivariate analysis showed that the number of lymph nodes after NAC, HR conversion, and radiotherapy were independent prognostic factors for overall survival. HR conversion implied a higher risk of death [hazard ratio, 2.56 (95% confidence interval: 1.19-5.51); P = 0.016]. Patients with HR conversion after NAC who received endocrine therapy had better DFS (P = 0.674) and OS (P = 0.363) than those who did not receive endocrine therapy, even if the HR changed from positive to negative. In conclusion, pathological testing should be performed before and after NAC, and even patients with HR conversion after NAC might benefit from endocrine therapy.
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Affiliation(s)
- Yang He
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Breast Cancer, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Jing Zhang
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Integrative Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Hui Chen
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Oncology, Characteristic Medical Center of PAP, Tianjin, China
| | - Ying Zhou
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Integrative Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Liping Hong
- Center for Precision Cancer Medicine and Translational Research, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Yue Ma
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Nannan Chen
- Department of Breast Cancer, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Weipeng Zhao
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhongsheng Tong
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Correspondence: Zhongsheng Tong
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4
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Muacevic A, Adler JR, Pinto M, Ferreira F, Martins A. Her2 Status Discrepancy Between Core Needle Biopsy and Surgically Resected Mastectomy Specimen: A Clinical Case. Cureus 2023; 15:e33501. [PMID: 36756030 PMCID: PMC9903343 DOI: 10.7759/cureus.33501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
The biomarker concordance between core needle biopsy (CNB) and surgical specimen (SS), in breast cancer, has long been a matter of discussion because of its influence on oncologic treatment choice. Particularly, human epidermal growth factor receptor 2 (Her2) status is quite important, because of the impact on breast cancer classification and target therapy. Many factors could influence the difference in biomarker status between samples, such as the technic itself, sample procedures and intratumoral heterogeneity. Neoadjuvant chemotherapy (NAC) can also contribute to this variation and should be taken into consideration. We report a clinical case of a 33-year-old man who was diagnosed with right breast cancer, initially Her2 negative in the CNB. Therefore, the NAC was completed without anti-Her2 treatment. Later, after the mastectomy, revision of the SS was found to be positive for Her2, after the silver in situ hybridization (SISH) technique. Consequently, the patient lost the chance of doing anti-Her2 therapy in the neoadjuvant setting, reducing his possibility to achieve a complete pathologic response and later jeopardizing his clinical outcome.
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5
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Morganti S, Ivanova M, Ferraro E, Ascione L, Vivanet G, Bonizzi G, Curigliano G, Fusco N, Criscitiello C. Loss of HER2 in breast cancer: biological mechanisms and technical pitfalls. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2022; 5:971-980. [PMID: 36627895 PMCID: PMC9771738 DOI: 10.20517/cdr.2022.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/18/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
Loss of HER2 in previously HER2-positive breast tumors is not rare, occurring in up to 50% of breast cancers; however, clinical research and practice underestimate this issue. Many studies have reported the loss of HER2 after neoadjuvant therapy and at metastatic relapse and identified clinicopathological variables more frequently associated with this event. Nevertheless, the biological mechanisms underlying HER2 loss are still poorly understood. HER2 downregulation, intratumoral heterogeneity, clonal selection, and true subtype switch have been suggested as potential causes of HER2 loss, but translational studies specifically investigating the biology behind HER2 loss are virtually absent. On the other side, technical pitfalls may justify HER2 loss in some of these samples. The best treatment strategy for patients with HER2 loss is currently unknown. Considering the prevalence of this phenomenon and its apparent correlation with worse outcomes, we believe that correlative studies specifically addressing HER2 loss are warranted.
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Affiliation(s)
- Stefania Morganti
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Department of Oncology and Haemato-Oncology, University of Milano, Milan 20122, Italy.,Breast Oncology Center, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02215, USA.,Correspondence to: Dr. Stefania Morganti, Department of Oncology and Haemato-Oncology, University of Milano, via Festa del Perdono 7, Milan 20122, Italy. E-mail:
| | - Mariia Ivanova
- Biobank for Translational and Digital Medicine Unit, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy
| | - Emanuela Ferraro
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Liliana Ascione
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Department of Oncology and Haemato-Oncology, University of Milano, Milan 20122, Italy
| | - Grazia Vivanet
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Department of Oncology and Haemato-Oncology, University of Milano, Milan 20122, Italy
| | - Giuseppina Bonizzi
- Biobank for Translational and Digital Medicine Unit, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Department of Oncology and Haemato-Oncology, University of Milano, Milan 20122, Italy
| | - Nicola Fusco
- Department of Oncology and Haemato-Oncology, University of Milano, Milan 20122, Italy.,Biobank for Translational and Digital Medicine Unit, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy
| | - Carmen Criscitiello
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan 20144, Italy.,Department of Oncology and Haemato-Oncology, University of Milano, Milan 20122, Italy
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6
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Slostad JA, Yun NK, Schad AE, Warrior S, Fogg LF, Rao R. Concordance of breast cancer biomarker testing in core needle biopsy and surgical specimens: A single institution experience. Cancer Med 2022; 11:4954-4965. [PMID: 35733293 PMCID: PMC9761085 DOI: 10.1002/cam4.4843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/24/2022] [Accepted: 05/05/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Accurate diagnostic biomarker testing is crucial to treatment decisions in breast cancer. Biomarker testing is performed on core needle biopsies (CNB) and is often repeated in the surgical specimen (SS) after resection. As differences between CNB and SS testing may alter treatment decisions, we evaluated concordance between CNB and SS as well as associated changes in treatment and clinical outcomes. METHODS We performed a retrospective analysis of breast cancer patients at our institution between January 2010 and May 2020. Concordance between CNB and SS was assessed for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Survival in patients, including recurrence, metastatic recurrence, and death, were assessed using chi-squared likelihood ratio. RESULTS In total, 961 patients met eligibility criteria. Concordance, minor discordance, total concordance (concordance plus minor discordance), and major discordance between CNB and SS were reported for ER (87.7%, 9.2%, 90.8%, and 2.9%), PR (58.1%, 29.1%, 87.2%, and 12.8%), and HER2 IHC (52.5%, 20.9%, 73.4%, 26.6%), respectively. HER2 FISH concordance and major discordance were 58.5% and 1.2%, respectively. Of major discordance, ER (48.2%, p < 0.001) and HER2 FISH (50.0%) led to more management changes than HER2 IHC (2.4%, p = 0.04) and PR (1.6%, p = 0.10). Patients with ER major discordance had increased risk of death (6.7% concordance vs. 22.2% major discordance, p = 0.004). CONCLUSION Overall, retesting ER and HER2 was more clinically beneficial than retesting PR. To aid decision-making and minimize healthcare costs, we propose patient-centered guidelines on retesting biomarker profiles.
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Affiliation(s)
- Jessica A. Slostad
- Division of Hematology‐OncologyRush University Medical CenterChicagoIllinoisUSA
| | - Nicole K. Yun
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Aimee E. Schad
- Division of Hematology and Medical OncologySt. Louis UniversitySt. LouisMissouriUSA
| | - Surbhi Warrior
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Louis F. Fogg
- Department of Community, Systems, and Mental Health Nursing; College of NursingRush University Medical CenterChicagoIllinoisUSA
| | - Ruta Rao
- Division of Hematology‐OncologyRush University Medical CenterChicagoIllinoisUSA
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7
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Concordance between core needle biopsy and surgical excision for breast cancer tumor grade and biomarkers. Breast Cancer Res Treat 2022; 193:151-159. [PMID: 35229238 DOI: 10.1007/s10549-022-06548-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Histopathological biomarkers guide breast cancer management. Testing histopathological biomarkers on both core needle biopsy (CNB) and surgical excision (SE) in patients who are treated with upfront surgery is unnecessary and costly if there is high concordance between the two. This study investigated the concordance between CNB and SE for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (HER2), tumor grade and Ki-67. METHODS Histopathological biomarker information were retrospectively collected from preoperative CNB and SE on patients diagnosed with breast cancer through the BreastScreen Sydney West program over a four-year period between January 2017 and December 2020. Data were then analyzed to calculate percentage of agreement and concordance using kappa values for ER, PR, HER2, tumor grade and Ki-67. RESULTS A total of 504 cases of invasive breast cancers were analyzed. There was substantial level of concordance for ER 96.7% (κ = 0.687) and PR 93.2% (κ = 0.69). Concordance for HER2 negative (IHC 0, IHC 1 +) or positive (IHC 3 +) tumor on CNB was 100% (κ = 1.00). Grade and Ki-67 showed moderate level of concordance, 72.6% (κ = 0.545) and 70.5% (κ = 0.453), respectively. CONCLUSION ER, PR and HER2 show high level of concordance. CNB is reliable in determining histopathological biomarkers for ER, PR positive and HER2 positive or negative tumors indicating that retesting these on SE may not be necessary.
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8
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Crozier JA, Barone J, Whitworth P, Cheong A, Maganini R, Tamayo JP, Dauer P, Wang S, Audeh W, Glas AM. High concordance of 70-gene recurrence risk signature and 80-gene molecular subtyping signature between core needle biopsy and surgical resection specimens in early-stage breast cancer. J Surg Oncol 2021; 125:596-602. [PMID: 34964996 PMCID: PMC9305900 DOI: 10.1002/jso.26780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES With increased neoadjuvant therapy recommendations for early-stage breast cancer patients due to the COVID-19 pandemic, it is imperative that molecular diagnostic assays provide reliable results from preoperative core needle biopsies (CNB). The study objective was to determine the concordance of MammaPrint and BluePrint results between matched CNB and surgical resection (SR) specimens. METHODS Matched tumor specimens (n = 121) were prospectively collected from women enrolled in the FLEX trial (NCT03053193). Concordance is reported using overall percentage agreement and Cohen's kappa coefficient. Correlation is reported using Pearson correlation coefficient. RESULTS We found good concordance for MammaPrint results between matched tumor samples (90.9%, κ = 0.817), and a very strong correlation of MammaPrint indices (r = 0.94). The concordance of BluePrint subtyping in matched samples was also excellent (98.3%). CONCLUSIONS CNB samples demonstrated high concordance with paired SR samples for MammaPrint risk classification and BluePrint molecular subtyping, suggesting that physicians are provided with accurate prognostic information that can be used to guide therapy decisions.
