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Santos MMD, Frasson AL, Silva VDD, Maciel ADCA, Watte G, Werutsky G, Reinert T, Fay AP. Core Needle Biopsy Accuracy for Androgen Receptor Expression in Invasive Breast Cancer. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e535-e541. [PMID: 37846186 PMCID: PMC10579921 DOI: 10.1055/s-0043-1772486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/04/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Breast cancer (BC) biomarkers, such as hormone receptors expression, are crucial to guide therapy in BC patients. Antiandrogens have been studied in BC; however, limited data are available on androgen receptor (AR) expression test methodology. We aim to report the core needle biopsy (CNB) accuracy for AR expression in BC. METHODS Patients diagnosed with stage I-III invasive BC from a single institution were included. Androgen receptor expression was evaluated by immunohistochemistry (IHC) using 1 and 10% cutoff and the AR expression in surgical specimens (SS) was the gold standard. Kappa coefficients were used to evaluate the intraprocedural agreement. RESULTS A total of 72 patients were included, with a mean age of 61 years old and 84% were Luminal A or B tumors. The prevalence of AR expression in all BC samples was 87.5% using a cutoff ≥ 10% in SS. With a cutoff value ≥ 1%, CNB had an accuracy of 95.8% (Kappa value = 0.645; 95% confidence interval [CI]: 0.272-1.000; p < 0.001) and 86.1% (Kappa value = 0.365; 95% CI: 0.052-0.679; p < 0.001) when ≥ 10% cutoff was used for AR positivity. Androgen receptor expression in CNB (cutoff ≥ 1%) had a sensitivity of 98.5%, specificity of 60%, positive predictive value of 97.0%, and a negative predictive value of 76.9% in the detection of AR expression in SS. CONCLUSION Core needle biopsy has good accuracy in evaluating AR expression in BC. The accuracy of CNB decreases with higher cutoff values for AR positivity.
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Affiliation(s)
- Marcelle Morais dos Santos
- Department of Breast Surgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Antonio Luiz Frasson
- Department of Breast Surgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Guilherme Watte
- Department of Medical Oncology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gustavo Werutsky
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tomás Reinert
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Oncoclínicas, Porto Alegre, RS, Brazil
| | - André Poisl Fay
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Oncoclínicas, Porto Alegre, RS, Brazil
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Abubakar S, More S, Tag N, Olabinjo A, Isah A, Lawal I. Differences in Tumour Aggressiveness Based on Molecular Subtype and Race Measured by [ 18F]FDG PET Metabolic Metrics in Patients with Invasive Carcinoma of the Breast. Diagnostics (Basel) 2023; 13:2059. [PMID: 37370954 DOI: 10.3390/diagnostics13122059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Breast cancer in women of African descent tends to be more aggressive with poorer prognosis. This is irrespective of the molecular subtype. [18F]FDG PET/CT metrics correlate with breast cancer aggressiveness based on molecular subtype. This study investigated the differences in [18F]FDG PET/CT metrics of locally advanced invasive ductal carcinoma (IDC) among different racial groups and molecular subtypes. Qualitative and semiquantitative readings of [18F]FDG PET/CT acquired in women with locally advanced IDC were performed. Biodata including self-identified racial grouping and histopathological data of the primary breast cancer were retrieved. Statistical analysis for differences in SUVmax, MTV and TLG of the primary tumour and the presence of regional and distant metastases was conducted based on molecular subtype and race. The primary tumour SUVmax, MTV, TLG and the prevalence of distant metastases were significantly higher in Black patients compared with other races (p < 0.05). The primary tumour SUVmax and presence of distant metastases in the luminal subtype and the primary tumour SUVmax and TLG in the basal subtype were significantly higher in Black patients compared with other races (p < 0.05). The significantly higher PET parameters in Black patients with IDC in general and in those with luminal and basal carcinoma subtypes suggest a more aggressive disease phenotype in this race.
