1
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Tweel JED, Ecclestone BR, Gaouda H, Dinakaran D, Wallace MP, Bigras G, Mackey JR, Reza PH. Photon Absorption Remote Sensing Imaging of Breast Needle Core Biopsies Is Diagnostically Equivalent to Gold Standard H&E Histologic Assessment. Curr Oncol 2023; 30:9760-9771. [PMID: 37999128 PMCID: PMC10670721 DOI: 10.3390/curroncol30110708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
Photon absorption remote sensing (PARS) is a new laser-based microscope technique that permits cellular-level resolution of unstained fresh, frozen, and fixed tissues. Our objective was to determine whether PARS could provide an image quality sufficient for the diagnostic assessment of breast cancer needle core biopsies (NCB). We PARS imaged and virtually H&E stained seven independent unstained formalin-fixed paraffin-embedded breast NCB sections. These identical tissue sections were subsequently stained with standard H&E and digitally scanned. Both the 40× PARS and H&E whole-slide images were assessed by seven breast cancer pathologists, masked to the origin of the images. A concordance analysis was performed to quantify the diagnostic performances of standard H&E and PARS virtual H&E. The PARS images were deemed to be of diagnostic quality, and pathologists were unable to distinguish the image origin, above that expected by chance. The diagnostic concordance on cancer vs. benign was high between PARS and conventional H&E (98% agreement) and there was complete agreement for within-PARS images. Similarly, agreement was substantial (kappa > 0.6) for specific cancer subtypes. PARS virtual H&E inter-rater reliability was broadly consistent with the published literature on diagnostic performance of conventional histology NCBs across all tested histologic features. PARS was able to image unstained tissues slides that were diagnostically equivalent to conventional H&E. Due to its ability to non-destructively image fixed and fresh tissues, and the suitability of the PARS output for artificial intelligence assistance in diagnosis, this technology has the potential to improve the speed and accuracy of breast cancer diagnosis.
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Affiliation(s)
- James E. D. Tweel
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Benjamin R. Ecclestone
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Hager Gaouda
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Deepak Dinakaran
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Michael P. Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Gilbert Bigras
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - John R. Mackey
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Parsin Haji Reza
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
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2
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Lashen AG, Toss MS, Ghannam SF, Makhlouf S, Green A, Mongan NP, Rakha E. Expression, assessment and significance of Ki67 expression in breast cancer: an update. J Clin Pathol 2023; 76:357-364. [PMID: 36813558 DOI: 10.1136/jcp-2022-208731] [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: 12/16/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Ki67 expression is one of the most important and cost-effective surrogate markers to assess for tumour cell proliferation in breast cancer (BC). The Ki67 labelling index has prognostic and predictive value in patients with early-stage BC, particularly in the hormone receptor-positive, HER2 (human epidermal growth factor receptor 2)-negative (luminal) tumours. However, many challenges exist in using Ki67 in routine clinical practice and it is still not universally used in the clinical setting. Addressing these challenges can potentially improve the clinical utility of Ki67 in BC. In this article, we review the function, immunohistochemical (IHC) expression, methods for scoring and interpretation of results as well as address several challenges of Ki67 assessment in BC. The prodigious attention associated with use of Ki67 IHC as a prognostic marker in BC resulted in high expectation and overestimation of its performance. However, the realisation of some pitfalls and disadvantages, which are expected with any similar markers, resulted in an increasing criticism of its clinical use. It is time to consider a pragmatic approach and weigh the benefits against the weaknesses and identify factors to achieve the best clinical utility. Here we highlight the strengths of its performance and provide some insights to overcome the existing challenges.
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Affiliation(s)
- Ayat Gamal Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzan Fathy Ghannam
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histology, Suez Canal University, Ismailia, Egypt
| | - Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Andrew Green
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
| | - Nigel P Mongan
- School of Veterinary Medicine and Sciences, University of Nottingham, Nottingham, UK.,Department of Pharmacology, Weill Cornell Medicine, New York, New York, USA
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK .,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.,Pathology Department, Hamad Medical Corporation, Doha, Qatar
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3
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Lee W, Law T, Lu Y, Lee TK, Ibarra JA. Mitotic counts in one high power field in breast core biopsies is equivalent to counts in 10 high power fields. Pathology 2021; 54:43-48. [DOI: 10.1016/j.pathol.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
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4
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Lu C, Wei D, Zhang Y, Wang P, Zhang W. Long Non-Coding RNAs as Potential Diagnostic and Prognostic Biomarkers in Breast Cancer: Progress and Prospects. Front Oncol 2021; 11:710538. [PMID: 34527584 PMCID: PMC8436618 DOI: 10.3389/fonc.2021.710538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
Breast cancer is the most common malignancy among women worldwide, excluding non-melanoma skin cancer. It is now well understood that breast cancer is a heterogeneous entity that exhibits distinctive histological and biological features, treatment responses and prognostic patterns. Therefore, the identification of novel ideal diagnostic and prognostic biomarkers is of utmost importance. Long non-coding RNAs (lncRNAs) are commonly defined as transcripts longer than 200 nucleotides that lack coding potential. Extensive research has shown that lncRNAs are involved in multiple human cancers, including breast cancer. LncRNAs with dysregulated expression can act as oncogenes or tumor-suppressor genes to regulate malignant transformation processes, such as proliferation, invasion, migration and drug resistance. Intriguingly, the expression profiles of lncRNAs tend to be highly cell-type-specific, tissue-specific, disease-specific or developmental stage-specific, which makes them suitable biomarkers for breast cancer diagnosis and prognosis.