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Affiliation(s)
- Jennifer A Crozier
- Division of Hematology & Oncology, Baptist MD Anderson, Jacksonville, Florida, USA
| | - Julie Barone
- SCL Health, St. Joseph's Hospital, Denver, Colorado, USA
| | - Pat Whitworth
- Department of Surgery, Nashville Breast Center, Nashville, Tennessee, USA
| | - Abraham Cheong
- Division of Hematology & Oncology, Southeast Georgia Health System, Brunswick, Georgia, USA
| | - Robert Maganini
- Division of Oncology, AMITA Health Alexian Brothers, Elk Grove Village, Illinois, USA
| | - Jose Perez Tamayo
- Department of Radiology, Ogden Regional Medical Center, Ogden, Utah, USA
| | - Patricia Dauer
- Division of Medical Affairs, Agendia Inc., Irvine, California, USA
| | - Shiyu Wang
- Division of Medical Affairs, Agendia Inc., Irvine, California, USA
| | - William Audeh
- Division of Medical Affairs, Agendia Inc., Irvine, California, USA
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Fernandes LE, Epstein CG, Bobe AM, Bell JSK, Stumpe MC, Salazar ME, Salahudeen AA, Pe Benito RA, McCarter C, Leibowitz BD, Kase M, Igartua C, Huether R, Hafez A, Beaubier N, Axelson MD, Pegram MD, Sammons SL, O'Shaughnessy JA, Palmer GA. Real-world Evidence of Diagnostic Testing and Treatment Patterns in US Patients With Breast Cancer With Implications for Treatment Biomarkers From RNA Sequencing Data. Clin Breast Cancer 2021; 21:e340-e361. [PMID: 33446413 DOI: 10.1016/j.clbc.2020.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE/BACKGROUND We performed a retrospective analysis of longitudinal real-world data (RWD) from patients with breast cancer to replicate results from clinical studies and demonstrate the feasibility of generating real-world evidence. We also assessed the value of transcriptome profiling as a complementary tool for determining molecular subtypes. METHODS De-identified, longitudinal data were analyzed after abstraction from records of patients with breast cancer in the United States (US) structured and stored in the Tempus database. Demographics, clinical characteristics, molecular subtype, treatment history, and survival outcomes were assessed according to strict qualitative criteria. RNA sequencing and clinical data were used to predict molecular subtypes and signaling pathway enrichment. RESULTS The clinical abstraction cohort (n = 4000) mirrored the demographics and clinical characteristics of patients with breast cancer in the US, indicating feasibility for RWE generation. Among patients who were human epidermal growth factor receptor 2-positive (HER2+), 74.2% received anti-HER2 therapy, with ∼70% starting within 3 months of a positive test result. Most non-treated patients were early stage. In this RWD set, 31.7% of patients with HER2+ immunohistochemistry (IHC) had discordant fluorescence in situ hybridization results recorded. Among patients with multiple HER2 IHC results at diagnosis, 18.6% exhibited intra-test discordance. Through development of a whole-transcriptome model to predict IHC receptor status in the molecular sequenced cohort (n = 400), molecular subtypes were resolved for all patients (n = 36) with equivocal HER2 statuses from abstracted test results. Receptor-related signaling pathways were differentially enriched between clinical molecular subtypes. CONCLUSIONS RWD in the Tempus database mirrors the overall population of patients with breast cancer in the US. These results suggest that real-time, RWD analyses are feasible in a large, highly heterogeneous database. Furthermore, molecular data may aid deficiencies and discrepancies observed from breast cancer RWD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark D Pegram
- Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Sarah L Sammons
- Department of Medicine, Duke University Medical Center, Duke University, Durham, NC
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10
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Orozco JIJ, Chang SC, Matsuba C, Ensenyat-Mendez M, Grunkemeier GL, Marzese DM, Grumley JG. Is the 21-Gene Recurrence Score on Core Needle Biopsy Equivalent to Surgical Specimen in Early-Stage Breast Cancer? A Comparison of Gene Expression Between Paired Core Needle Biopsy and Surgical Specimens. Ann Surg Oncol 2021; 28:5588-5596. [PMID: 34244898 DOI: 10.1245/s10434-021-10457-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Molecular testing on surgical specimens predicts disease recurrence and benefit of adjuvant chemotherapy in hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) early-stage breast cancer (EBC). Testing on core biopsies has become common practice despite limited evidence of concordance between core/surgical samples. In this study, we compared the gene expression of the 21 genes and the recurrence score (RS) between paired core/surgical specimens. METHODS Eighty patients with HR+/HER2- EBC were evaluated from two publicly available gene expression datasets (GSE73235, GSE76728) with paired core/surgical specimens without neoadjuvant systemic therapy. The expression of the 21 genes was compared in paired samples. A microarray-based RS was calculated and a value ≥ 26 was defined as high-RS. The concordance rate and kappa statistic were used to evaluate the agreement between the RS of paired samples. RESULTS Overall, there was no significant difference and a high correlation in the gene expression levels of the 21 genes between paired samples. However, CD68 and RPLP0 in GSE73235, AURKA, BAG1, and TFRC in GSE76728, and MYLBL2 and ACTB in both datasets exhibited weak to moderate correlation (r < 0.5). There was a high correlation of the microarray-based RS between paired samples in GSE76728 (r = 0.91, 95% confidence interval [CI] 0.81-0.96) and GSE73235 (r = 0.82, 95% CI 0.71-0.89). There were no changes in RS category in GSE76728, whereas 82% of patients remained in the same RS category in GSE73235 (κ = 0.64). CONCLUSIONS Gene expression levels of the 21-gene RS showed a high correlation between paired specimens. Potential sampling and biological variability on a set of genes need to be considered to better estimate the RS from core needle biopsy.
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Affiliation(s)
- Javier I J Orozco
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shu-Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Saint Joseph Health, Portland, OR, USA
| | - Chikako Matsuba
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Miquel Ensenyat-Mendez
- Cancer Epigenetics Laboratory, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Gary L Grunkemeier
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Saint Joseph Health, Portland, OR, USA
| | - Diego M Marzese
- Cancer Epigenetics Laboratory, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Janie G Grumley
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
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11
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Ryu MJ, Kim YS, Lee SE. Association between Imaging Features using the BI-RADS and Tumor Subtype in Patients with Invasive Breast Cancer. Curr Med Imaging 2021; 18:648-657. [PMID: 34061005 DOI: 10.2174/1573405617666210520155157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Different molecular breast cancer subtypes present different biologic features, treatment options, and clinical prognoses. The breast cancer imaging phenotype may help precisely classify breast cancer in a non-invasive manner. OBJECTIVE To identify the association between the imaging and clinicopathologic features of invasive breast cancer according to the molecular subtype. METHODS We retrospectively reviewed the electronic medical records of 313 consecutive women with breast cancer who underwent surgery between March 2018 and February 2019. Preoperative imaging studies were also reviewed and the association between the clinicopathologic and imaging features was evaluated according to the molecular subtype. RESULTS On mammography, the presence of microcalcifications was correlated with the human epidermal factor receptor 2-positive subtype (67%, 14/21). Luminal A and B tumors were more likely to have a spiculated margin (57% [63/110] and 41% [34/81]), while human epidermal factor receptor 2-positive and triple-negative breast cancers were more likely to have an indistinct margin (56% [10/18] and 35% [17/48]). On ultrasonography, luminal A tumors were likely to be depicted as masses with an irregular shape (85%, 115/136) and spiculated margin (49%, 66/136). On magnetic resonance imaging, triple-negative breast cancer appeared as a mass (n=13) that frequently had an irregular shape (62%, 8/13) but was more likely to be oval or round (39%, 5/13) than other subtypes. CONCLUSION Some imaging features on mammography, ultrasonography, and magnetic resonance imaging could be useful predictors of the molecular subtype of breast cancer and may aid precision medicine development for patients with breast cancer according to the subtype.
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Affiliation(s)
- Min Jung Ryu
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Young Seon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Seung Eun Lee
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
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12
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Rottmann D, Assem H, Matsumoto N, Wong S, Hui P, Buza N. Does Specimen Type Have an Impact on HER2 Status in Endometrial Serous Carcinoma? Discordant HER2 Status of Paired Endometrial Biopsy and Hysterectomy Specimens in the Presence of Frequent Intratumoral Heterogeneity. Int J Gynecol Pathol 2021; 40:263-271. [PMID: 32897955 DOI: 10.1097/pgp.0000000000000690] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A recent clinical trial showed prolonged progression-free survival in human epidermal growth factor receptor 2 (HER2)-positive advanced stage and recurrent endometrial serous carcinomas when trastuzumab was added to traditional chemotherapy. Approximately one third of these tumors are HER2-positive and have been described to show unique characteristics of HER2 protein expression and gene amplification, including significant intratumoral heterogeneity, in recent studies. However, currently, there are no standard protocols for the selection of optimal specimen type or algorithm for HER2 testing in endometrial serous carcinomas. The current study aimed to evaluate the concordance of HER2 status between endometrial biopsy/curettage and subsequent hysterectomy specimens in endometrial serous carcinoma. A total of 57 patients with endometrial serous carcinoma with available HER2 status were identified during the study period, 14 of which (14/57, 25%) were HER2-positive by immunohistochemistry and/or fluorescent in situ hybridization (FISH). The final study cohort consisted of 40 paired endometrial biopsies/curettings and hysterectomies to include all 14 HER2-positive tumors and 26 selected HER2-negative tumors to represent an equal distribution of HER2 immunohistochemical scores. HER2 FISH was performed on all tumors with an immunohistochemical score of 2+. HER2 immunohistochemical scores, heterogeneity of HER2 expression, FISH results, and the overall HER2 status were compared between the 2 specimen types. HER2 status was successfully assigned in both specimen types in 37 cases, as three specimens showed inadequate FISH signals. Concordant HER2 status was observed in 84% of cases (31/37), with identical HER2 immunohistochemical scores in 65% (26/40) of tumors. Among the 6 tumors with a discordant HER2 status, 2 were HER2 negative in the biopsy and positive in the hysterectomy, and 4 were HER2-positive in the biopsy and negative in the hysterectomy. The false-negative rate would be 15.4% and 26.7% if only the biopsy or only the hysterectomy would be the basis for the result, respectively. Intratumoral heterogeneity of HER2 protein expression was present in 22 tumors (55%), including all cases with a discordant HER2 status. The concordance rate of HER2 status between paired endometrial biopsies/curettings and hysterectomies of endometrial serous carcinoma is lower than the reported rates of breast cancer, and comparable to those of gastric carcinomas. Frequent heterogeneity of HER2 protein expression combined with the possibility of a spatially more heterogenous sampling of endometrial cavity in biopsies and curettings, and the potential differences in specimen handling/fixation between the 2 specimen types may explain our findings. HER2 testing of multiple specimens may help identify a greater proportion of patients eligible for targeted trastuzumab therapy and should be taken into account in future efforts of developing endometrial cancer-specific HER2 testing algorithm.
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Affiliation(s)
- Douglas Rottmann
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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13
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Janeva S, Parris TZ, Nasic S, De Lara S, Larsson K, Audisio RA, Olofsson Bagge R, Kovács A. Comparison of breast cancer surrogate subtyping using a closed-system RT-qPCR breast cancer assay and immunohistochemistry on 100 core needle biopsies with matching surgical specimens. BMC Cancer 2021; 21:439. [PMID: 33879115 PMCID: PMC8059293 DOI: 10.1186/s12885-021-08171-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Routine clinical management of breast cancer (BC) currently depends on surrogate subtypes according to estrogen- (ER) and progesterone (PR) receptor, Ki-67, and HER2-status. However, there has been growing demand for reduced immunohistochemistry (IHC) turnaround times. The Xpert® Breast Cancer STRAT4* Assay (STRAT4)*, a standardized test for ESR1/PGR/MKi67/ERBB2 mRNA biomarker assessment, takes less than 2 hours. Here, we compared the concordance between the STRAT4 and IHC/SISH, thereby evaluating the effect of method choice on surrogate subtype assessment and adjuvant treatment decisions. Methods In total, 100 formalin-fixed paraffin-embedded core needle biopsy (CNB) samples and matching surgical specimens for 98 patients with primary invasive BC were evaluated using the STRAT4 assay. The concordance between STRAT4 and IHC was calculated for individual markers for the CNB and surgical specimens. In addition, we investigated whether changes in surrogate BC subtyping based on the STRAT4 results would change adjuvant treatment recommendations. Results The overall percent agreement (OPA) between STRAT4 and IHC/SISH ranged between 76 and 99% for the different biomarkers. Concordance for all four biomarkers in the surgical specimens and CNBs was only 66 and 57%, respectively. In total, 74% of surgical specimens were concordant for subtype, regardless of the method used. IHC- and STRAT4-based subtyping for the surgical specimen were shown to be discordant for 25/98 patients and 18/25 patients would theoretically have been recommended a different adjuvant treatment, primarily receiving more chemotherapy and trastuzumab. Conclusions A comparison of data from IHC/in situ hybridization and STRAT4 demonstrated that subsequent changes in surrogate subtyping for the surgical specimen may theoretically result in more adjuvant treatment given, primarily with chemotherapy and trastuzumab.