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Affiliation(s)
- Sofiullah Abubakar
- Department of Radiology and Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Al-Khoud, Muscat 123, Oman
| | - Stuart More
- Department of Nuclear Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa
| | - Naima Tag
- Department of Radiology and Nuclear Medicine, Sultan Qaboos University Hospital, Al-Khoud, Muscat 123, Oman
| | - Afusat Olabinjo
- Department of Obstetrics and Gynecology, Armed Forces Hospital, Al-Khoud, Muscat 123, Oman
| | - Ahmed Isah
- Department of Nuclear Medicine, National Hospital, Abuja 90001, Nigeria
| | - Ismaheel Lawal
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
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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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Tong Y, Dai J, Huang J, Fei X, Shen K, Liu Q, Chen X. Ki67 increase after core needle biopsy associated with worse disease outcome in HER2-negative breast cancer patients. Sci Rep 2023; 13:2489. [PMID: 36781892 PMCID: PMC9925825 DOI: 10.1038/s41598-022-25206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 02/15/2023] Open
Abstract
Ki67 would change after core needle biopsy (CNB) in invasive breast cancer. However, whether Ki67 alteration (ΔKi67) influences disease outcomes remains unclear. Here we aim to evaluate the prognostic value of ΔKi67. Patients with paired CNB and open excision biopsy (OEB) samples between January 2009 and June 2016 were retrospectively analyzed. ΔKi67 was calculated as the absolute difference between Ki67 level in CNB and OEB samples, and the median value of 5% was adopted to category patients into high- and low ΔKi67 groups. Disease-free survival (DFS) and overall survival (OS) were compared between different ΔKi67 groups. Overall, 2173 invasive breast cancer patients were included. Median Ki67 was higher in OEB than CNB samples: 25.00% versus 20.00% (P < 0.001). Axillary nodal status, STI, histological grading, and molecular subtype were independently associated with ΔKi67 (P < 0.05). In the whole population, patients with low ΔKi67 showed superior 5-year DFS (89.6% vs 87.0%, P = 0.026), but similar OS (95.8% vs 94.3%, P = 0.118) compared to those with high ΔKi67. HER2 status at surgery was the only significant factor interacting with ΔKi67 on both DFS (P = 0.026) and OS (P = 0.007). For patients with HER2-negative disease, high ΔKi67 was associated with worse 5-year DFS (87.2% vs 91.2%, P = 0.004) as well as impaired 5-year OS (93.9% vs 96.8%, P = 0.010). ΔKi67 had no significant impact on survival of HER2-positive patients. Ki67 increase after CNB was significantly associated with worse disease outcomes in HER2-negative, but not in HER2-positive patients, which warrants further study.
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Affiliation(s)
- Yiwei Tong
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jiangfeng Dai
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Qingmeng Liu
- Department of Pathology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
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Chen R, Qi Y, Huang Y, Liu W, Yang R, Zhao X, Wu Y, Li Q, Wang Z, Sun X, Wei B, Chen J. Diagnostic value of core needle biopsy for determining HER2 status in breast cancer, especially in the HER2-low population. Breast Cancer Res Treat 2023; 197:189-200. [PMID: 36346486 PMCID: PMC9823013 DOI: 10.1007/s10549-022-06781-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/22/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE The status of human epidermal growth factor receptor 2 (HER2) is important for treatment decision-making of breast cancer and was commonly determined by core needle biopsy (CNB). The concordance of CNB with surgical excision biopsy (SEB) has been verified, but remain unclear according to the newly developed classification of HER2 status. Our study aimed to re-evaluate the diagnostic value of CNB for determining HER2 status in breast cancer, especially in the HER2-low population. METHODS Eligible breast cancer patients in West China Hospital between January 1, 2007 and December 31, 2021 were enrolled consecutively and data were extracted from the Hospital Information System. The agreement of HER2 status between CNB and SEB was calculated by concordance rate and κ statistics, as well as the sensitivity, specificity, positive, and negative predictive values (PPV & NPV). Logistic models were used to explore potential factors associated with the discordance between both tests. RESULTS Of 1829 eligible patients, 1097 (60.0%) and 1358 (74.2%) were consistent between CNB and SEB by pathological and clinical classifications, respectively, with κ value being 0.46 (0.43-0.49) and 0.57 (0.53-0.60). The sensitivity (50.9%-52.7%) and PPV (50.5%-55.2%) of CNB were especially low among IHC 1+ and 2+/ISH - subgroups by pathological classifications; however, it showed the highest sensitivity (77.5%) and the lowest specificity (73.9%) in HER2-low population by clinical classifications. Advanced N stages might be a stable indicator for the discordance between both tests. CONCLUSION The diagnostic value of CNB was limited for determining HER2 status in breast cancer, especially in HER2-low population.