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Affiliation(s)
- Cuicui Lu
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Duncan Wei
- Department of Pharmacy, The First Affiliated Hospital of Medical College of Shantou University, Shantou, China
| | - Yahui Zhang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Peng Wang
- Department of Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wen Zhang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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5
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Lashen A, Ibrahim A, Katayama A, Ball G, Mihai R, Toss M, Rakha E. Visual assessment of mitotic figures in breast cancer: a comparative study between light microscopy and whole slide images. Histopathology 2021; 79:913-925. [PMID: 34455620 DOI: 10.1111/his.14543] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/24/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Visual assessment of mitotic figures in breast cancer (BC) remains a challenge. This is expected to be more pronounced in the digital pathology era. This study aims to refine the criteria of mitotic figure recognition, particularly in whole slide images (WSI). METHOD AND RESULTS Haematoxylin and eosin (H&E)-stained BC sections (n = 506) were examined using light microscopy (LM) and WSI. A set of features for identifying mitosis in WSI and to distinguish true figures from mimickers was developed. Changes in the mitotic count between the two platforms was explored. Morphological features of mitoses were recorded separately, including absence of nuclear membrane, chromatin hairy-like projections, shape, cytoplasmic features, mitotic cell size and relationship to surrounding cells. Each mitotic phase has its own mimickers. Fifty-eight per cent of mitoses showed absent hairy-like projection in WSI; however, 89% retained their ragged nuclear border, which distinguished them from mimickers including apoptotic cells, lymphocytes and dark elongated hyperchromatic structures. Mitosis in WSI showed loss of fine details, and there was a 20% average reduction rate of mitotic counts when compared to the same area on LM. Using refined mitosis recognition criteria in WSI resulted in a twofold improvement of interobserver concordance. However, when compared to LM, 19% of cases were underscored in WSIs. CONCLUSIONS All morphological features of mitosis should be considered to enable recognition and differentiation from their mimickers, particularly in WSI, to ensure reliable BC grading. Refining mitotic cut-offs per specific area when using WSI, based on the degree of reduction and association with outcome, is warranted.
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Affiliation(s)
- Ayat Lashen
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Asmaa Ibrahim
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ayaka Katayama
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Graham Ball
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Raluca Mihai
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Toss
- 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 Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
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6
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van Steenhoven JEC, Kuijer A, Kornegoor R, van Leeuwen G, van Gorp J, van Dalen T, van Diest PJ. Assessment of tumour proliferation by use of the mitotic activity index, and Ki67 and phosphohistone H3 expression, in early-stage luminal breast cancer. Histopathology 2020; 77:579-587. [PMID: 32557844 PMCID: PMC7539961 DOI: 10.1111/his.14185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022]
Abstract
AIMS Phosphohistone H3 (PhH3) has been proposed as a novel proliferation marker in breast cancer. This study compares the interobserver agreement for assessment of the mitotic activity index (MAI), Ki67 expression, and PhH3 in a cohort of oestrogen receptor (ER)-positive breast cancer patients. METHODS AND RESULTS Tumour samples of 159 luminal breast cancer patients were collected. MAI and PhH3 scores were assessed by three breast cancer pathologists. Ki67 scores were assessed separately by two of the three pathologists. PhH3-positive cells were counted in an area of 2 mm2 , with a threshold of ≥13 positive cells being used to discriminate between low-proliferative and high-proliferative tumours. Ki67 expression was assessed with the global scoring method. Ki67 percentages of <20% were considered to be low. The intraclass correlation coefficient (ICC) and Cohen's κ statistics were used to evaluate interobserver agreement. The impact on histological grading of replacing the MAI with PhH3 was assessed. Counting PhH3-positive cells was highly reproducible among all three observers (ICC of 0.86). The κ scores for the categorical PhH3 count (κ = 0.78, κ = 0.68, and κ = 0.80) reflected substantial agreement among all observers, whereas agreement for the MAI (κ = 0.38, κ = 0.52, and κ = 0.26) and Ki67 (κ = 0.55) was fair to moderate. When PhH3 was used to determine the histological grade, agreement in grading increased (PhH3, κ = 0.52, κ = 0.48, and κ = 0.52; MAI, κ = 0.43, κ = 0.35, and κ = 0.32), and the proportion of grade III tumours increased (14%, 18%, and 27%). CONCLUSION PhH3 seems to outperform Ki67 and the MAI as a reproducible means to measure tumour proliferation in luminal-type breast cancer. Variation in the assessment of histological grade might be reduced by using PhH3, but would result in an increase in the proportion of high-grade cancers.
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Affiliation(s)
- Julia E C van Steenhoven
- Department of SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Anne Kuijer
- Department of SurgerySt Antonius HospitalNieuwegeinThe Netherlands
| | | | - Gijs van Leeuwen
- Department of PathologySt Antonius HospitalNieuwegeinThe Netherlands
| | - Joost van Gorp
- Department of PathologySt Antonius HospitalNieuwegeinThe Netherlands
| | - Thijs van Dalen
- Department of SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Paul J van Diest
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
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7
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Cui H, Zhang D, Peng F, Kong H, Guo Q, Wu T, Wen X, Zhang L, Tian J. Identifying ultrasound features of positive expression of Ki67 and P53 in breast cancer using radiomics. Asia Pac J Clin Oncol 2020; 17:e176-e184. [PMID: 32779399 DOI: 10.1111/ajco.13397] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/21/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the relationship between ultrasonic findings and positive expression of Ki67 and P53 in breast cancer. MATERIAL AND METHODS Surgical resection specimens of 263 breast cancer lesions were examined. Ultrasound examination and pathological examination were performed on each lesion for retrospective analysis. We applied regression analysis to the ultrasonic features related to the positive expression of Ki67 and P53 and obtained the corresponding models. To analyze diagnostic efficiency, we calculated the area under the curve (AUC). Additionally, we created a heat map to show the results of the cluster analysis. RESULTS Lesions with higher Ki67 expression were associated with posterior acoustic enhancement, absence of an echo halo and a higher Breast Imaging Reporting and Data System (BI-RADS) category. P53-positive cancer were associated with an absence of an echo halo and a higher BI-RADS category. The AUC of the regression models of Ki67 and P53 was 0.78 and 0.71, respectively. CONCLUSIONS Our study revealed that breast cancer ultrasonic findings were closely related to expression of molecular indicators, suggesting that ultrasound can be used to provide useful information to clinicians.