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Affiliation(s)
- Slavica Janeva
- Sahlgrenska Breast Center, Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden. .,Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Toshima Z Parris
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Shahin De Lara
- Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Karolina Larsson
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Riccardo A Audisio
- Sahlgrenska Breast Center, Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Breast Center, Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anikó Kovács
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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14
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Acs B, Fredriksson I, Rönnlund C, Hagerling C, Ehinger A, Kovács A, Røge R, Bergh J, Hartman J. Variability in Breast Cancer Biomarker Assessment and the Effect on Oncological Treatment Decisions: A Nationwide 5-Year Population-Based Study. Cancers (Basel) 2021; 13:1166. [PMID: 33803148 PMCID: PMC7963154 DOI: 10.3390/cancers13051166] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/08/2023] Open
Abstract
We compared estrogen receptor (ER), progesterone receptor (PR), human epidermal growth-factor receptor 2 (HER2), Ki67, and grade scores among the pathology departments in Sweden. We investigated how ER and HER2 positivity rates affect the distribution of endocrine and HER2-targeted treatments among oncology departments. All breast cancer patients diagnosed between 2013 and 2018 in Sweden were identified in the National Quality Register for Breast Cancer. Cases with data on ER, PR, HER2, Ki67, grade, and treatment were selected (43,261 cases from 29 departments following the guidelines for biomarker testing). The ER positivity rates ranged from 84.2% to 97.6% with 6/29 labs out of the overall confidence intervals (CIs), while PR rates varied between 64.8% and 86.6% with 7/29 labs out of the CIs. HER2 positivity rates ranged from 9.4% to 16.3%, with 3/29 labs out of the overall CIs. Median Ki67 varied between 15% and 30%, where 19/29 labs showed significant intra-laboratory variability. The proportion of grade-II cases varied between 42.9% and 57.1%, and 13/29 labs were outside of the CI. Adjusting for patient characteristics, the proportion of endocrine and anti-HER2 treatments followed the rate of ER and HER2 positivity, illustrating the clinical effect of inter- and intra-laboratory variability. There was limited variability among departments in ER, PR, and HER2 testing. However, even a few outlier pathology labs affected endocrine and HER2-targeted treatment rates in a clinically relevant proportion, suggesting the need for improvement. High variability was found in grading and Ki67 assessment, illustrating the need for the adoption of new technologies in practice.
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Affiliation(s)
- Balazs Acs
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, 11883 Stockholm, Sweden
| | - Irma Fredriksson
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, 17176 Stockholm, Sweden;
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Caroline Rönnlund
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, 11883 Stockholm, Sweden
| | - Catharina Hagerling
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden; (C.H.); (A.E.)
| | - Anna Ehinger
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden; (C.H.); (A.E.)
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, 22184 Lund, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden;
| | - Rasmus Røge
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- NordiQC, Institute of Pathology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Breast Center, Cancer Theme, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Gävlegatan 55, 17164 Solna, Sweden
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, 11883 Stockholm, Sweden
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15
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Qi P, Yang Y, Bai QM, Xue T, Ren M, Yao QL, Yang WT, Zhou XY. Concordance of the 21-gene assay between core needle biopsy and resection specimens in early breast cancer patients. Breast Cancer Res Treat 2021; 186:327-342. [PMID: 33439420 PMCID: PMC7804587 DOI: 10.1007/s10549-020-06075-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adjuvant therapy decisions may be partly based on the results of a multigene quantitative reverse transcription-polymerase chain reaction (RT-PCR)-based assay: the 21-gene recurrence score (RS) test of resection specimens. When necessary, core needle biopsy (CNB) may be considered as a surrogate. Here, we evaluated the concordance in gene expression according to results from RT-PCR-based RS testing between paired CNBs and resection specimens. METHODS CNBs and resection specimens from 50 breast cancer (BC) patients were tested to calculate RSs. First, we examined the concordance of the ER, PR and HER-2 status of tissue samples indicated by immunohistochemical (IHC) and RT-PCR analyses. Then, we compared the IHC findings of ER, PR, HER-2 and Ki-67 staining across paired samples. Ultimately, the RS and single-gene results for ER, PR, HER-2 and Ki-67 were explored between paired samples. RESULTS The concordance between IHC and RT-PCR was 100%, 80.0% and 100% for ER, PR and HER-2, respectively, in both resection specimens and CNBs. The concordance for IHC ER, PR, HER-2 and Ki-67 status was 100%, 94.0%, 52.0% and 82.0%, respectively, between paired samples. RS results from paired samples showed a strong correlation. The overall concordance in RS group classification between samples was 74%, 72% and 78% based on traditional cutoffs, TAILORx cutoffs and ASCO guidelines, respectively. ER, PR, HER-2 and Ki-67 were modestly- to- strongly correlated between paired samples according to the RT-PCR results. CONCLUSION A modest- to- strong correlation of ER, PR, HER-2 and Ki-67 gene expression and RS between CNBs and resection specimens was observed in the present study. The 21-gene RS test could be reliably performed on CNBs. ER, PR and HER-2 status showed remarkable concordance between the IHC and RT-PCR analyses. The concordance between paired samples was high for the IHC ER, PR and Ki-67 results and low for HER-2.
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Affiliation(s)
- Peng Qi
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Yu Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Qian-Ming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Tian Xue
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Qian-Lan Yao
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Wen-Tao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Institute of Pathology, Fudan University, Shanghai, 200032, China
| | - Xiao-Yan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, No. 270 Dong An Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Institute of Pathology, Fudan University, Shanghai, 200032, China.
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16
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Candás G, García A, Ocampo MD, Korbenfeld E, Vuoto HD, Isetta J, Cogorno L, Zimmermann AG, Sigal M, Acevedo S, Berwart J, Naveira M, Bemi A, Uriburu JL. Impact of immunohistochemical profile changes following neoadjuvant therapy in the treatment of breast cancer. Ecancermedicalscience 2021; 15:1162. [PMID: 33680076 PMCID: PMC7929771 DOI: 10.3332/ecancer.2021.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Currently, the indication for neoadjuvant chemotherapy is increasing in the treatment of breast cancer. Variability in the expression of biomarkers following neoadjuvant treatment has been observed, which could be accompanied by changes in the adjuvant treatment. Objectives The primary objective was to evaluate the variability of biomarkers prior to and following neoadjuvant therapy. Secondary objectives were to determine which tumour subtype (as determined by immunohistochemical markers) most frequently achieved pathological complete response (pCR); whether the biomarker variation resulted in a change in immunophenotype and subsequently modification to the adjuvant treatment. Materials and methods A retrospective observational analysis was carried out on patients with a diagnosis of breast cancer who had neoadjuvant therapy prior to surgery in the Breast Care Service of the Buenos Aires British Hospital between January 2009 and June 2020. Results One hundred and seventy-two patients were included. The pCR rate was 28.5%. The tumour immunophenotype that achieved pCR most frequently was the hormone receptor negative /HER2+ group with a value of 85.2%. The analysis was carried out on the 123 patients with residual disease. The observed variability for oestrogen receptors (ER) was 8.9%, for progesterone receptors (PR), 29.9% and for HER2, 13.8%. These changes were statistically significant. There were changes to the tumour immunophenotype in 26 cases (21.1%) with modifications to the adjuvant treatment in nine of these (34.6%; 7.3% of all tumours with residual disease). Conclusions In this study, we observed statistically significant variability in the expression of ER, PR and HER2 prior to and following neoadjuvant treatment, which identified modifications in the tumour immunophenotype in 21.1%, and changes to the adjuvant treatment in 7.3% of all tumours with residual disease, justifying the re-assay of biomarkers in the surgical specimen.
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Affiliation(s)
- Gabriela Candás
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Alejandra García
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - María Delfina Ocampo
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Ernesto Korbenfeld
- Oncology Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - H Daniel Vuoto
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Juan Isetta
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Lucas Cogorno
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | | | - Marca Sigal
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Santiago Acevedo
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Julia Berwart
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Martín Naveira
- Oncology Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Agustina Bemi
- Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
| | - Juan Luis Uriburu
- Head of the Mastology Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina
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17
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Nakajima H, Maeno K, Ito T, Kanai T, Oba T, Ono M, Takayama F, Uehara T, Ito KI. Concomitant use of 18F-FDG PET-CT SUVmax is useful in the assessment of Ki67 labeling index in core-needle biopsy specimens of breast cancer. Gland Surg 2021; 10:1-9. [PMID: 33633957 DOI: 10.21037/gs-20-485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Ki67 is a recognized proliferative and predictive marker in invasive breast cancer. However, results of Ki67 evaluation are affected by the method employed for sample fixation or biopsy, as well as by intratumor heterogeneity. Here, we aimed to compare the Ki67 labeling index (Ki67LI) between core-needle biopsy specimens (CNBSs) and surgically resected specimens (SRSs) of invasive breast cancer, and verify whether the discordance in Ki67LI can be reduced by analyzing the maximum standardized uptake value (SUVmax) obtained from pretreatment whole-body positron emission tomography/computed tomography (PET/CT) in combination with Ki67LI. Methods Tumor tissues were obtained from 118 patients with invasive breast cancer. Ki67LI was evaluated in CNBSs and SRSs by immunohistochemistry. First, we directly compared Ki67LI between CNBS and SRS, "allowing a tolerance margin of 5%." We divided the Ki67LI values into three groups (Low: 0≤ Ki67LI ≤10, Intermediate: 10< Ki67LI <30, and High: 30≤ Ki67LI) and the SUVmax into three groups (SUVmax ≤4, 4< SUVmax <8, and 8≤ SUVmax). We then verified the concordance rate between CNBS and SRS in each group in combination with the SUVmax obtained by PET/CT. Results The median Ki67LI was 17.8% (0.5-75.9%) and 17.0% (1.0-75.7%) in CNBS and SRS, respectively. The overall Ki67LI concordance rate between CNBS and SRS was 37.3% (44/118). The concordance was improved in the Low and High Ki67LI groups by applying SUVmax thresholds of 4 [82.6% (19/23), P=0.033 and 8 (92.3% (12/13), P=0.009], respectively. Conclusions Our results indicated that CNBS Ki67LI alone was not able to reflect SRS Ki67LI with sufficient accuracy. By dividing CNBS Ki67LI into three classes in combination with SUVmax, tumor proliferation could be predicted with higher accuracy in patients with invasive breast carcinoma.
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Affiliation(s)
- Hiroki Nakajima
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kazuma Maeno
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Tokiko Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Takaaki Oba
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Mayu Ono
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | | | - Tsuyoshi Uehara
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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18
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Heng B, Bilgin AA, Lovejoy DB, Tan VX, Milioli HH, Gluch L, Bustamante S, Sabaretnam T, Moscato P, Lim CK, Guillemin GJ. Differential kynurenine pathway metabolism in highly metastatic aggressive breast cancer subtypes: beyond IDO1-induced immunosuppression. Breast Cancer Res 2020; 22:113. [PMID: 33109232 PMCID: PMC7590459 DOI: 10.1186/s13058-020-01351-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Immunotherapy has recently been proposed as a promising treatment to stop breast cancer (BrCa) progression and metastasis. However, there has been limited success in the treatment of BrCa with immune checkpoint inhibitors. This implies that BrCa tumors have other mechanisms to escape immune surveillance. While the kynurenine pathway (KP) is known to be a key player mediating tumor immune evasion and while there are several studies on the roles of the KP in cancer, little is known about KP involvement in BrCa. Methods To understand how KP is regulated in BrCa, we examined the KP profile in BrCa cell lines and clinical samples (n = 1997) that represent major subtypes of BrCa (luminal, HER2-enriched, and triple-negative (TN)). We carried out qPCR, western blot/immunohistochemistry, and ultra-high pressure liquid chromatography on these samples to quantify the KP enzyme gene, protein, and activity, respectively. Results We revealed that the KP is highly dysregulated in the HER2-enriched and TN BrCa subtype. Gene, protein expression, and KP metabolomic profiling have shown that the downstream KP enzymes KMO and KYNU are highly upregulated in the HER2-enriched and TN BrCa subtypes, leading to increased production of the potent immunosuppressive metabolites anthranilic acid (AA) and 3-hydroxylanthranilic acid (3HAA). Conclusions Our findings suggest that KMO and KYNU inhibitors may represent new promising therapeutic targets for BrCa. We also showed that KP metabolite profiling can be used as an accurate biomarker for BrCa subtyping, as we successfully discriminated TN BrCa from other BrCa subtypes.