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Affiliation(s)
- Ruixian Chen
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Yana Qi
- grid.13291.380000 0001 0807 1581Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Ya Huang
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Weijing Liu
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Ruoning Yang
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Xin Zhao
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Yunhao Wu
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Qintong Li
- grid.13291.380000 0001 0807 1581Departments of Obstetrics & Gynecology and Pediatrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, China
| | - Zhu Wang
- grid.13291.380000 0001 0807 1581Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- grid.13291.380000 0001 0807 1581Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Bing Wei
- grid.13291.380000 0001 0807 1581Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Jie Chen
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
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Acs B, Leung SCY, Kidwell KM, Arun I, Augulis R, Badve SS, Bai Y, Bane AL, Bartlett JMS, Bayani J, Bigras G, Blank A, Buikema H, Chang MC, Dietz RL, Dodson A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hartman J, Kos Z, Lænkholm AV, Laurinavicius A, Levenson RM, Mahboubi-Ardakani R, Mastropasqua MG, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Quintayo MA, Rau TT, Reinhard S, Robertson S, Salgado R, Sugie T, van der Vegt B, Viale G, Zabaglo LA, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Systematically higher Ki67 scores on core biopsy samples compared to corresponding resection specimen in breast cancer: a multi-operator and multi-institutional study. Mod Pathol 2022; 35:1362-1369. [PMID: 35729220 PMCID: PMC9514990 DOI: 10.1038/s41379-022-01104-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023]
Abstract
Ki67 has potential clinical importance in breast cancer but has yet to see broad acceptance due to inter-laboratory variability. Here we tested an open source and calibrated automated digital image analysis (DIA) platform to: (i) investigate the comparability of Ki67 measurement across corresponding core biopsy and resection specimen cases, and (ii) assess section to section differences in Ki67 scoring. Two sets of 60 previously stained slides containing 30 core-cut biopsy and 30 corresponding resection specimens from 30 estrogen receptor-positive breast cancer patients were sent to 17 participating labs for automated assessment of average Ki67 expression. The blocks were centrally cut and immunohistochemically (IHC) stained for Ki67 (MIB-1 antibody). The QuPath platform was used to evaluate tumoral Ki67 expression. Calibration of the DIA method was performed as in published studies. A guideline for building an automated Ki67 scoring algorithm was sent to participating labs. Very high correlation and no systematic error (p = 0.08) was found between consecutive Ki67 IHC sections. Ki67 scores were higher for core biopsy slides compared to paired whole sections from resections (p ≤ 0.001; median difference: 5.31%). The systematic discrepancy between core biopsy and corresponding whole sections was likely due to pre-analytical factors (tissue handling, fixation). Therefore, Ki67 IHC should be tested on core biopsy samples to best reflect the biological status of the tumor.