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Affiliation(s)
- Hao Cui
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Dandan Zhang
- Department of Ultrasound Medicine, Heilongjiang provincial hospital, Heilongjiang, China
| | - Fuhui Peng
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Hanqing Kong
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qiang Guo
- Department of Ultrasound Medicine, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Tong Wu
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Xin Wen
- Department of Ultrasound Medicine, the Third Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Lei Zhang
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jiawei Tian
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
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8
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Huang YC, Chung HH, Dutkiewicz EP, Chen CL, Hsieh HY, Chen BR, Wang MY, Hsu CC. Predicting Breast Cancer by Paper Spray Ion Mobility Spectrometry Mass Spectrometry and Machine Learning. Anal Chem 2019; 92:1653-1657. [DOI: 10.1021/acs.analchem.9b03966] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ying-Chen Huang
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Hsin-Hsiang Chung
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | | | - Chih-Lin Chen
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Hua-Yi Hsieh
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Bo-Rong Chen
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Cheng-Chih Hsu
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
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Abstract
Since its first description at the Institute of Pathology in Kiel more than 34 years ago, the immunohistochemical proliferation marker Ki67 has been shown to be of prognostic significance in a huge number of retrospective and even some prospective trials on malignant tumours of various tissue derivation. Lack of standardization in the evaluation provides potential sources of variance in assessment. Tumour area to be assessed, minimum number of cells to be analyzed, tedious counting cell by cell or semiquantitative eyeballing, choice of immunohistochemical techniques represent nonstandardized issues that potentially lead to considerable assay heterogeneity. In addition, interpretation is not homogeneous, in particular with regard to thresholds between high and low proliferative activity. Due to these numerous potential methodological limitations, for a long time Ki67 was not generally accepted as a prognostic marker, in particular outside Germany and by nonpathologists. However, in recent years a shift has taken place. Despite the challenge that biological heterogeneity may be hidden by differences in assay performance, Ki67 now plays an important auxiliary role in grading of malignant neoplasms such as breast cancer, neuroendocrine tumours and malignant lymphomas. In this context it is applied in clinical diagnostics as well as in clinical trials for the purpose of stratification. Because of its widespread use, it is of utmost importance to raise awareness of the potential methodological limitations in order to use Ki67 in a meaningful way.
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Affiliation(s)
- H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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10
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Ahmeidat H, Purdie C, Jordan L, Fleming D, McCullough J, Evans A. Non-histopathological parameters associated with upgrade of breast tumours yielding a core biopsy report of histological grade 2 ductal no special type to grade 3 on excision. Eur J Surg Oncol 2018; 44:1720-1724. [DOI: 10.1016/j.ejso.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/10/2018] [Indexed: 01/29/2023] Open
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Dianatpour A, Faramarzi S, Geranpayeh L, Mirfakhraie R, Motevaseli E, Ghafouri-Fard S. Expression analysis of AFAP1-AS1 and AFAP1 in breast cancer. Cancer Biomark 2018; 22:49-54. [PMID: 29439313 DOI: 10.3233/cbm-170831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Long non-coding RNAs (lncRNA) constitute a significant percentage of RNAs with no translation to proteins. Their participation in fundamental aspects of cell physiology as well as their dysregulation in a number of pathologic conditions such as cancer have been documented. Among lncRNAs is actin filament associated protein 1 antisense RNA1 (AFAP1-AS1) whose elevated expression levels have been demonstrated in different cancers. In the in the present study we evaluated expression levels of AFAP1-AS1 and its antisense protein coding gene AFAP1 in breast cancer samples compare with adjacent non-cancerous tissues (ANCTs) as well as breast cancer cell lines with special focus on the assessment of the association between their transcript levels and patients' clinicopathological data. AFAP1-AS1 has shown significant up-regulation in both MDA-MB-231 and MCF-7 compared with control sample. AFAP1-AS1 has been shown to be expressed in all of tumor tissues but 76% (39 out of 51) ANCTs. AFAP1 expression was not significantly different between tumor samples and ANCTs. AFAP1-AS1 has been demonstrated to be significantly up-regulated in tumor tissues compared with ANCTs (fold change = 4.65, P= 0.028). No significant correlation has been detected between the levels of these two transcripts in tumor tissues (R=2 0.081) or ANCTs (R=2 0.115). No significant associations have been found between expression levels of these genes and patients' characteristics. However, both genes were significantly down-regulated in Ki-67 negative tumor samples. The observed up-regulation of AFAP1-AS1 in tumor samples compared with ANCTs implies its involvement in breast cancer pathogenesis and potentiates it as a biomarker or therapeutic target.
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Affiliation(s)
- Ali Dianatpour
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Faramarzi
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lobat Geranpayeh
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mirfakhraie
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Motevaseli
- Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Differentiation of benign and metastatic axillary lymph nodes in breast cancer: additive value of shear wave elastography to B-mode ultrasound. Clin Imaging 2018; 50:258-263. [DOI: 10.1016/j.clinimag.2018.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 12/18/2022]
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13
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Liu H, Xu G, Yao MH, Pu H, Fang Y, Xiang LH, Wu R. Association of conventional ultrasound, elastography and clinicopathological factors with axillary lymph node status in invasive ductal breast carcinoma with sizes > 10 mm. Oncotarget 2018; 9:2819-2828. [PMID: 29416814 PMCID: PMC5788682 DOI: 10.18632/oncotarget.18969] [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: 11/22/2016] [Accepted: 06/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate whether conventional ultrasound, elastography [conventional strain elastography of elasticity imaging, acoustic radiation force impulse induced strain elastography of virtual touch tissue imaging, and a novel two-dimensional shear wave elastography of virtual touch tissue imaging quantification] and clinicopathological factors are associated with axillary lymph node metastasis in invasive ductal breast carcinoma with sizes > 10 mm. Materials and Methods We evaluated 150 breast lesions from 148 patients using the above methods and the clinicopathological factors. Univariate and multivariate logistic regression analysis were performed to determine the axillary lymph node metastasis risk factors. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. Results Sixty-three tumors (42%) were node-positive, 87 (58%) were node-negative. Aspect ratio, virtual touch tissue imaging grade, shear wave velocity, pathological invasive tumor size, and histological grade maintained independent significance in predicting nodal involvement. The mean tumor shear wave velocitys (4.60, 6.49, 7.16) increased in proportion to metastatic node number (0, 1-3, ≥ 4, respectively; P < 0.001). For all tumors in this study, the cut-off shear wave velocity was 6.16 m/s and was associated with 64.1% sensitivity, 78.0% specificity and an area under the ROC curve of 0.799 (95% confidence interval, 0.731-0.868). Conclusions Aspect ratio, virtual touch tissue imaging grade, shear wave velocity, pathological invasive tumor size and histological grade are independently associated with axillary lymph node metastasis in invasive ductal breast carcinoma with sizes > 10 mm.