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Affiliation(s)
- Benjamin Heng
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - Ayse A Bilgin
- Faculty of Sciences and Engineering, Macquarie University, Sydney, Australia
| | - David B Lovejoy
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Vanessa X Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Heloisa H Milioli
- School of Environmental and Life Sciences, The University of Newcastle, Callaghan, Australia
| | | | - Sonia Bustamante
- Bioanalytical Mass Spectrometry Facility, University of New South Wales, Sydney, Australia
| | - Tharani Sabaretnam
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Pablo Moscato
- School of Electrical Engineering and Life Sciences, The University of Newcastle, Callaghan, Australia
| | - Chai K Lim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Gilles J Guillemin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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19
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Ambrosini-Spaltro A, Zunarelli E, Bettelli S, Lupi M, Bernardelli G, Milani M, Ficarra G. Surrogate Molecular Classification of Invasive Breast Carcinoma: A Comparison Between Core Needle Biopsy and Surgical Excision, With and Without Neoadjuvant Therapy. Appl Immunohistochem Mol Morphol 2020; 28:551-557. [PMID: 31335485 DOI: 10.1097/pai.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surrogate molecular classification identifies different subtypes of invasive breast carcinoma on the basis of their immunohistochemical markers. The purpose of the study is to verify whether the immunohistochemical markers and surrogate molecular subtypes can be correctly assessed on the core needle biopsy (CNB) when compared with the corresponding surgical excision (SE), with or without neoadjuvant treatment (NAT). Cases with invasive carcinomas identified on both CNB and SE were retrospectively selected. With immunohistochemistry for estrogen receptors (ER), progesterone receptors (PgR), Ki67, human epidermal growth factor receptor 2 (Her2), and molecular analysis for Her2, surrogate molecular classification was determined in 4 and 5 groups, according to the 2013 St Gallen consensus. A total of 1067 cases was considered and complete data for surrogate molecular classification were available for 988 cases (655 without NAT, 333 with NAT). Without NAT, concordance was strong for ER and Her2, moderate for PgR, and weak for Ki67; concordance for surrogate molecular classification was moderate. After NAT, lower concordance rates were recorded, with significant reduction of PgR (P<0.001) and Ki67 (P<0.001). Without NAT, the surrogate molecular subtypes of breast carcinoma can be reliably assessed on CNB; Ki67 and/or PgR may be repeated on SE when values are close to cutoffs to avoid tumor subtype misclassification. After NAT, it seems advisable to repeat at least Ki67 and PgR.
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Estrogen, progesterone, and human epidermal growth factor receptor 2 discordance between primary and metastatic breast cancer. Breast Cancer Res Treat 2020; 183:137-144. [PMID: 32613540 PMCID: PMC7375990 DOI: 10.1007/s10549-020-05746-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/01/2020] [Indexed: 12/24/2022]
Abstract
Background The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses are frequently discordant between the primary tumor and metastatic lesions in metastatic breast cancer. This can have important therapeutic implications. Patients and methods In all, 541 patients with available receptor statuses from both primary tumor and metastatic lesion treated at Heidelberg and Tuebingen University Hospitals between 1982 and 2018 were included. Results Statistically significant discordance rates of 14% and 32% were found for ER and PR. HER2 status was statistically insignificantly discordant in 15% of patients. Gain in HER2 positivity was associated with an improved overall survival, whereas loss of HR positivity was associated with worse overall survival. Antiendocrine treatment differed in 20% of cases before and after biopsy and HER2-directed treatment in 14% of cases. Conclusions Receptor statuses are discordant between primary tumor and metastasis in a considerable fraction of patients with metastatic breast cancer. Next to a highly presumed predictive value with respect to efficacy of endocrine and HER2-targeted therapy, discordance seems to provide prognostically relevant information. Where feasible, metastatic lesions should be biopsied in accordance with current guidelines. Electronic supplementary material The online version of this article (10.1007/s10549-020-05746-8) contains supplementary material, which is available to authorized users.
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A Prospective Study on Level of Concordance Between Core Needle Biopsy and Surgical Specimen for Assessing Oestrogen Receptor, Progesterone Receptor, and Her2/Neu Receptor Status in Carcinoma Breast and Its Implications on Treatment Decisions. Indian J Surg Oncol 2020; 11:446-450. [PMID: 33013125 DOI: 10.1007/s13193-020-01146-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022] Open
Abstract
A prospective study on the level of concordance between core needle biopsy specimen (CNB) and surgical specimen (SS) assesses the oestrogen receptor (ER), progesterone receptor (PR) and Her2/Neu receptor status in Carcinoma breast and its implications on treatment decisions. Ninety consecutive treatment naive operable breast cancer patients treated between September 2015 and April 2017 were included in our prospective study. All patients underwent core needle biopsy prior to definitive surgery. Immunohistochemistry (IHC) studies for ER, PR, and Her2/Neu receptor assay were done in both the CNB specimen and SS. The concordances between CNB specimen and SS for ER, PR, and Her2/Neu receptor were 92%, 88%, and 78% respectively. In our study, overall discordance for ER, PR, and Her2/Neu status based on IHC tests on CNB specimen and its corresponding SS was 41% (37 out of total 90 patients), which was mostly for Her2/Neu (20 patients). Altogether, there was a change in treatment decision based on IHC test results of CNB specimen for 14 out of 37 discordant tests, translating to 15% of the overall study group. Four patients received adjuvant hormonal therapy, and 10 patients got adjuvant Traztuzumab added to their protocol. There is almost perfect to substantial concordance between CNB specimen and SS of IHC tests for ER and PR status. However, the concordance for Her2/Neu receptor is only moderate. Her2/Neu receptor assay by IHC is more sensitive in CNB specimen than in SS.
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Skálová H, Hájková N, Majerová B, Bártů M, Povýšil C, Tichá I. Impact of chemotherapy on the expression of claudins and cadherins in invasive breast cancer. Exp Ther Med 2019; 18:3014-3024. [PMID: 31572543 PMCID: PMC6755479 DOI: 10.3892/etm.2019.7930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/05/2019] [Indexed: 12/31/2022] Open
Abstract
The importance of the expression profile of claudins in the molecular classification of breast cancer (BC) is currently under investigation. Claudins, together with cadherins, serve an important role in the epithelial-mesenchymal transition and influence the chemosensitivity of cancer cells. Adjuvant chemotherapy is administered following surgical resection in selected cases of BC. Previous neoadjuvant chemotherapy may change the molecular profile of a tumour and subsequently also its chemosensitivity. In the current study, the expression of claudin-1, −3 and −4, E- and N-cadherin and the standard BC biomarkers [oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and marker of proliferation Ki-67 (Ki-67)] in formalin-fixed, paraffin-embedded sections from 62 patients with invasive BC was analysed using immunohistochemistry prior to and following neoadjuvant chemotherapy. The results revealed increased expression of claudin-1 (P=0.03) and decreased expression of claudin-3 (P=0.005), PR (P<0.001) and Ki-67 (P=0.01) following the neoadjuvant therapy. No significant changes in the expression of ER, claudin-4 or E- and N-cadherin were observed following therapy. Furthermore, an association between the expression of claudin-1 and the standard BC markers (P<0.05) was identified. A high expression of claudin-1 was more frequently observed in the triple-negative BC cohort than in the cohort with positive ER, PR and/or HER2 before (P=0.04) and after chemotherapy (P=0.02). The expression of N-cadherin was associated with the expression of ER, PR, HER2 and tumour grade (P<0.05). A positive association between the expression of claudin-3 and E-cadherin (P=0.005) was observed. No association was found between the expression of E- and N-cadherin. In conclusion, significant changes in the expression of claudin-1 and −3 but not in the expression of claudin-4, E- and N-cadherin were observed in samples taken from patients with BC following chemotherapy. These findings indicate that claudins-1 and −3 serve a role in the response of BC to chemotherapy.
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Affiliation(s)
- Helena Skálová
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Nikola Hájková
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Barbora Majerová
- First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Michaela Bártů
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Ctibor Povýšil
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Ivana Tichá
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
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Noordhoek I, de Groot AF, Cohen D, Liefers GJ, Portielje JEA, Kroep JR. Higher ER load is not associated with better outcome in stage 1-3 breast cancer: a descriptive overview of quantitative HR analysis in operable breast cancer. Breast Cancer Res Treat 2019; 176:27-36. [PMID: 30997625 PMCID: PMC6548750 DOI: 10.1007/s10549-019-05233-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/10/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE In breast cancer, hormone receptor (HR) status is generally a qualitative measure; positive or negative. Quantitatively measured oestrogen and progesterone receptors (ER and PR) are frequently proposed prognostic and predictive markers, some guidelines even provide different treatment options for patients with strong versus weak expression. AIM To evaluate quantitative HR load assessed by immunohistochemistry as a prognostic and predictive measure in stage 1-3 breast cancer. METHODS We reviewed all the available literature on quantitatively measured HRs using immunohistochemistry. RESULTS All included studies (n = 19) comprised a cohort of 30,754 patients. Only 2 out of 17 studies found a clear correlation between higher quantitative ER and better disease outcome. Only one trial examined quantitative ER both as prognostic and predictive marker and found no association between ER% and survival. Ten studies examined quantitative PR load, only two of those found a significant correlation between higher PR load and better disease outcome. Two trials examined quantitative PR both as prognostic and predictive marker, neither found any association between PR% and disease outcome. CONCLUSIONS There is no clear evidence for using quantitatively assessed ER and PR as prognostic nor predictive marker in patients with stage 1-3 breast cancer. We recommend only using a qualitative HR status in future guidelines and treatment considerations.
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Affiliation(s)
- I Noordhoek
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - A F de Groot
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Cohen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
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Resende U, Cabello C, Ramalho SOB, Zeferino LC. Prognostic assessment of breast carcinoma submitted to neoadjuvant chemotherapy with pathological non-complete response. BMC Cancer 2019; 19:601. [PMID: 31208353 PMCID: PMC6580604 DOI: 10.1186/s12885-019-5812-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background Breast cancer with pathological non-complete response (non-pCR) after neoadjuvant chemotherapy (NAC) has a worse prognosis. Despite Neo-Bioscore has been validated as an independent prognostic model for breast cancer submitted to NAC, non-pCR carcinoma was not assessed in this setting. Methods This is a retrospective trial that included women with localized breast cancer who underwent NAC and had non-pCR carcinoma in surgical specimen between 01/01/2013 to 12/31/2015 with a three-year follow-up. Survival analysis was performed by Kaplan-Meier estimator and hazard ratio (HR) set by log-rank test for the primary and secondary endpoints, respectively Disease-Free Survival (DFS) and Overall Survival (OS). According to Neo-Bioscore, the proposed prognostic model named Clustered Neo-Bioscore was classified into low (0–3), low-intermediate (4–5), high-intermediate (6) and high (7) risk. The prognostic accuracy for recurrence risk was assessed by time-dependent receiver operating characteristic (time-ROC) methodology. Multivariate Cox regression assessed the menopausal status, histological grade, Ki-67, estrogen receptor, HER2, tumor subtype, pathological and clinical stages. Confidence interval at 95% (CI95%) and statistical significance at set 2-sided p-value less than 0.05 were adopted. Results Among the 310 women enrolled, 267 patients (86.2%) had non-pCR carcinoma presenting size T3/T4 (63.3%), node-positive axilla (74.9%), stage III (62.9%), Ki-67 ≥ 20% (71.9%) and non-luminal A (78.3%). Non-pCR carcinoma presented worse DFS-3y (HR = 3.88, CI95% = 1.18–11.95) but not OS-3y (HR = 2.73, CI95% = 0.66–11.40). Clustered Neo-Bioscore discerned the recurrence risk for non-pCR carcinoma: low (DFS-3y = 0.86; baseline), low-intermediate (DFS-3y = 0.70; HR = 2.61), high-intermediate (DFS-3y = 0.13, HR = 14.05), and high (DFS-3y = not achieved; HR = 22.19). The prognostic accuracy was similar between Clustered Neo-Bioscore and Neo-Bioscore (0.76 vs 0.78, p > 0.05). Triple-negative subtype (HR = 3.6, CI95% = 1.19–10.92) and pathological stages II (HR = 5.35, CI95% = 1.19–24.01) and III (HR = 6.56, CI95% = 1.29–33.32) were prognoses for low-intermediate risk, whereas pathological stage III (HR = 13.0, CI95% = 1.60–106.10) was prognosis for low risk. Conclusions Clustered Neo-Bioscore represents a novel prognostic model of non-pCR carcinoma undergoing NAC with a more simplified and appropriate score pattern in the assessment of prognostic factors. Electronic supplementary material The online version of this article (10.1186/s12885-019-5812-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Uanderson Resende
- Division of Gynecological and Mammary Oncology, Woman's Hospital Dr José Aristodemo Pinotti (CAISM) of State University of Campinas (UNICAMP), Rua Alexander Fleming 101, Campinas, São Paulo, 13083-083, Brazil.