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Affiliation(s)
- Balazs Acs
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Indu Arun
- Tata Medical Center, Kolkata, West Bengal, India
| | - Renaldas Augulis
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yalai Bai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Anita L Bane
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Jane Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gilbert Bigras
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Annika Blank
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Henk Buikema
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C Chang
- Department of Pathology & Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Robin L Dietz
- Department of Pathology, Olive View-UCLA Medical Center, Los Angeles, CA, USA
| | - Andrew Dodson
- UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, United Kingdom
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cornelia M Focke
- Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany
| | - Dongxia Gao
- University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Arvydas Laurinavicius
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Richard M Levenson
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Rustin Mahboubi-Ardakani
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Sharon Nofech-Mozes
- University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Frédérique M Penault-Llorca
- Imagerie Moléculaire et Stratégies Théranostiques, UMR1240, Université Clermont Auvergne, INSERM, Clermont-Ferrand, France
- Service de Pathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | - Tammy Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Stefan Reinhard
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Stephanie Robertson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | | | - Bert van der Vegt
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy
- European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | - Lila A Zabaglo
- The Institute of Cancer Research, London, United Kingdom
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
| | | | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
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Li S, Chen X, Shen K. Association of Ki-67 Change Pattern After Core Needle Biopsy and Prognosis in HR+/HER2− Early Breast Cancer Patients. Front Surg 2022; 9:905575. [PMID: 35836600 PMCID: PMC9275673 DOI: 10.3389/fsurg.2022.905575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background To investigate the association of Ki-67 change pattern after core needle biopsy (CNB) and prognosis in HR+/HER2− early breast cancer patients. Method Eligible patients were categorized into three groups: Low group, Elevation group, and High group. Chi-square test and logistic regression analysis were used to compare the clinic-pathological characteristics. Kaplan–Meier method was used to estimate the rates of recurrence-free interval (RFI) and breast cancer-specific survival (BCSS), which were compared via the Log-rank test. Cox proportional hazard analysis was performed to investigate independent prognostic factors. Results A total of 2,858 patients were included: 1,179 (41.3%), 482 (16.9%), and 1,197 (41.8%) patients were classified into the low, elevation, and high groups, respectively. Age, tumor size, histological grade, lymph-vascular invasion (LVI), and ER level status were associated with Ki-67 change pattern after CNB. With a median follow-up of 53.6 months, the estimated 5-year RFI rates for the low group, elevation, and high groups were 96.4%, 95.3% and 90.9%, respectively (P < 0.001). And 5-year BCSS rates were 99.3%, 98.3% and 96.8%, respectively (P = 0.001). Compared with patients in the low group, patients in the high group had significantly worse RFI (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.16–2.54) in multivariate analysis. Conclusions Ki-67 change after CNB was associated with prognosis in HR+/HER2− early breast cancer. Patients with Ki-67 high or elevation after CNB had an inferior disease outcome, indicating the necessity of re-evaluating Ki-67 on surgical specimens after CNB.
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8
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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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9
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Miglietta F, Griguolo G, Bottosso M, Giarratano T, Lo Mele M, Fassan M, Cacciatore M, Genovesi E, De Bartolo D, Vernaci G, Amato O, Porra F, Conte P, Guarneri V, Dieci MV. HER2-low-positive breast cancer: evolution from primary tumor to residual disease after neoadjuvant treatment. NPJ Breast Cancer 2022; 8:66. [PMID: 35595761 PMCID: PMC9122970 DOI: 10.1038/s41523-022-00434-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Abstract
Approximately a half of breast tumors classified as HER2-negative exhibit HER2-low-positive expression. We recently described a high instability of HER2-low-positive expression from primary breast cancer (BC) to relapse. Previous studies reporting discordance in HER2 status between baseline biopsy and residual disease (RD) in patients undergoing neoadjuvant treatment did not include the HER2-low-positive category. The aim of this study is to track the evolution of HER2-low-positive expression from primary BC to RD after neoadjuvant treatment. Patients undergoing neoadjuvant treatment with available baseline tumor tissue and matched samples of RD (in case of no pCR) were included. HER2-negative cases were sub-classified as HER2-0 or HER2-low-positive (IHC 1+ or 2+ and ISH negative). Four-hundred forty-six patients were included. Primary BC phenotype was: HR-positive/HER2-negative 23.5%, triple-negative (TN) 35%, HER2-positive 41.5%. HER2-low-positive cases were 55.6% of the HER2-negative cohort and were significantly enriched in the HR-positive/HER2-negative vs. TN subgroup (68.6% vs. 46.8%, p = 0.001 χ2 test). In all, 35.3% of non-pCR patients (n = 291) had a HER2-low-positive expression on RD. The overall rate of HER2 expression discordance was 26.4%, mostly driven by HER2-negative cases converting either from (14.8%) or to (8.9%) HER2-low-positive phenotype. Among HR-positive/HER2-negative patients with HER2-low-positive expression on RD, 32.0% and 57.1% had an estimated high risk of relapse according to the residual proliferative cancer burden and CPS-EG score, respectively. In conclusion, HER2-low-positive expression showed high instability from primary BC to RD after neoadjuvant treatment. HER2-low-positive expression on RD may guide personalized adjuvant treatment for high-risk patients in the context of clinical trials with novel anti-HER2 antibody-drug conjugates.