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Affiliation(s)
- Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Ming-Hua Yao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Yan Fang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
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14
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Seo M, Ahn HS, Park SH, Lee JB, Choi BI, Sohn YM, Shin SY. Comparison and Combination of Strain and Shear Wave Elastography of Breast Masses for Differentiation of Benign and Malignant Lesions by Quantitative Assessment: Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:99-109. [PMID: 28688156 DOI: 10.1002/jum.14309] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the diagnostic performance of strain and shear wave elastography of breast masses for quantitative assessment in differentiating benign and malignant lesions and to evaluate the diagnostic accuracy of combined strain and shear wave elastography. METHODS Between January and February 2016, 37 women with 45 breast masses underwent both strain and shear wave ultrasound (US) elastographic examinations. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) final assessment on B-mode US imaging was assessed. We calculated strain ratios for strain elastography and the mean elasticity value and elasticity ratio of the lesion to fat for shear wave elastography. Diagnostic performances were compared by using the area under the receiver operating characteristic curve (AUC). RESULTS The 37 women had a mean age of 47.4 years (range, 20-79 years). Of the 45 lesions, 20 were malignant, and 25 were benign. The AUCs for elasticity values on strain and shear wave elastography showed no significant differences (strain ratio, 0.929; mean elasticity, 0.898; and elasticity ratio, 0.868; P > .05). After selectively downgrading BI-RADS category 4a lesions based on strain and shear wave elastographic cutoffs, the AUCs for the combined sets of B-mode US and elastography were improved (B-mode + strain, 0.940; B-mode + shear wave; 0.964; and B-mode, 0.724; P < .001). Combined strain and shear wave elastography showed significantly higher diagnostic accuracy than each individual elastographic modality (P = .031). CONCLUSIONS These preliminary results showed that strain and shear wave elastography had similar diagnostic performance. The addition of strain and shear wave elastography to B-mode US improved diagnostic performance. The combination of strain and shear wave elastography results in a higher diagnostic yield than each individual elastographic modality.
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Affiliation(s)
- Mirinae Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Sung Hee Park
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
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Ahn S, Lee J, Cho MS, Park S, Sung SH. Evaluation of Ki-67 Index in Core Needle Biopsies and Matched Breast Cancer Surgical Specimens. Arch Pathol Lab Med 2017; 142:364-368. [DOI: 10.5858/arpa.2017-0014-oa] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The Ki-67 index is strongly prognostic and is used as a surrogate marker to distinguish luminal A from luminal B breast cancer types.
Objective.—
To investigate differences in Ki-67 index between core needle biopsy samples and matched surgical samples in breast cancer.
Design.—
We included patients with invasive breast cancer who did not receive neoadjuvant therapy. A total of 89 pairs of core needle biopsies and surgical specimens were collected, and the Ki-67 index was assessed in hot spot areas using an image analyzer. We applied a 14% Ki-67 index to define low versus high groups.
Results.—
The Ki-67 index was significantly higher in core needle biopsies than in surgical specimens (P < .001), with a median absolute difference of 3.5%. When we applied 14% as a cutoff, 16 of 89 cases (18%) showed discrepancy. Thirteen cases showed a high Ki-67 index in core needle biopsies but a low Ki-67 index in surgical samples. There were 10 cases (11.2%) that showed discordant luminal A/B types between core needle biopsy and the matched surgical specimen. The reasons for the discordance were poor staining of MIB1 accompanied by fixation issues and intratumoral heterogeneity of the Ki-67 index.
Conclusions.—
A significant difference in the Ki-67 index between core biopsy and surgical specimens was observed. Our findings indicate that it may be better to perform the Ki-67 assay on the core needle biopsy and the surgical specimen than on only one sample.
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Affiliation(s)
| | | | | | | | - Sun Hee Sung
- From the Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (Dr Ahn); and the Department of Pathology, Ewha Womans University Medical Center, Seoul, Korea (Drs Lee, Cho, Park, and Sung)
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16
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Focke CM, Bürger H, van Diest PJ, Finsterbusch K, Gläser D, Korsching E, Decker T. Interlaboratory variability of Ki67 staining in breast cancer. Eur J Cancer 2017; 84:219-227. [PMID: 28829990 DOI: 10.1016/j.ejca.2017.07.041] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/17/2017] [Accepted: 07/25/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Postanalytic issues of Ki67 assessment in breast cancers like counting method standardisation and interrater bias have been subject of various studies, but little is known about analytic variability of Ki67 staining between pathology labs. Our aim was to study interlaboratory variability of Ki67 staining in breast cancer using tissue microarrays (TMAs) and central assessment to minimise preanalytic and postanalytic influences. METHODS Thirty European pathology labs stained serial slides of a TMA set of breast cancer tissues with Ki67 according to their routine in-house protocol. The Ki67-labelling index (Ki67-LI) of 70 matched samples was centrally assessed by one observer who counted all cancer cells per sample. We then tested for differences between the labs in Ki67-LI medians by analysing variance on ranks and in proportions of tumours classified as luminal A after dichotomising oestrogen receptor-positive cancers into cancers showing low (<14%, luminal A) and high (≥14%, luminal B HER2 negative) Ki67-LI using Cochran's Q. RESULTS Substantial differences between the 30 labs were indicated for median Ki67-LI (0.65%-33.0%, p < 0.0001) and proportion of cancers classified as luminal A (17%-57%, p < 0.0001). The differences remained significant when labs using the same antibody (MIB-1, SP6, or 30-9) were analysed separately or labs without prior participation in external quality assurance programs were excluded (p < 0.0001, respectively). CONCLUSION Substantial variability in Ki67 staining of breast cancer tissue was found between 30 routine pathology labs. Clinical use of the Ki67-LI for therapeutic decisions should be considered only fully aware of lab-specific reference values.