| | - César Cabello
- Division of Gynecological and Mammary Oncology, Woman's Hospital Dr José Aristodemo Pinotti (CAISM) of State University of Campinas (UNICAMP), Rua Alexander Fleming 101, Campinas, São Paulo, 13083-083, Brazil
| | - Susana Oliveira Botelho Ramalho
- Division of Gynecological and Mammary Oncology, Woman's Hospital Dr José Aristodemo Pinotti (CAISM) of State University of Campinas (UNICAMP), Rua Alexander Fleming 101, Campinas, São Paulo, 13083-083, Brazil
| | - Luiz Carlos Zeferino
- Division of Gynecological and Mammary Oncology, Woman's Hospital Dr José Aristodemo Pinotti (CAISM) of State University of Campinas (UNICAMP), Rua Alexander Fleming 101, Campinas, São Paulo, 13083-083, Brazil
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Palacios J, Matías-Guiu X, Rodríguez-Peralto JL, de Álava E, López JI. [Clinical challenges and implications of intratumor heterogeneity]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:234-241. [PMID: 31530406 DOI: 10.1016/j.patol.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 02/06/2023]
Abstract
Tumors display a high, albeit variable, grade of intratumor heterogeneity, both from a clinical and a morphological viewpoint. Furthermore, recent methods of large-scale molecular analysis demonstrate to what extent tumors can also be heterogeneous from a molecular perspective. This is of paramount importance for patients as it has a great impact on the success of so-called precision therapies and explains the reason for a significant number of therapeutic failures in modern oncology. We present an up-to-date review of the latest findings in a group of tumors with a high social impact, commonly seen in the daily routine of the pathology laboratory.
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Affiliation(s)
- José Palacios
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, IRyCIS, CIBERONC, Universidad de Alcalá de Henares, Madrid, España.
| | - Xavier Matías-Guiu
- Servicio de Anatomía Patológica, Hospital Universitario Arnau de Vilanova y Hospital Universitario Bellvitge, Universidad de Lleida, IRBLLEIDA, IDIBELL, CIBERONC, Lleida, España
| | - Jose Luis Rodríguez-Peralto
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Instituto I+12, CIBERONC, Universidad Complutense, Madrid, España
| | - Enrique de Álava
- Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío y AGS Osuna, Universidad de Sevilla, IBiS, CSIC, CIBERONC, Sevilla, España
| | - José Ignacio López
- Servicio de Anatomía Patológica, Hospital Universitario Cruces, Instituto Biocruces-Bizkaia, Universidad del País Vasco (UPV/EHU), Barakaldo, Vizcaya, España; Servicio de Anatomía Patológica, Hospital Universitario Cruces, Instituto Biocruces-Bizkaia, Universidad del País Vasco (UPV/EHU), Barakaldo, Vizcaya, España.
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Li HN, Chen CH. Ultrasound-Guided Core Needle Biopsies of Breast Invasive Carcinoma: When One Core is Sufficient for Pathologic Diagnosis and Assessment of Hormone Receptor and HER2 Status. Diagnostics (Basel) 2019; 9:diagnostics9020054. [PMID: 31086096 PMCID: PMC6627756 DOI: 10.3390/diagnostics9020054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023] Open
Abstract
Ultrasound (US)-guided core needle biopsy is considered the gold standard procedure with regard to preoperative diagnosis of breast carcinomas. However, there is no clear standard for the number of cores considered to be sufficient for pathologic evaluation, including the expression of surface hormone markers and HER2 status. Images and pathologic slides demonstrating breast invasive carcinoma from a single institution were thus retrospectively reviewed over a 12 month period. The results indicated that one core is sufficient for the diagnosis of invasive carcinomas, along with a reliable assessment of hormone receptor and HER2 status in many cases. The option of applying additional cores is recommended for some cases.
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Affiliation(s)
- Hsin-Ni Li
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung City 40705, Taiwan.
| | - Chuan-Han Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung City 40705, Taiwan.
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Estrogen receptor variants in ER-positive basal-type breast cancers responding to therapy like ER-negative breast cancers. NPJ Breast Cancer 2019; 5:15. [PMID: 31016233 PMCID: PMC6472385 DOI: 10.1038/s41523-019-0109-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/22/2019] [Indexed: 01/05/2023] Open
Abstract
Immunohistochemically ER-positive HER2-negative (ER+HER2−) breast cancers are classified clinically as Luminal-type. We showed previously that molecular subtyping using the 80-gene signature (80-GS) reclassified a subset of ER+HER2− tumors to molecular Basal-type. We report here that molecular reclassification is associated with expression of dominant-negative ER variants and evaluate response to neoadjuvant therapy and outcome in the prospective neoadjuvant NBRST study (NCT01479101). The 80-GS reclassified 91 of 694 (13.1%) immunohistochemically Luminal-type tumors to molecular Basal-type. Importantly, all 91 discordant tumors were classified as high-risk, whereas only 66.9% of ER+/Luminal-type tumors were classified at high-risk for disease recurrence (i.e., Luminal B) (P < 0.001). ER variant mRNA (ER∆3, ER∆7, and ERα-36) analysis performed on 84 ER+/Basal tumors and 48 ER+/Luminal B control tumors revealed that total ER mRNA was significantly lower in ER+/Basal tumors. The relative expression of ER∆7/total ER was significantly higher in ER+/Basal tumors compared to ER+/Luminal B tumors (P < 0.001). ER+/Basal patients had similar pathological complete response (pCR) rates following neoadjuvant chemotherapy as ER−/Basal patients (34.3 vs. 37.6%), and much higher than ER+/Luminal A or B patients (2.3 and 5.8%, respectively). Furthermore, 3-year distant metastasis-free interval (DMFI) for ER+/Basal patients was 65.8%, significantly lower than 96.3 and 88.9% for ER+/Luminal A and B patients, respectively, (log-rank P < 0.001). Significantly lower total ER mRNA and increased relative ER∆7 dominant-negative variant expression provides a rationale why ER+/Basal breast cancers are molecularly ER-negative. Identification of this substantial subset of patients is clinically relevant because of the higher pCR rate to neoadjuvant chemotherapy and correlation with clinical outcome.
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Koopman T, Buikema HJ, Hollema H, de Bock GH, van der Vegt B. What is the added value of digital image analysis of HER2 immunohistochemistry in breast cancer in clinical practice? A study with multiple platforms. Histopathology 2019; 74:917-924. [PMID: 30585668 PMCID: PMC6850320 DOI: 10.1111/his.13812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/20/2018] [Indexed: 11/27/2022]
Abstract
AIMS We aimed to compare digital image analysis (DIA) of human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) in breast cancer by two platforms: (i) to validate DIA against standard diagnostics; and (ii) to evaluate the added value of DIA in clinical practice. METHODS AND RESULTS HER2 IHC and in-situ hybridisation (ISH) were performed on 152 consecutive invasive breast carcinomas. IHC scores were determined with DIA using two independent platforms. Manual scoring was performed by two independent observers. HER2 status was considered positive in 3+ and ISH-positive 2+ cases. HER2 status using DIA was compared to HER2 status with standard diagnostics (manual scoring with ISH in 2+ cases). Interplatform agreement of IHC scores was 'moderate' (linear weighted κ = 0.58), agreement between manual scoring and platform A was 'moderate' (κ = 0.60) and between manual scoring and platform B 'almost perfect' (κ = 0.85). Compared to manual scoring, DIA resulted in a reduction of 2+ cases from 17.1 to 1.3% with platform A and from 17.1 to 15.8% with platform B. However, compared to standard diagnostics, there were three false-negative cases with DIA using platform A [81.3% sensitivity, 100% specificity, 100% positive predictive value (PPV), 97.8% negative predictive value (NPV)]. Sensitivity, specificity, PPV and NPV were 100% with DIA using platform B. CONCLUSIONS DIA of HER2 IHC is a valid tool in determining HER2 status in breast carcinoma. Algorithms in different platforms can behave differently, and optimal calibration is essential. In clinical practice, DIA offers an objective alternative to manual scoring, but a reduction in 2+ cases could result in loss of sensitivity.
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Affiliation(s)
- Timco Koopman
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henk J Buikema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Harry Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hormone- and HER2-receptor assessment in 33,046 breast cancer patients: a nationwide comparison of positivity rates between pathology laboratories in the Netherlands. Breast Cancer Res Treat 2019; 175:487-497. [PMID: 30825048 PMCID: PMC6533417 DOI: 10.1007/s10549-019-05180-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 01/13/2023]
Abstract
Purpose Patient management of invasive breast cancer (IBC) is to a large extent based on hormone- and HER2-receptor assessment. High-quality, reliable receptor assessment is of key importance as false results may lead to under- or overtreatment of patients. Surveillance of case-mix adjusted positivity rates has been suggested as a tool to identify laboratories with insufficient testing assays, as this covers the whole process of receptor assessment and enables laboratories to benchmark their positivity rates against other laboratories. We studied laboratory-specific variation in hormone- and HER2 positivity rates of 33,046 breast cancer patients using real-life nationwide data. Methods All synoptic pathology reports of IBC resection-specimens, obtained between 2013 and 2016, were retrieved from the nationwide Dutch pathology registry (PALGA). Absolute and case-mix adjusted receptor positivity rates were compared to the mean national proportion and presented in funnel plots in separate analyses for estrogen (ER), progesterone (PR) and HER2. Case-mix adjustment was performed by multivariable logistic regression. Results 33,794 IBC lesions from 33,046 patients of 39 pathology laboratories were included. After case-mix adjustment, mean positivity rates were 87.2% for ER (range 80.4–94.3), 71.3% for PR (62.5–77.5%), and 9.9% for HER2 (5.5–12.7%). Overall, 14 (35.9%), 17 (43.6%) and 11 (28.2%) laboratories showed positivity rates outside the 95% confidence interval for ER, PR and HER2, respectively. Conclusion This nationwide study shows that absolute variation in hormone- and HER2-receptor positivity rates between Dutch pathology laboratories is limited. Yet, the considerable number of outlying laboratories shows that there is still need for improvement. Continuous monitoring and benchmarking of positivity rates may help to realize this.