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Affiliation(s)
- Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Michele Bottosso
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Tommaso Giarratano
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Marcello Lo Mele
- Surgical Pathology Unit, University Hospital of Padua, 35121, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, 35121, Padua, Italy
- Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Matilde Cacciatore
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Elisa Genovesi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Debora De Bartolo
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, 35121, Padua, Italy
| | - Grazia Vernaci
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Ottavia Amato
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Francesca Porra
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy.
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy.
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
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10
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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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11
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Sharma R, Verma P, Sharma N, Gulati A, Parashar A, Kaundal A. Comparison of the molecular profiling of core biopsy with surgical specimens in breast cancers and the effect of neoadjuvant therapy on the same – A North Indian study. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_918_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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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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13
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Associations between the Levels of Estradiol-, Progesterone-, and Testosterone-Sensitive MiRNAs and Main Clinicopathologic Features of Breast Cancer. J Pers Med 2021; 12:jpm12010004. [PMID: 35055320 PMCID: PMC8779432 DOI: 10.3390/jpm12010004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the existing advances in the diagnosis and treatment of breast cancer (BC), the search for markers associated with the clinicopathological features of BC is still in demand. MiRNAs (miRs) have potential as markers, since a change in the miRNA expression profile accompanies the initiation and progression of malignant diseases. The receptors for estrogen, androgen, and progesterone (ER, AR, and PR) play an important role in breast carcinogenesis. Therefore, to search for miRNAs that may function as markers in BC, using bioinformatic analysis and the literature data, we selected 13 miRNAs whose promoter regions contain binding sites for ER or AR, or putative binding sites for ER, AR, and PR. We quantified their expression in MCF-7 cells treated with estradiol, progesterone, or testosterone. The levels of miRNAs sensitive to one or more of these hormones were quantified in BC samples (n = 196). We discovered that high expression levels of miR-190b in breast tumor tissue indicate a positive ER status, and miR-423 and miR-200b levels differ between patients with and without HER2 amplification. The miR-193b, -423, -190a, -324, and -200b levels were associated with tumor size or lymph node status in BC patients, but the presence of these associations depended on the status and expression level of ER, PR, HER2, and Ki-67. We also found that miR-21 expression depends on HER2 expression in ER- and/or PR-positive BC. The levels of miRNA were significantly different between HER2 0 and HER2 1+ tumors (p = 0.027), and between HER2 0 and HER2 2+, 3+ tumors (p = 0.005).
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14
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Kalvala J, Parks RM, Green AR, Cheung KL. Concordance between core needle biopsy and surgical excision specimens for Ki-67 in breast cancer - a systematic review of the literature. Histopathology 2021; 80:468-484. [PMID: 34473381 DOI: 10.1111/his.14555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 12/20/2022]
Abstract
AIMS The biomarkers oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) are routinely measured in patients with breast cancer with international consensus on how they should be interpreted. There is evidence to support use of other biomarkers to give more detailed predictive and prognostic information. Ki-67 is one example, and measures the proliferative activity of cancer cells. It is important that this can be performed at diagnosis of breast cancer for patients who do not have initial surgical treatment (mainly older women) and those receiving neoadjuvant therapies. METHODS AND RESULTS A systematic review was performed to assess concordance of measurement of Ki-67 between core needle biopsy (CNB) samples and surgical excision (SE) samples in patients with invasive breast cancer. MEDLINE and Embase databases were searched. Studies were eligible if performed within the last 10 years; included quantitative measurement of Ki-67 in both CNB and SE samples with no prior breast cancer treatment; measured concordance between two samples; and had full text available. A total of 22 studies, including 5982 paired CNB and SE samples on which Ki-67 was measured, were appraised. Overall, there appeared to be concordance; however, reliability was unclear. Where given, the Cohen's kappa coefficient (κ) of correlation between samples ranged from 0.261 to 0.712. The concordance rate between CNB and SE where measured as a percentage had a range from 70.3 to 92.7% CONCLUSIONS: Assessment of level of concordance of Ki-67 between CNB and SE samples is hampered by different methodologies. International consensus on Ki-67 measurement is urgently needed.