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Affiliation(s)
- Cornelia M Focke
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany; Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Horst Bürger
- Institute of Pathology Paderborn/Höxter, Breast Center Paderborn, Husener Str. 46 a, 33098 Paderborn, Germany
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Kai Finsterbusch
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany
| | - Doreen Gläser
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany
| | - Eberhard Korsching
- Institute of Bioinformatics, University of Münster, Niels-Stensen-Straße 14, 48149 Münster, Germany
| | - Thomas Decker
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany
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Christgen M, Länger F, Kreipe H. [Histological grading of breast cancer]. DER PATHOLOGE 2017; 37:328-36. [PMID: 27363708 DOI: 10.1007/s00292-016-0182-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
From a historical perspective, histological grading was the earliest cell-based method for assessing tumor biology and the prognosis of breast cancer. This review article provides detailed and practical instructions for grading of breast cancer in routine diagnostics. Furthermore, the increasing relevance of precise histological grading in the era of molecular pathology is discussed.
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Affiliation(s)
- M Christgen
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland.
| | - F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland
| | - H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland
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18
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The Performance of Ki-67 Labeling Index in Different Specimen Categories of Invasive Ductal Carcinoma of the Breast Using 2 Scoring Methods. Appl Immunohistochem Mol Morphol 2017; 25:86-90. [PMID: 26509909 DOI: 10.1097/pai.0000000000000268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In breast carcinoma proliferative rate is not only prognostic, but also predictive factor. Ki-67 labeling index (Ki-67 LI) is a superior and more reproducible way to assess proliferation than counting mitoses. There are different Ki-67 LI cut-off values proposed for stratification. The best method of scoring Ki-67 LI is still controversial. Our aim was to test the consensus of Ki-67 LI read in the 2 most common specimens, diagnostic core biopsies (CNB) and surgical excision (SE), first using the hot spot (HS) for counting, and then the average (Av) Ki-67 LI. Cases diagnosed as having invasive duct breast carcinoma on CNB followed by SE over 6 years were recruited (n=96). Ki-67 LI was counted in both specimen types using HS and Av scoring methods. For both methods, agreement between the 2 specimen categories was tested using different cut-off values. Intraobserver reproducibility was also measured for both scoring methods. Ki-67 LI was significantly lower in CNBs compared with SEs (mean difference: -13.3 and -6.3, P<0.001, using HS and Av methods, respectively). The agreement between Ki-67 LI in CNBs and SEs using 10, 14, and 20 as cut-off value was superior when we used Av method (for κ=0.793, 0.814, and 0.745; vs. for HS: κ=0.542, 0.525, and 0.672, respectively). Intraobserver reproducibility ranged from very good to perfect for both methods. Our results suggested that specimen-specific cut-off value should be applied for both scoring methods.
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19
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Focke CM, Decker T, van Diest PJ. Reliability of the Ki67-Labelling Index in Core Needle Biopsies of Luminal Breast Cancers is Unaffected by Biopsy Volume. Ann Surg Oncol 2016; 24:1251-1257. [PMID: 28008571 DOI: 10.1245/s10434-016-5730-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Assessing prognostic and predictive factors like the Ki67 labelling index (Ki67-LI) in breast cancer core needle biopsies (CNB) may be hampered by undersampling. Our aim was to arrive at a representative assessment of Ki67-LI in CNB of luminal breast cancers by defining optimal cutoffs and establishing the minimum CNB volume needed for highest concordance of Ki67-LI between CNB and subsequent surgical excision biopsy (SEB). METHODS We assessed the Ki67-LI in CNB and subsequent SEB of 170 luminal breast cancers according to two counting methods recommended by the International Ki67 in Breast Cancer Working Group and applied the cutoffs to distinguish low and high proliferation given by the St Gallen 2013 and 2015 consensus, respectively. We then compared CNB volume characteristics for cases with concordant and discordant Ki67-LI between CNB versus SEB. RESULTS Highest concordance (75%, κ = 0.44) between CNB and SEB was achieved using the method that assesses the average tumor Ki67-LI and a cutoff of 20%. No significant differences were found between cases with concordant and discordant Ki67-LI in CNB versus SEB for number of biopsy cores, total core length, tumor tissue length, or total CNB or tumor tissue area size in the CNB for two various cutoffs. CONCLUSIONS A concordance of 75% between CNB and SEB can be achieved for the Ki67-LI using a method assessing average Ki67-LI at the threshold of 20%. Increasing CNB volume did not result in improved agreement rates, indicating that reliability of Ki67 levels in CNB of luminal breast cancers is unaffected by CNB volume.
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Affiliation(s)
- C M Focke
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany. .,Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - T Decker
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
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20
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Focke CM, Decker T, van Diest PJ. The reliability of histological grade in breast cancer core needle biopsies depends on biopsy size: a comparative study with subsequent surgical excisions. Histopathology 2016; 69:1047-1054. [PMID: 27417415 DOI: 10.1111/his.13036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/09/2016] [Indexed: 12/14/2022]
Abstract
AIMS In breast cancer patients undergoing neoadjuvant chemotherapy, histological grading needs to be performed on core needle biopsies (CNBs) that may not be representative of the whole tumour when they are small. Our aim was to study the influence of biopsy size on agreement rates for histological grade between CNBs and subsequent surgical excision biopsies (SEBs). METHODS AND RESULTS We calculated agreement and Cohen's κ between CNBs and SEBs of 300 early-stage breast cancers. The number of cores, total core length, total tumour length and tumour/tissue ratio were assessed for each CNB set. Agreement rates for grade were calculated for different classes of core number and tumour/tissue ratio, and for total core lengths and tumour lengths per CNB set in 5-15-mm intervals. Agreement on grade between CNBs and SEBs was 73% (κ = 0.59), with underestimation of grade in CNBs in 26% of cases and overestimation in 1% of cases. There was significantly higher concordance between CNBs and SEBs at a total core length of ≥50 mm than at a total core length of <50 mm (83% versus 68% agreement, P = 0.007), at a tumour length of ≥15 mm than at tumour length of <15 mm in CNBs (79% versus 67% agreement, P = 0.036), and at three or more cores than at fewer than three cores (75% versus 58% agreement, P = 0.048). The tumour/tissue ratio, pathological tumour size and radiological tumour size were not statistically different between concordant and discordant cases. CONCLUSIONS Agreement rates for histological grade in CNBs versus SEBs improve with increasing biopsy sample size.