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Robertson S, Rönnlund C, de Boniface J, Hartman J. Re-testing of predictive biomarkers on surgical breast cancer specimens is clinically relevant. Breast Cancer Res Treat 2019; 174:795-805. [PMID: 30659433 PMCID: PMC6439213 DOI: 10.1007/s10549-018-05119-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE The accuracy of predictive and prognostic biomarker assessment in breast cancer is paramount since these guide therapy decisions. The aim was to investigate the concordance of biomarkers and immunohistochemical (IHC)-based surrogate tumor subtypes between core needle biopsies (CNB) and consecutive paired breast cancer surgical resections. METHODS This retrospective study comprised two cohorts of patients with primary breast cancer diagnosed between 2016 and 2017: one treated with primary surgery (n = 526) and one with neoadjuvant chemotherapy (NAC) (n = 216). The agreement between preoperative CNB and paired tumor specimens regarding the assessment of biomarkers and surrogate tumor subtypes was evaluated in both cohorts. RESULTS In the primary surgery cohort, the concordance rates and kappa values for estrogen receptor (ER), progesterone receptor (PR) and Ki67 were 98.6% (κ = 0.917), 89.3% (κ = 0.725) and 78.8% (κ = 0.529), respectively. Importantly, human epidermal growth factor receptor 2 (HER2) IHC assessment showed only moderate agreement (κ = 0.462). HER2 status combining IHC and in situ hybridization was discordant in 3.6% of cases, potentially impacting on indications for HER2-targeted therapy. The concordance rate for IHC-based surrogate tumor subtypes was only 73.2-78.3%. Generally lower concordance rates for ER, PR and HER2 were observed in the NAC cohort. Here, HER2 status was discordant in 7.4%. CONCLUSIONS The agreement of HER2 and Ki67 between CNB and paired surgical specimen in primary breast cancer is insufficient. Limited agreement of surrogate tumor subtypes indicates a significant clinical value of biomarker re-testing on surgical specimens.
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Affiliation(s)
- Stephanie Robertson
- Department of Oncology and Pathology, CCK, Karolinska Institutet, 17176, Stockholm, Sweden.
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden.
| | - Caroline Rönnlund
- Department of Oncology and Pathology, CCK, Karolinska Institutet, 17176, Stockholm, Sweden
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Capio St Göran's Hospital, Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology and Pathology, CCK, Karolinska Institutet, 17176, Stockholm, Sweden
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
- Stockholm South General Hospital, Stockholm, Sweden
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Liu M, Tang SX, Tsang JYS, Shi YJ, Ni YB, Law BKB, Tse GMK. Core needle biopsy as an alternative to whole section in IHC4 score assessment for breast cancer prognostication. J Clin Pathol 2018; 71:1084-1089. [PMID: 30228212 DOI: 10.1136/jclinpath-2018-205228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/17/2018] [Accepted: 08/18/2018] [Indexed: 12/21/2022]
Abstract
AIMS IHC4 score, based on expression of four routine markers (oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation marker, Ki67), is a recently developed, cost-effective prognostic tool in breast cancer. Possibly, the score may be useful also in advanced diseases where only core needle biopsy (CNB) is available and neoadjuvant therapy. However, its studies on CNB are scant. This study examined whether IHC4 score assessment on CNB is comparable to that from whole section (WS). METHODS Immunohistochemical (IHC) analysis was performed for ER, PR, HER2 and Ki67 on 108 paired CNB and WS to evaluate IHC4 score (with follow-up range 1-230 months and 5 relapse/death). Concordance between the two was examined. Factors that affected the concordance were analysed. Additionally, IHC4 score was compared with Nottingham Prognostic Index (NPI). RESULTS There was moderate concordance between IHC4 score on CNB and WS (all cases: κ=0.699, p<0.001; ER+ cases: κ=0.595, p<0.001). Among the IHC4 components, concordance for HER2 was the poorest (κ=0.178, p<0.001 in all cases; ER+ cases: κ=0.082, p<0.097). Significant factors affecting concordance between CNB and WS included number of cores, total core length and percentage of tumour cells in cores (p≤0.030), indicating the importance of sufficient sampling. Interestingly, the concordance was also affected by patients' age (p=0.039). There was poor agreement between IHC4 score and NPI (κ≤0.160). CONCLUSION Our results suggested that IHC4 score can be used on adequately sampled CNB. Its poor agreement with NPI highlights the independence of the two factors.
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Affiliation(s)
- Ming Liu
- Department of Pathology, First Affiliated Hospital, Xin-Jiang Medical University, Xin-Jiang, China
| | - Shao-Xian Tang
- Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Julia Y S Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu-Jie Shi
- Department of Pathology, Henan Province People's Hospital, Zhengzhou, China
| | - Yun-Bi Ni
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Gary M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Bulte JP, Halilovic A, Kalkman S, van Cleef PHJ, van Diest PJ, Strobbe LJA, de Wilt JHW, Bult P. Assessment of HER2 status in breast cancer biopsies is not affected by accelerated tissue processing. Histopathology 2018; 73:81-89. [PMID: 29495112 DOI: 10.1111/his.13507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022]
Abstract
AIMS To establish whether core needle biopsy (CNB) specimens processed with an accelerated processing method with short fixation time can be used to determine accurately the human epidermal growth factor receptor 2 (HER2) status of breast cancer. METHODS AND RESULTS A consecutive case-series from two high-volume breast clinics was created. We compared routine HER2 immunohistochemistry (IHC) assessment between accelerated processing CNB specimens and routinely processed postoperative excision specimens. Additional amplification-based testing was performed in cases with equivocal results. The formalin fixation time was less than 2 h and between 6 and 72 h, respectively. Fluorescence in-situ hybridisation and multiplex ligation-dependent probe amplification were used for amplification testing. One hundred and forty-four cases were included, 15 of which were HER2-positive on the routinely processed excision specimens. On the CNB specimens, 44 were equivocal on IHC and required an amplification-based test. Correlation between the CNB specimens and the corresponding excision specimens was high for final HER2 status, with an accuracy of 97% and a kappa of 0.85. CONCLUSIONS HER2 status can be determined reliably on CNB specimens with accelerated processing time using standard clinical testing methods. Using this accelerated technology the minimum 6 h of formalin fixation, which current guidelines consider necessary, can be decreased safely. This allows for a complete and expedited histology-based diagnosis of breast lesions in the setting of a one-stop-shop, same-day breast clinic.
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Affiliation(s)
- Joris P Bulte
- Department of General Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Altuna Halilovic
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Shona Kalkman
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Johannes H W de Wilt
- Department of General Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
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Kombak FE, Şahin H, Mollamemişoğlu H, Önem İ, Kaya H, Buğdaycı O, Arıbal E. Concordance of immunohistochemistry between core needle biopsy and surgical resection of breast cancer. Turk J Med Sci 2017; 47:1791-1796. [PMID: 29306240 DOI: 10.3906/sag-1702-152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: The purpose of this study was to evaluate the concordance of immunohistochemical (IHC) parameters of breast lesions between the core needle biopsy (CNB) and the surgical resection specimen. Materials and methods: CNB and resection specimens of female patients were retrospectively analyzed. ER, PR, HER-2, and Ki-67 parameters were compared for each patient. A total of 284 cases were assessed. Forty-one and 48 cases were excluded from the HER-2 and Ki-67 examinations, respectively, because the CNBs did not allow for IHC. Results: Concordance rates were 93.3% for ER, 89.4% for PR, 90.1% for HER-2, and 80.9% for Ki-67.Conclusion: CNB is accurate for the evaluation of the surrogate molecular profile of invasive breast cancer despite the heterogeneity of tumors.
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34
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You K, Park S, Ryu JM, Kim I, Lee SK, Yu J, Kim SW, Nam SJ, Lee JE. Comparison of Core Needle Biopsy and Surgical Specimens in Determining Intrinsic Biological Subtypes of Breast Cancer with Immunohistochemistry. J Breast Cancer 2017; 20:297-303. [PMID: 28970856 PMCID: PMC5620445 DOI: 10.4048/jbc.2017.20.3.297] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/20/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE We evaluated the concordance between core needle biopsy (CNB) and surgical specimens on examining intrinsic biological subtypes and receptor status, and determined the accuracy of CNB as a basic diagnostic method. METHODS We analyzed breast cancer patients with paired CNB and surgical specimen samples during 2014. We used monoclonal antibodies for nuclear staining, and estrogen receptor (ER) and progesterone receptor (PR) status evaluation. A positive test was defined as staining greater than or equal to 1% of tumor cells. Human epidermal growth factor receptor 2 (HER2) was graded by immunohistochemistry and scored as 0 to 3+ according to the recommendations of the American Society of Clinical Oncology/College of American Pathologists. Ki-67 immunostaining was performed using the monoclonal antibody Ki-67, and the results were divided at 10% intervals. The cutoff value for high Ki-67 was defined as 20%. Concordance analysis of ER, PR, HER2, Ki-67, and five intrinsic biological subtypes was performed on CNB and surgical specimens. Statistical analysis for concordance was calculated using κ-tests. RESULTS We found very good agreement for ER and PR with a concordance of 96.7% for ER (κ=0.903), and 94.3% for PR (κ=0.870). HER2 and Ki-67 showed concordance rates of 84.8% (κ=0.684) and 83.5% (κ=0.647), respectively, which were interpreted as good agreement. Five subgroups analysis showed 85.8% agreement and κ-value of 0.786, also indicating good agreement. CONCLUSION CNB showed high diagnostic accuracy compared with surgical specimens, and good agreement for ER, PR, HER2, and Ki-67. Our findings reaffirmed the recommendation of CNB as an initial procedure for breast cancer diagnosis, and the assessment of receptor status and intrinsic biological subtypes to determine further treatment plans.
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Affiliation(s)
- Kiho You
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungmin Park
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Isaac Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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van Zelst JCM, Balkenhol M, Tan T, Rutten M, Imhof-Tas M, Bult P, Karssemeijer N, Mann RM. Sonographic Phenotypes of Molecular Subtypes of Invasive Ductal Cancer in Automated 3-D Breast Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1820-1828. [PMID: 28576620 DOI: 10.1016/j.ultrasmedbio.2017.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/27/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Our aim was to investigate whether Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon descriptors can be used as imaging biomarkers to differentiate molecular subtypes (MS) of invasive ductal carcinoma (IDC) in automated breast ultrasound (ABUS). We included 125 IDCs diagnosed between 2010 and 2014 and imaged with ABUS at two institutes retrospectively. IDCs were classified as luminal A or B, HER2 enriched or triple negative based on reports of histopathologic analysis of surgical specimens. Two breast radiologists characterized all IDCs using the BI-RADS-US lexicon and specific ABUS features. Univariate and multivariate analyses were performed. A multinomial logistic regression model was built to predict the MSs from the imaging characteristics. BI-RADS-US descriptor margins and the retraction phenomenon are significantly associated with MSs (both p < 0.001) in both univariate and multivariate analysis. Posterior acoustic features and spiculation pattern severity were only significantly associated in univariate analysis (p < 0.001). Luminal A IDCs tend to have more prominent retraction patterns than luminal B IDCs. HER2-enriched and triple-negative IDCs present significantly less retraction than the luminal subtypes. The mean accuracy of MS prediction was 0.406. Overall, several BI-RADS-US descriptors and the coronal retraction phenomenon and spiculation pattern are associated with MSs, but prediction of MSs on ABUS is limited.
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Affiliation(s)
- Jan C M van Zelst
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Maschenka Balkenhol
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tao Tan
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Matthieu Rutten
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Mechli Imhof-Tas
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Chen J, Wang Z, Lv Q, Du Z, Tan Q, Zhang D, Xiong B, Zeng H, Gou J. Comparison of Core Needle Biopsy and Excision Specimens for the Accurate Evaluation of Breast Cancer Molecular Markers: a Report of 1003 Cases. Pathol Oncol Res 2017; 23:769-775. [PMID: 28074330 DOI: 10.1007/s12253-017-0187-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/02/2017] [Indexed: 02/05/2023]
Abstract
In this study, we compared the accuracy of marker evaluation in core needle biopsy (CNB) specimens versus excision specimens (ESs) from breast cancer patients. This retrospective study used data collected from the breast cancer database at the West China Hospital, China. Immunohistochemistry (IHC) results from CNB specimens and ESs were compared, using estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 as markers. Molecular subtyping and endocrine therapy usage correlations based on CNB samples and ESs were evaluated. The results obtained from CNB samples and ESs exhibited substantial agreement for the detection of ER (κ = 0.522), PR (κ = 0.441), and HER2 (κ = 0.451), and also influenced endocrine therapy usage. Fair and poor correlations were observed for Ki-67 staining and molecular subtyping (κ = 0.195), respectively. This disagreement might be attributable to a combination of heterogeneity and large tumor size. This study indicates that the discordance rate in molecular marker staining between CNB specimens and ESs is significant enough that results obtained with CNB specimens should be used cautiously or verified using ESs.