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Affiliation(s)
- Jahnavi Kalvala
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew R Green
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kwok-Leung Cheung
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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15
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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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16
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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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17
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Pölcher M, Braun M, Tischitz M, Hamann M, Szeterlak N, Kriegmair A, Brambs C, Becker C, Stoetzer O. Concordance of the molecular subtype classification between core needle biopsy and surgical specimen in primary breast cancer. Arch Gynecol Obstet 2021; 304:783-790. [PMID: 33585986 DOI: 10.1007/s00404-021-05996-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Molecular profiling of breast cancer (BC) classifies several intrinsic subtypes based on different patterns of gene expression. Multigene assays estimate the risk of recurrence and help to select high-risk patients for adjuvant chemotherapy. However, these tests are associated with significant costs. Immunohistochemistry (IHC) offers a surrogate classification for molecular subtypes by determining estrogen (ER) and progesterone receptors (PR), human epidermal growth factor (Her2neu), as well as the proliferation marker Ki67. Core needle biopsy (CNB) is well established in BC diagnosis and allows a pre-operative assessment of biomarkers. The aim of this study was to analyze the concordance of these markers between CNB and surgical specimens to assess whether re-testing of the surgical specimen is mandatory. MATERIALS AND METHODS Within a 3-year period, patients with primary BC and paired samples of CNB and surgical specimens were analyzed retrospectively. Concordance rates of ER, PR, Her2neu, Ki67, and the surrogate classification for molecular subtypes were calculated using the Landis and Koch agreement grades. RESULTS Out of 2254 patients with primary breast cancer, 1307 paired specimens without pre-operative treatment were available for analysis Concordance rates for ER, PR, Her2neu, and Ki67 status showed substantial-to-almost perfect agreement grades (κ = 0.91, 0.75, 0.89, and 0.61, respectively). Though substantial concordance was also found for the subtype classification (κ = 0.70), the molecular subtype changed in 18.5% of patients based on the testing of the surgical specimen, mainly from luminal A-like to luminal B-like. CONCLUSIONS Though the concordance rates for single markers were convincing, a significant proportion of the molecular subtypes differed between CNB and the surgical specimen. Re-testing of PR and Ki67 is mandatory to ensure optimal treatment decisions. Further research is necessary to define safe, efficient, and cost-effective predictive models in adjuvant breast cancer therapy.
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Affiliation(s)
- M Pölcher
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany.
| | - M Braun
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - M Tischitz
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - M Hamann
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - N Szeterlak
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - A Kriegmair
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - C Brambs
- School of Medicine, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - C Becker
- Department of Pathology, Rotkreuzklinikum München, Winthirstraße 11, 80639, Munich, Germany
| | - O Stoetzer
- MVZ (Ambulatort Health Care Center) for Hematology and Oncology, Winthirstraße 11, 80639, Munich, Germany
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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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19
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Jakubowski DM, Bailey H, Abran J, Blacklock A, Ciau N, Mies C, Tan V, Young R, Lau A, Baehner FL. Molecular characterization of breast cancer needle core biopsy specimens by the 21-gene Breast Recurrence Score test. J Surg Oncol 2020; 122:611-618. [PMID: 32497318 PMCID: PMC7496790 DOI: 10.1002/jso.26050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Recent COVID-19 pandemic guidelines recommend genomic assessment of core biopsies to help guide treatment decisions in estrogen receptor (ER)-positive early-stage breast cancer. Herein we characterize biopsy and excisional breast cancer specimens submitted for 21-gene testing. METHODS US samples submitted to Genomic Health for 21-gene testing (01/2004-04/2020) were assessed by pathologists and analyzed by a standardized quantitative reverse transcription-polymerase chain reaction. Predefined cutoffs were: ESR1 (positive ≥6.5), PGR (positive ≥5.5), and ERBB2 (negative <10.7). ER status by immunohistochemistry (IHC) and lymph node status were determined locally. Median and interquartile range were reported for continuous variables, and total and percent for categorical variables. Distributions were assessed overall, by age, and by nodal involvement. RESULTS Of 919 701 samples analyzed, 13% were biopsies and 87% were excisions. Initial assay success rates were 94.5% (biopsies) and 97.3% (excisions). ER IHC concordance with central ESR1 was 96.8% (biopsies) and 97.6% (excisions). Biopsy and excisional medians were: Recurrence Score results 16 (each); ESR1 10.2 (each); PGR 7.7 and 7.6; ERBB2 9.4 and 9.2, respectively. CONCLUSIONS Biopsy submissions for 21-gene testing are common and consistently generate results that are very similar to the experience with excisions. The 21-gene test can be performed reliably on core biopsies.