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Affiliation(s)
- Cornelia M Focke
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany.,Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Thomas Decker
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
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21
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Abstract
The commonly used Nottingham Grading System in breast cancer takes into consideration the presence of tubular formation, nuclear pleomorphism, and the mitotic index (MI), among which the latter has been shown to be the most powerful prognostic factor. In practice, histologic grading is highly subjective, with only moderate interobserver reproducibility. Phosphorylation of histone H3 has been demonstrated to be a specific event in the mitotic phase, and is negligible during interphase. In this study, we evaluated the efficacy of Phosphohistone H3 (PHH3) in the breast cancer grading of 97 consecutive biopsy specimens. PHH3 antibodies clearly revealed discrete, strong nuclear immunoreactivity in mitotically active cells even under low magnification. The PHH3 MI showed a significant correlation with that derived by hematoxylin and eosin (H&E) staining as well as the Ki-67 proliferation index. Further, the pairwise κ-value of the MI was significantly increased, and the pairwise agreement was also markedly improved by PHH3 immunostaining, although a significant proportion of breast cancer cases were upgraded by use of the PHH3 MI. Our data showed that PHH3 provided a more sensitive and accurate MI with less interobserver variability when compared with conventional H&E staining, thus emphasizing its potentially increased value in practice. Reconsideration of breast cancer grading with integration of PHH3 should be considered if it continues to demonstrate superiorly to traditional H&E staining.
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22
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Knuttel FM, Menezes GLG, van Diest PJ, Witkamp AJ, van den Bosch MAAJ, Verkooijen HM. Meta-analysis of the concordance of histological grade of breast cancer between core needle biopsy and surgical excision specimen. Br J Surg 2016; 103:644-655. [PMID: 26990850 DOI: 10.1002/bjs.10128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/24/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the increasing use of neoadjuvant chemotherapy and minimally invasive ablative therapy in breast cancer, pretreatment assessment of tumour grade on core needle biopsy (CNB) is increasingly needed. However, grading on CNB is possibly less accurate than grading based on the surgical excision specimen. A systematic review and meta-analysis of the literature was conducted to derive a reliable estimate of the agreement in tumour grading between CNB and subsequent surgical excision. METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, Embase, PubMed and the Cochrane Library were searched. Pooled proportions of agreement in grading between CNB and the excision specimen, Cohen's κ and percentages of overestimation and underestimation were calculated. Random-effects models were applied because of substantial heterogeneity, assessed by I2 test. Determinants of the level of agreement in grading were explored with meta-regression. RESULTS Thirty-four articles were included in the systematic review (6029 patients) and 33 in the meta-analysis (4980 patients). Pooled agreement and κ were 71·1 (95 per cent c.i. 68·8 to 73·3) per cent and 0·54 (0·50 to 0·58) respectively. Underestimation and overestimation occurred in 19·1 (17·1 to 21·3) and 9·3 (7·7 to 11·4) per cent respectively. Meta-regression showed associations between agreement of histological type (positive association) and proportion of patients with oestrogen receptor-positive disease (negative association) and grade agreement. CONCLUSION Grading on CNB corresponds moderately with grading based on excision specimens, with underestimation in about one in five patients. Incorrect CNB tumour grading has limited clinical implications, as multiple factors influence decision-making for adjuvant systemic therapy.
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Affiliation(s)
- F M Knuttel
- Departments of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G L G Menezes
- Departments of Radiology, 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
| | - M A A J van den Bosch
- Departments of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H M Verkooijen
- Departments of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Validation of mitosis counting by automated phosphohistone H3 (PHH3) digital image analysis in a breast carcinoma tissue microarray. Pathology 2015; 47:329-34. [DOI: 10.1097/pat.0000000000000248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evaluation of Ki67 expression across distinct categories of breast cancer specimens: a population-based study of matched surgical specimens, core needle biopsies and tissue microarrays. PLoS One 2014; 9:e112121. [PMID: 25375149 PMCID: PMC4223011 DOI: 10.1371/journal.pone.0112121] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/12/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction Tumor cell proliferation in breast cancer is strongly prognostic and may also predict response to chemotherapy. However, there is no consensus on counting areas or cut-off values for patient stratification. Our aim was to assess the matched level of proliferation by Ki67 when using different tissue categories (whole sections, WS; core needle biopsies, CNB; tissue microarrays, TMA), and the corresponding prognostic value. Methods We examined a retrospective, population-based series of breast cancer (n = 534) from the Norwegian Breast Cancer Screening Program. The percentage of Ki67 positive nuclei was evaluated by visual counting on WS (n = 534), CNB (n = 154) and TMA (n = 459). Results The median percentage of Ki67 expression was 18% on WS (hot-spot areas), 13% on CNB, and 7% on TMA, and this difference was statistically significant in paired cases. Increased Ki67 expression by all evaluation methods was associated with aggressive tumor features (large tumor diameter, high histologic grade, ER negativity) and reduced patient survival. Conclusion There is a significant difference in tumor cell proliferation by Ki67 across different sample categories. Ki67 is prognostic over a wide range of cut-off points and for different sample types, although Ki67 results derived from TMA sections are lower compared with those obtained using specimens from a clinical setting. Our findings indicate that specimen specific cut-off values should be applied for practical use.
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25
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Christgen M, Winkens W, Kreipe HH. [Determination of proliferation in breast cancer by immunohistochemical detection of Ki-67]. DER PATHOLOGE 2014; 35:54-60. [PMID: 24414612 DOI: 10.1007/s00292-013-1843-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gene expression profiling has demonstrated the prognostic relevance of genes associated with proliferation in breast cancer. The immunohistochemical marker Ki-67 enables routine assessment of proliferation activity in pathology. In a number of retrospective but only few prospective studies the prognostic relevance of Ki-67 in breast cancer could be shown. Although there is no standardized approach with regard to which area of a histological section and how many cells should be counted in a quantitative or semiquantitative fashion as well as to the threshold, Ki-67 is broadly applied in breast pathology. This can be explained by the good reproducibility of the degree of proliferation assessed by Ki-67, at least in the low and high ranges, the possibility to substantiate grading and better practicability in core biopsies in comparison to mitotic counting. In neoadjuvant therapy of hormone receptor positive breast cancer, Ki-67 can probably predict the efficacy of pure hormone receptor blockade without chemotherapy.