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Affiliation(s)
- Jie Chen
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zu Wang
- Tumor Molecular Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qing Lv
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Zhenggui Du
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qiuwen Tan
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | | | | | - Helin Zeng
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Juxiang Gou
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Meattini I, Bicchierai G, Saieva C, De Benedetto D, Desideri I, Becherini C, Abdulcadir D, Vanzi E, Boeri C, Gabbrielli S, Lucci F, Sanchez L, Casella D, Bernini M, Orzalesi L, Vezzosi V, Greto D, Mangoni M, Bianchi S, Livi L, Nori J. Impact of molecular subtypes classification concordance between preoperative core needle biopsy and surgical specimen on early breast cancer management: Single-institution experience and review of published literature. Eur J Surg Oncol 2016; 43:642-648. [PMID: 27889196 DOI: 10.1016/j.ejso.2016.10.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/01/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Core needle biopsy (CNB) plays a crucial role as diagnostic tool for breast cancer (BC). The characterization of biomarkers status before surgical treatment is crucial when primary systemic therapy is a therapeutic option. The aim of this analysis was to report concordance between preoperative CNB and surgical specimen (SS) in evaluating biomarkers and molecular subtypes. METHODS Data have been collected from a cohort of 101 patients affected by early BC treated at Careggi Florence University Hospital, between January 2014 and March 2015. The conformity between molecular subtype classification was tested using kappa (κ) test. RESULTS Mean age was 57.5 years (range 29-86). There was concordance between the estrogen receptor (ER) assessment on CNB and SS in 95 cases (94.1%). Concordance of the progesterone receptor (PgR) assessment was observed in 89 cases (88.1%). Concordance for detecting immunohistochemistry-assessed BC molecular subtypes was 87.1% (κ = 0.78). Concerning Ki-67 evaluation, we report a concordance rate of 88.1% (κ = 0.68). The evaluation of luminal A plus luminal B/HER negative subgroup showed a κ-value of 0.65. CONCLUSIONS CNB showed good accuracy in evaluating hormonal receptors status, HER2, and BC molecular subtypes. Evaluation of Ki67 status was less accurate than other biomarkers; therefore, we recommend that it should be detected both on CNB and SS samples, especially in hormonal positive HER2 negative tumors, in order to avoid a misclassification of tumor subtypes that could lead to an omission of potential effective systemic therapy.
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Affiliation(s)
- I Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy.
| | - G Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - C Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - D De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - I Desideri
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy
| | - C Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy
| | - D Abdulcadir
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - E Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - C Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S Gabbrielli
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - F Lucci
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - L Sanchez
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - D Casella
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - M Bernini
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - L Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - V Vezzosi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - D Greto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy
| | - M Mangoni
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy
| | - S Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - L Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy
| | - J Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Bernhardt SM, Dasari P, Walsh D, Townsend AR, Price TJ, Ingman WV. Hormonal Modulation of Breast Cancer Gene Expression: Implications for Intrinsic Subtyping in Premenopausal Women. Front Oncol 2016; 6:241. [PMID: 27896218 PMCID: PMC5107819 DOI: 10.3389/fonc.2016.00241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/27/2016] [Indexed: 12/12/2022] Open
Abstract
Clinics are increasingly adopting gene-expression profiling to diagnose breast cancer subtype, providing an intrinsic, molecular portrait of the tumor. For example, the PAM50-based Prosigna test quantifies expression of 50 key genes to classify breast cancer subtype, and this method of classification has been demonstrated to be superior over traditional immunohistochemical methods that detect proteins, to predict risk of disease recurrence. However, these tests were largely developed and validated using breast cancer samples from postmenopausal women. Thus, the accuracy of such tests has not been explored in the context of the hormonal fluctuations in estrogen and progesterone that occur during the menstrual cycle in premenopausal women. Concordance between traditional methods of subtyping and the new tests in premenopausal women is likely to depend on the stage of the menstrual cycle at which the tissue sample is taken and the relative effect of hormones on expression of genes versus proteins. The lack of knowledge around the effect of fluctuating estrogen and progesterone on gene expression in breast cancer patients raises serious concerns for intrinsic subtyping in premenopausal women, which comprise about 25% of breast cancer diagnoses. Further research on the impact of the menstrual cycle on intrinsic breast cancer profiling is required if premenopausal women are to benefit from the new technology of intrinsic subtyping.
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Affiliation(s)
- Sarah M Bernhardt
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Pallave Dasari
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - David Walsh
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide , Woodville, SA , Australia
| | - Amanda R Townsend
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Timothy J Price
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Wendy V Ingman
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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Hadad SM, Jordan LB, Roy PG, Purdie CA, Iwamoto T, Pusztai L, Moulder-Thompson SL, Thompson AM. A prospective comparison of ER, PR, Ki67 and gene expression in paired sequential core biopsies of primary, untreated breast cancer. BMC Cancer 2016; 16:745. [PMID: 27658825 PMCID: PMC5034430 DOI: 10.1186/s12885-016-2788-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sequential biopsy of breast cancer is used to assess biomarker effects and drug efficacy. The preoperative "window of opportunity" setting is advantageous to test biomarker changes in response to therapeutic agents in previously untreated primary cancers. This study tested the consistency over time of paired, sequential biomarker measurements on primary, operable breast cancer in the absence of drug therapy. METHODS Immunohistochemistry was performed for ER, PR and Ki67 on paired preoperative/operative tumor samples taken from untreated patients within 2 weeks of each other. Microarray analysis on mRNA extracted from formalin fixed paraffin embedded cores was performed using Affymetrix based arrays on paired core biopsies analysed using Ingenuity Pathway Analysis (IPA) and Gene Set Analysis (GSA). RESULTS In 41 core/resection pairs, the recognised trend to lower ER, PR and Ki67 score on resected material was confirmed. Concordance for ER, PR and Ki67 without changing biomarker status (e.g. ER+ to ER-) was 90, 74 and 80 % respectively. However, in 23 paired core samples (diagnostic core v on table core), Ki67 using a cut off of 13.25 % was concordant in 22/23 (96 %) and differences in ER and PR immunohistochemistry by Allred or Quickscore between the pairs did not impact hormone receptor status. IPA and GSA demonstrated substantial gene expression changes between paired cores at the mRNA level, including reduced expression of ER pathway analysis on the second core, despite the absence of drug intervention. CONCLUSIONS Sequential core biopsies of primary breast cancer (but not core versus resection) was consistent and is appropriate to assess the effects of drug therapy in vivo on ER, PR and Ki67 using immunohistochemistry. Conversely, studies utilising mRNA expression may require non-treatment controls to distinguish therapeutic from biopsy differences.
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Affiliation(s)
| | - Lee B. Jordan
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | | | - Colin A. Purdie
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | - Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University, Okayama, Japan
| | - Lajos Pusztai
- Yale Medical Oncology, PO Box 208028, New Haven, 06520 CT USA
| | - Stacy L. Moulder-Thompson
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Houston, 77030 TX USA
| | - Alastair M. Thompson
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Houston, 77030 TX USA
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Pearce DA, Arthur LM, Turnbull AK, Renshaw L, Sabine VS, Thomas JS, Bartlett JMS, Dixon JM, Sims AH. Tumour sampling method can significantly influence gene expression profiles derived from neoadjuvant window studies. Sci Rep 2016; 6:29434. [PMID: 27384960 PMCID: PMC4935948 DOI: 10.1038/srep29434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/17/2016] [Indexed: 01/09/2023] Open
Abstract
Patient-matched transcriptomic studies using tumour samples before and after treatment allow inter-patient heterogeneity to be controlled, but tend not to include an untreated comparison. Here, Illumina BeadArray technology was used to measure dynamic changes in gene expression from thirty-seven paired diagnostic core and surgically excised breast cancer biopsies obtained from women receiving no treatment prior to surgery, to determine the impact of sampling method and tumour heterogeneity. Despite a lack of treatment and perhaps surprisingly, consistent changes in gene expression were identified during the diagnosis-surgery interval (48 up, 2 down; Siggenes FDR 0.05) in a manner independent of both subtype and sampling-interval length. Instead, tumour sampling method was seen to directly impact gene expression, with similar effects additionally identified in six published breast cancer datasets. In contrast with previous findings, our data does not support the concept of a significant wounding or immune response following biopsy in the absence of treatment and instead implicates a hypoxic response following the surgical biopsy. Whilst sampling-related gene expression changes are evident in treated samples, they are secondary to those associated with response to treatment. Nonetheless, sampling method remains a potential confounding factor for neoadjuvant study design.
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Affiliation(s)
- Dominic A Pearce
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Laura M Arthur
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Arran K Turnbull
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Lorna Renshaw
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Vicky S Sabine
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jeremy S Thomas
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - John M S Bartlett
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - J Michael Dixon
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Andrew H Sims
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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41
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Vohra P, Buelow B, Chen YY, Serrano M, Vohra MS, Berry A, Ljung BM. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression in breast cancer FNA cell blocks and paired histologic specimens: A large retrospective study. Cancer Cytopathol 2016; 124:828-835. [PMID: 27315045 DOI: 10.1002/cncy.21745] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/24/2016] [Accepted: 04/19/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Molecular analysis represents an increasingly important component of the pathologic examination of tumor specimens. Notably, the characterization of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression in breast cancer specimens provides critical prognostic and predictive information. The objective of the current study was to compare the concordance of these markers as determined on fine-needle aspiration (FNA) cell blocks compared with tissue blocks prepared from surgical specimens. METHODS A total of 134 cases of breast carcinoma were identified from 2002 through 2014 with both FNA cell blocks (fixed in 10% formalin) and corresponding available tissue blocks and ER, PR, and HER2 were characterized in both specimens. Negative and positive concordances were determined for ER and PR in cell blocks compared with tissue blocks, and for HER2 immunohistochemistry on cell blocks and tissue blocks versus the corresponding reference method, fluorescence in situ hybridization (FISH). RESULTS Concordance for ER expression evaluated on a cell block compared with the corresponding tissue block was 96.2%. Concordance for PR expression was 77.5%. Overall agreement of HER2 FISH testing between cell blocks and tissue blocks was 96.7%. For both cell blocks and tissue blocks, HER2 expression by immunohistochemistry demonstrated ≥98% positive and negative concordance with the FISH reference method. CONCLUSIONS ER, PR, and HER2 determination on FNA-acquired cell block (fixed exclusively in 10% formalin) showed excellent agreement for ER and HER2 and moderate agreement for PR with the corresponding tissue block. These findings support the equivalency of ER and HER2 evaluation performed on FNA cell blocks compared with surgical tissue blocks. Cancer Cytopathol 2016;124:828-35. © 2016 American Cancer Society.
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Affiliation(s)
- Poonam Vohra
- Department of Pathology, University of California at San Francisco, San Francisco, California
| | - Benjamin Buelow
- Department of Pathology, University of California at San Francisco, San Francisco, California
| | - Yunn-Yi Chen
- Department of Pathology, University of California at San Francisco, San Francisco, California
| | - Maria Serrano
- Department of Pathology, Kaiser Permanente Medical Center, San Francisco
| | | | - Anna Berry
- Cell Netix Pathology and Laboratories, Swedish Cancer Institute
| | - Britt-Marie Ljung
- Department of Pathology, University of California at San Francisco, San Francisco, California
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42
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Gahlaut R, Bennett A, Fatayer H, Dall BJ, Sharma N, Velikova G, Perren T, Dodwell D, Lansdown M, Shaaban AM. Effect of neoadjuvant chemotherapy on breast cancer phenotype, ER/PR and HER2 expression – Implications for the practising oncologist. Eur J Cancer 2016; 60:40-8. [DOI: 10.1016/j.ejca.2016.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 02/08/2023]
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43
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Buckley NE, Forde C, McArt DG, Boyle DP, Mullan PB, James JA, Maxwell P, McQuaid S, Salto-Tellez M. Quantification of HER2 heterogeneity in breast cancer-implications for identification of sub-dominant clones for personalised treatment. Sci Rep 2016; 6:23383. [PMID: 26996207 PMCID: PMC4800308 DOI: 10.1038/srep23383] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/01/2016] [Indexed: 01/25/2023] Open
Abstract
Breast cancer is a heterogeneous disease, at both an inter- and intra-tumoural level. Appreciating heterogeneity through the application of biomarkers and molecular signatures adds complexity to tumour taxonomy but is key to personalising diagnosis, treatment and prognosis. The extent to which heterogeneity exists, and its interpretation remains a challenge to pathologists. Using HER2 as an exemplar, we have developed a simple reproducible heterogeneity index. Cell-to-cell HER2 heterogeneity was extensive in a proportion of both reported 'amplified' and 'non-amplified' cases. The highest levels of heterogeneity objectively identified occurred in borderline categories and higher ratio non-amplified cases. A case with particularly striking heterogeneity was analysed further with an array of biomarkers in order to assign a molecular diagnosis. Broad biological complexity was evident. In essence, interpretation, depending on the area of tumour sampled, could have been one of three distinct phenotypes, each of which would infer different therapeutic interventions. Therefore, we recommend that heterogeneity is assessed and taken into account when determining treatment options.
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Affiliation(s)
- Niamh E. Buckley
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
| | - Claire Forde
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
| | - Darragh G. McArt
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
| | - David P. Boyle
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road., Belfast, UK
| | - Paul B. Mullan
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
| | - Jacqueline A. James
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road., Belfast, UK
| | - Perry Maxwell
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road., Belfast, UK
| | - Stephen McQuaid
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road., Belfast, UK
| | - Manuel Salto-Tellez
- Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road., Belfast, UK
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44
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Niikura N, Tomotaki A, Miyata H, Iwamoto T, Kawai M, Anan K, Hayashi N, Aogi K, Ishida T, Masuoka H, Iijima K, Masuda S, Tsugawa K, Kinoshita T, Nakamura S, Tokuda Y. Changes in tumor expression of HER2 and hormone receptors status after neoadjuvant chemotherapy in 21 755 patients from the Japanese breast cancer registry. Ann Oncol 2016; 27:480-7. [DOI: 10.1093/annonc/mdv611] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/28/2015] [Indexed: 12/17/2022] Open
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45
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Gheybi MK, Baradaran A, Mohajeri MR, Ostovar A, Hajalikhani P, Farrokhi S. Validity of immunohistochemistry method in predictingHER-2gene status and association of clinicopathological variables with it in invasive breast cancer patients. APMIS 2016; 124:365-71. [DOI: 10.1111/apm.12518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 12/21/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Mohammad Kazzem Gheybi
- Persian Gulf Tropical Medicine Research Centre; Bushehr University of Medical Sciences; Bushehr Iran
| | - Azar Baradaran
- Department of Pathology; Isfahan University of Medical Sciences; Isfahan Iran
| | | | - Afshin Ostovar
- Department of Epidemiology; Persian Gulf Tropical Medicine Research Centre; Bushehr University of Medical Sciences; Bushehr Iran
| | | | - Shokrollah Farrokhi
- Department of Immunology; Persian Gulf Tropical Medicine Research Center; Bushehr University of Medical Sciences; Bushehr Iran
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46
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Moten AS, Jayarajan SN, Willis AI. Spindle cell carcinoma of the breast: a comprehensive analysis. Am J Surg 2016; 211:716-21. [PMID: 26830716 DOI: 10.1016/j.amjsurg.2015.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast spindle cell malignancies are rare. No standard treatment exists. METHODS The Surveillance, Epidemiology, and End Results database was used to identify patients with breast spindle cell malignancies, 1992 to 2011. Descriptive statistical analysis and survival analysis were performed. RESULTS A total of 286 patients were identified (98.6% female). Approximately, 15% had estrogen receptor-positive tumors and 12.5% had progesterone receptor-positive tumors. Nearly 38% underwent partial mastectomy, whereas 55.5% underwent mastectomy. The frequency of partial mastectomy has increased in more recent years. One-third received radiation. Lymph node metastases were infrequent (9.3%) and distant metastases were uncommon (6.1%). Ten-year survival rates for patients with early-stage (I and II) disease were 83.9% after partial mastectomy, 86.7% after partial mastectomy plus radiation, and 71.6% after complete mastectomy. Three-year survival rates for patients with late-stage (III and IV) disease were low with 40.0% after complete mastectomy and 0% after complete mastectomy plus radiation. CONCLUSIONS This nationally representative analysis demonstrates that early-stage spindle cell carcinoma of the breast is adequately treated by partial mastectomy. Radiation may be considered for small, potentially early survival benefit. For late stage disease, complete mastectomy is appropriate; however, survival is poor, and radiation contributes no significant additional benefit.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Senthil N Jayarajan
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Alliric I Willis
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
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47
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Albanghali M, Green A, Rakha E, Aleskandarany M, Nolan C, Ellis I, Cheung KL. Construction of tissue microarrays from core needle biopsies - a systematic literature review. Histopathology 2015; 68:323-32. [PMID: 26266325 DOI: 10.1111/his.12802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In some clinical circumstances, core needle biopsy (CNB) may be the only source of material from cancer tissue for diagnostic use. The volume of tissue available in a CNB is low, and opportunities for research use can therefore be limited. The tissue microarray (TMA) principle, if applied to the use of CNBs, could facilitate research studies in circumstances where CNB specimens are available. However, various challenges are expected in applying such a technique in CNBs, which has limited their use in research. We therefore conducted a systematic review of the literature on this subject. A systematic search was carried out with CINAHL, EMBASE, the Cochrane library, and MEDLINE, to identify studies that have primarily developed methods for constructing TMAs from CNBs. Eight studies were found to meet the inclusion criteria; six of these employed the vertical rearrangement technique, and two used multiple layers of biopsy tissue. Representation of the CNB was significantly influenced by the quantity of tumour cells present in the original biopsy and the degree of heterogeneity of biomarker expression. This review shows that technologies have been developed to enable construction of TMAs from CNBs. However, challenges remain to improve amplification and representation.
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Affiliation(s)
- Mohammad Albanghali
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Andrew Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emad Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals City Hospital Campus, Nottingham, UK
| | - Mohamed Aleskandarany
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Nolan
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Ellis
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals City Hospital Campus, Nottingham, UK
| | - Kwok-Leung Cheung
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
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48
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Hicks DG, Fitzgibbons P, Hammond E. Core vs Breast Resection Specimen: Does It Make a Difference for HER2 Results? Am J Clin Pathol 2015; 144:533-5. [PMID: 26386073 DOI: 10.1309/ajcpp28eqmvaejih] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- David G. Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | | | - Elizabeth Hammond
- Department of Pathology, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City
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49
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Petrau C, Clatot F, Cornic M, Berghian A, Veresezan L, Callonnec F, Baron M, Veyret C, Laberge S, Thery JC, Picquenot JM. Reliability of Prognostic and Predictive Factors Evaluated by Needle Core Biopsies of Large Breast Invasive Tumors. Am J Clin Pathol 2015; 144:555-62. [PMID: 26386076 DOI: 10.1309/ajcp9kfvm2gzmndv] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Preoperative biopsy of breast cancer allows for prognostic/predictive marker assessment. However, large tumors, which are the main candidates for preoperative chemotherapy, are potentially more heterogeneous than smaller ones, which questions the reliability of histologic analyses of needle core biopsy (NCB) specimens compared with whole surgical specimens (WSS). We studied the histologic concordance between NCB specimens and WSS in tumors larger than 2 cm. METHODS Early pT2 or higher breast cancers diagnosed between 2008 and 2011 in our center, with no preoperative treatments, were retrospectively screened. We assessed the main prognostic and predictive validated parameters. Comparisons were performed using the κ test. RESULTS In total, 163 matched NCB specimens and WSS were analyzed. The correlation was excellent for ER and HER2 (κ = 0.94 and 0.91, respectively), moderate for PR (κ = 0.79) and histologic type (κ = 0.74), weak for Ki-67 (κ = 0.55), and minimal for SBR grade (κ = 0.29). Three of the 21 HER2-positive cases (14% of HER2-positive patients or 1.8% of all patients), by WSS analysis, were initially negative on NCB specimens even after chromogenic in situ hybridization. CONCLUSIONS NCB for large breast tumors allowed reliable determination of ER/PR expression. However, the SBR grade may be deeply underestimated, and false-negative evaluation of the HER2 status would have led to a detrimental lack of trastuzumab administration.
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Affiliation(s)
- Camille Petrau
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
- INSERM U918, Centre Henri Becquerel, Rouen, France
| | - Marie Cornic
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Anca Berghian
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Liana Veresezan
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | | | - Marc Baron
- Department of Surgery, Centre Henri Becquerel, Rouen, France
| | - Corinne Veyret
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Sophie Laberge
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | | | - Jean-Michel Picquenot
- INSERM U918, Centre Henri Becquerel, Rouen, France
- Department of Pathology, Centre Henri Becquerel, Rouen, France
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50
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Waaijer L, Willems SM, Verkooijen HM, Buck DB, van der Pol CC, van Diest PJ, Witkamp AJ. Impact of preoperative evaluation of tumour grade by core needle biopsy on clinical risk assessment and patient selection for adjuvant systemic treatment in breast cancer. Br J Surg 2015; 102:1048-55. [PMID: 26176340 DOI: 10.1002/bjs.9858] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/05/2015] [Accepted: 04/16/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Histological characteristics are important when making a decision on adjuvant systemic treatment in breast cancer. Preoperative assessments of core needle biopsy (CNB) specimens are becoming increasingly relevant as novel minimally invasive ablative techniques are introduced, because a surgical specimen is no longer obtained with these methods. The clinical impact of potential underestimation of tumour grade on preoperative CNB on clinical decision-making was evaluated. METHODS Histological tumour grade was reassessed on CNB and resection specimens from consecutive invasive ductal carcinomas diagnosed between 2010 and 2013. For each patient, the indication for systemic therapy was assessed, based on either CNB or surgical excision, in combination with clinical characteristics and imaging findings. The clinical impact of discordance between tumour grade on CNB versus the resection specimen was assessed. RESULTS The analysis included 213 invasive ductal carcinomas in 199 patients. Discordance in tumour grade between CNB and the resection specimen was observed in 64 (30.0 per cent) of 213 tumours (κ = 0.53, 95 per cent c.i. 0.43 to 0.63). A decision on adjuvant treatment based on CNB would have resulted in overtreatment in seven (3.5 per cent) and undertreatment in three (1.5 per cent) of 199 patients. In the undertreated patients, incorrect omission of adjuvant systemic treatment would have increased the predicted 10-year mortality rate by 2.6-5.2 per cent and 10-year recurrence rate by 8.2-15.3 per cent based on the online risk assessment tool Adjuvant! CONCLUSION The substantial discordance in tumour grading between CNB and resection specimens from breast cancer affects the indication for adjuvant therapy in only a small minority of patients with invasive ductal carcinoma. Assessment of tumour grade by CNB is feasible and accurate for the planning of postoperative treatment.
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Affiliation(s)
- L Waaijer
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S M Willems
- Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H M Verkooijen
- Departments of Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D B Buck
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C C van der Pol
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A J Witkamp
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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