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Affiliation(s)
- M Christgen
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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26
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Dhaliwal CA, Graham C, Loane J. Grading of breast cancer on needle core biopsy: does a reduction in mitotic count threshold improve agreement with grade on excised specimens? J Clin Pathol 2014; 67:1106-8. [DOI: 10.1136/jclinpath-2014-202294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAccurate assessment of invasive breast cancer grade on needle core biopsy (NCB) is important as it guides treatment.AimTo assess the agreement between grade of invasive cancer on NCB and excision and determine whether altering the mitotic count score threshold on NCB improves it.MethodsPathology slides from patients with an NCB diagnosis of invasive breast cancer who underwent subsequent breast conservation surgery in 2012 were reviewed. Mitotic counts were assessed and tumour grade agreement between NCB and excision evaluated. The mitotic count thresholds were altered and grade agreement was reassessed.ResultsIn 283/359 (79%) cases, there was concurrence on histological grade between NCB and excision. Reduction in mitotic count thresholds did not improve either overall tumour grade agreement or agreement within any subgroup of patients.ConclusionsIn our experience, the current mitotic count score thresholds are appropriate and should be maintained.
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Can ki-67 play a role in prediction of breast cancer patients' response to neoadjuvant chemotherapy? BIOMED RESEARCH INTERNATIONAL 2014; 2014:628217. [PMID: 24783217 PMCID: PMC3982412 DOI: 10.1155/2014/628217] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/11/2014] [Indexed: 12/16/2022]
Abstract
Background. Currently the choice of breast cancer therapy is based on prognostic factors. The proliferation marker Ki-67 is used increasingly to determine the method of therapy. The current study analyses the predictive value of Ki-67 in foreseeing breast cancer patients' responses to neoadjuvant chemotherapy. Methods. This study includes patients with invasive breast cancer treated between 2008 and 2013. The clinical response was assessed by correlating Ki-67 to histological examination, mammography, and ultrasonography findings. Results. The average Ki-67 value in our patients collectively (n = 77) is 34.9 ± 24.6%. The average Ki-67 value is the highest with 37.4 ± 24.0% in patients with a pCR. The Ki-67 values do not differ significantly among the 3 groups: pCR versus partial pathological response versus stable disease/progress (P = 0.896). However, Ki-67 values of patients with luminal, Her2 enriched, and basal-like cancers differed significantly from each other. Furthermore, within the group of luminal tumors Ki-67 values of patients with versus without pCR also differed significantly. Conclusion. Our data shows that the Ki-67 value predicts the response to neoadjuvant chemotherapy as a function of the molecular subtype, reflecting the daily routine concerning Ki-67 and its impressing potential and limitation as a predictive marker for neoadjuvant chemotherapy response.
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Munch-Petersen HD, Rasmussen BB, Balslev E. Reliability of histological malignancy grade, ER and HER2 status on core needle biopsy vs surgical specimen in breast cancer. APMIS 2013; 122:750-4. [DOI: 10.1111/apm.12213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Eva Balslev
- Department of Pathology; Herlev Hospital; Herlev Denmark
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29
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Evans A, Rauchhaus P, Whelehan P, Thomson K, Purdie CA, Jordan LB, Michie CO, Thompson A, Vinnicombe S. Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer? Breast Cancer Res Treat 2013; 143:153-7. [PMID: 24305976 PMCID: PMC4363519 DOI: 10.1007/s10549-013-2747-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Abstract
Shear wave elastography (SWE) shows promise as an adjunct to greyscale ultrasound examination in assessing breast masses. In breast cancer, higher lesion stiffness on SWE has been shown to be associated with features of poor prognosis. The purpose of this study was to assess whether lesion stiffness at SWE is an independent predictor of lymph node involvement. Patients with invasive breast cancer treated by primary surgery, who had undergone SWE examination were eligible. Data were retrospectively analysed from 396 consecutive patients. The mean stiffness values were obtained using the Aixplorer® ultrasound machine from SuperSonic Imagine Ltd. Measurements were taken from a region of interest positioned over the stiffest part of the abnormality. The average of the mean stiffness value obtained from each of two orthogonal image planes was used for analysis. Associations between lymph node involvement and mean lesion stiffness, invasive cancer size, histologic grade, tumour type, ER expression, HER-2 status and vascular invasion were assessed using univariate and multivariate logistic regression. At univariate analysis, invasive size, histologic grade, HER-2 status, vascular invasion, tumour type and mean stiffness were significantly associated with nodal involvement. Nodal involvement rates ranged from 7 % for tumours with mean stiffness <50 kPa to 41 % for tumours with a mean stiffness of >150 kPa. At multivariate analysis, invasive size, tumour type, vascular invasion, and mean stiffness maintained independent significance. Mean stiffness at SWE is an independent predictor of lymph node metastasis and thus can confer prognostic information additional to that provided by conventional preoperative tumour assessment and staging.
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Affiliation(s)
- Andrew Evans
- Dundee Cancer Centre, Ninewells Hospital & Medical School, Mailbox 4, Dundee, DD1 9SY, UK,
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Mammakarzinom: aktuelle Empfehlungen für Pathologen auf Basis der S3-Leitlinie. DER PATHOLOGE 2013; 34:293-302; quiz 303-4. [DOI: 10.1007/s00292-013-1763-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ciulla MM, Acquistapace G, Perrucci GL, Nicolini P, Toffetti L, Braidotti P, Ferrero S, Zucca I, Aquino D, Busca G, Magrini F. Immunohistochemical expression of oncological proliferation markers in the hearts of rats during normal pregnancy. Biomark Med 2013; 7:119-29. [DOI: 10.2217/bmm.12.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Pregnancy is characterized by left ventricular hypertrophy that is potentially accounted for by cardiomyocyte proliferation, although no such evidence is currently available. This study investigates if the left ventricular mass (LVM) increase during pregnancy implies cell hyperplasia. Materials & methods: In nonpregnant and late-pregnant rats, cardiac function and LVM were evaluated by MRI, and cardiomyocyte dimensions and proliferations were assessed quantitatively by morphometric analysis and immunohistochemistry using oncological markers (Ki67 and MCM2). Results: In late-pregnant rats, LVM and cardiomyocyte area were greater. No mitotic figures were found nor was there any significant difference between groups in Ki67 expression. MCM2 expression was related to LVM. Conclusion: During pregnancy, rat cardiomyocytes undergo hypertrophy but not hyperplasia; the expression of MCM2, related to LVM, suggests it could be a marker of protein synthesis. The application of oncological markers to physiological contexts may provide insight into their role within the cell cycle.
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Affiliation(s)
- Michele M Ciulla
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
| | - Giulia Acquistapace
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
| | - Gianluca L Perrucci
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
| | - Paola Nicolini
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
| | - Laura Toffetti
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
| | - Paola Braidotti
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| | - Stefano Ferrero
- Department of Biomedical, Surgical & Dental Science, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ileana Zucca
- Scientific Direction Unit, Foundation IRCCS Neurological Institute ‘Carlo Besta’, 20133 Milan, Italy
| | - Domenico Aquino
- Scientific Direction Unit, Foundation IRCCS Neurological Institute ‘Carlo Besta’, 20133 Milan, Italy
- Neuroradiology Unit, Foundation IRCCS Neurological Institute ‘Carlo Besta’, 20133 Milan, Italy
| | - Giuseppe Busca
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
| | - Fabio Magrini
- Department of Clinical Science & Community Health, Laboratory of Clinical Informatics & Cardiovascular Imaging, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Abstract
In breast cancer, tumor biological markers are gaining impact and have become equal to traditional markers of pathology. Molecular expression profiling has led to new categories, which by receiving translation into immunohistochemical terms have entered routine pathology use. Besides the triple negative (basal) type, there are hormone receptor positive luminal A and B types and the HER2 type. The distinction between luminal A and B type is not yet clear cut and the proliferation marker Ki-67 as well as diverse RNA expression profiles are used for distinction in order to decide which patients might benefit from pure endocrine and which from combined chemo-endocrine therapy. Prospective studies are necessary to answer these questions. Study data are further awaited to clarify the heterogeneity of triple negative cases which include most of the BRCA1 associated cancers and to elucidate whether within the HER2 category, polysome or pseudopolysome cancer will respond to therapy.
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Affiliation(s)
- H H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover.
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Xu H, Varghese T, Jiang J, Zagzebski JA. In vivo classification of breast masses using features derived from axial-strain and axial-shear images. ULTRASONIC IMAGING 2012; 34:222-36. [PMID: 23160475 PMCID: PMC3662535 DOI: 10.1177/0161734612465520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Breast cancer is currently the second leading cause of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. In this article, we present classification results for features extracted from ultrasound-based, axial-strain and axial-shear images of breast masses. The breast-mass stiffness contrast, size ratio, and a normalized axial-shear strain area feature are evaluated for the classification of in vivo breast masses using a leave-one-out classifier. Radiofrequency echo data from 123 patients were acquired using Siemens Antares or Elegra clinical ultrasound systems during freehand palpation. Data from four different institutions were analyzed. Axial displacements and strains were estimated using a multilevel, pyramid-based two-dimensional cross-correlation algorithm, with final processing block dimensions of 0.385 mm × 0.507 mm (three A-lines). Since mass boundaries on B-mode images for 21 patients could not be delineated (isoechoic), the combined feature analysis was only performed for 102 patients. Results from receiver operating characteristic (ROC) demonstrate that the area under the curve was 0.90, 0.84, and 0.52 for the normalized axial-shear strain, size ratio, and stiffness contrast, respectively. When these three features were combined using a leave-one-out classifier and support vector machine approach, the overall area under the curve improved to 0.93.
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Affiliation(s)
- Haiyan Xu
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
- Department of Electrical and Computer Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
- Department of Electrical and Computer Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | - Jingfeng Jiang
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - James A. Zagzebski
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
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Aleskandarany MA, Green AR, Benhasouna AA, Barros FF, Neal K, Reis-Filho JS, Ellis IO, Rakha EA. Prognostic value of proliferation assay in the luminal, HER2-positive, and triple-negative biologic classes of breast cancer. Breast Cancer Res 2012; 14:R3. [PMID: 22225836 PMCID: PMC3496118 DOI: 10.1186/bcr3084] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 11/13/2011] [Accepted: 01/06/2012] [Indexed: 12/20/2022] Open
Abstract
Introduction Although the prognostic significance of proliferation in early invasive breast cancer has been recognized for a long time, recent gene-expression profiling studies have reemphasized its biologic and prognostic value and the potential application of its assessment in routine practice, particularly to define prognostic subgroups of luminal/hormone receptor-positive (HR+) tumors. This study aimed to assess the prognostic value of a proliferation assay by using Ki-67 immunohistochemistry as compared with mitotic count scores. Method Proliferation was assessed by using Ki-67 labeling index (Ki-67LI) and mitotic scores in a large (n = 1,550) and well-characterized series of clinically annotated primary operable invasive breast cancer with long-term follow-up. Tumors were phenotyped based on their IHC profiles into luminal/HR+, HER2+, and triple-negative (TN) classes. We used a split-sample development and validation approach to determine the optimal Ki-67LI cut-offs. Results The optimal cut-points of Ki-67LI were 10% and 50% for the luminal class. Both Ki7LI and MS were able to split luminal tumors into subgroups with significantly variable outcomes, independent of other variables. Neither mitotic count scores nor Ki-67LI was associated with outcome in the HER2+ or the TN classes. Conclusions Assessment of proliferation by using Ki-67LI and MS can distinguish subgroups of patients within luminal/hormone receptor-positive breast cancer significantly different in clinical outcomes. Overall, both Ki-67 LI and mitotic-count scores showed comparable results. The method described could provide a cost-effective method for prognostic subclassification of luminal/hormone receptor-positive breast cancer in routine clinical practice.
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Affiliation(s)
- Mohammed A Aleskandarany
- Department of Histopathology, School of Molecular Medical Sciences, Queens Medical Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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O’Shea AM, Rakha EA, Hodi Z, Ellis IO, Lee AHS. Histological grade of invasive carcinoma of the breast assessed on needle core biopsy - modifications to mitotic count assessment to improve agreement with surgical specimens. Histopathology 2011; 59:543-8. [DOI: 10.1111/j.1365-2559.2011.03916.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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