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Affiliation(s)
| | - Helen Bailey
- Exact Sciences CorporationRedwood CityCalifornia
| | - John Abran
- Exact Sciences CorporationRedwood CityCalifornia
| | | | - Nancy Ciau
- Exact Sciences CorporationRedwood CityCalifornia
| | - Carolyn Mies
- Exact Sciences CorporationRedwood CityCalifornia
| | - Vivian Tan
- Exact Sciences CorporationRedwood CityCalifornia
| | | | - Anna Lau
- Exact Sciences CorporationRedwood CityCalifornia
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20
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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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21
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Electrically guided interventional radiology, in-vivo electrochemical tracing of suspicious lesions to breast cancer prior to core needle biopsy. Biosens Bioelectron 2020; 161:112209. [PMID: 32442106 DOI: 10.1016/j.bios.2020.112209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 02/08/2023]
Abstract
An electrochemical biopsy probe was designed and fabricated to detect cancer tumors under the sonography guide without the need for any sample dissection (biopsy). The system was based on recording the hypoxic function of cancer tumors by Multi-wall carbon nanotubes (MWCNTs) sensing agents had been decorated on the tip of the needle electrodes by an electrostatic deposition method. This system named BGP successfully distinct 4T1 and MC4L2 breast tumors from normal lesions. It also diagnosed the treated tumors from vital ones. BGP as a clinically useful biosensor would detect the cancerous probability of any suspicious breast mass without any sample excision. Also, it can present a profile from neoplastic states of different regions of a tumor. This ability would make ensure for the radiologist to do biopsy or not, especially in the cases which are suspicious between BIRADS III and IVa. This would not only shed new light in detecting breast cancer tumors without biopsy (applied in radiological BIRADS classifications) but also evaluate the therapeutic effects on cancer tumors after chemotherapy/radiotherapy therapies without complicated and expensive scanning.
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22
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Park JH, Kim HY, Jung YJ, Kim DI, Kim JY, Paik HJ. Identifying breast cancer patients who require a double-check of preoperative core needle biopsy and postoperative surgical specimens to determine the molecular subtype of their tumor. Ann Surg Treat Res 2019; 97:223-229. [PMID: 31742206 PMCID: PMC6848005 DOI: 10.4174/astr.2019.97.5.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Core needle biopsy (CNB) is a widely used procedure for breast cancer diagnosis and analyzing results of immunohistochemistry (IHC). Several studies have shown concordance or discordance in IHC results between CNB and surgical specimens (SS). A double-check (CNB and SS) is inefficient and costly to perform a double-check on all patients. Therefore, it is important to determine which patients would benefit from a double-check. Methods We collected the medical records of patients who underwent breast cancer surgery at Pusan National University Yangsan Hospital between April 2009 and June 2018 (n = 620). Molecular subtypes were classified as follows by hormone receptors (HR) and human epidermal growth factor receptor-2 (HER2): HR+/HER2+, HR+/HER2−, HR−/HER2+, HR−/HER2−. Clinicopathological factors including age, obesity, histological grade, preoperative CEA, CA15-3, T stage, N stage, and menopausal status were assessed to determine whether they were associated with subtype change. Results Increasing histological grade (P < 0.001; odds ratio [OR], 3.693; 95% confidence interval [CI], 1.941–7.025), preoperative CEA ≥ 5 ng/mL (P =0.042; OR, 2.399; 95% CI, 1.009–5.707) and higher T stage (P = 0.015; OR, 2.241; 95% CI, 1.152–4.357) were significantly associated with subtype change. On multivariable analyses, subtype changes were more common in high-grade breast cancer (P < 0.001; OR, 1.077; 95% CI, 1.031–1.113) and CEA ≥ 5 (P = 0.032; OR, 2.658; 95% CI, 1.088–6.490). Conclusion Patients with moderate- to high-grade tumors or CEA ≥ 5 ng/mL are required a double-check to determine the molecular subtype of breast cancer.
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Affiliation(s)
- Je Hyung Park
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Yul Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jee Yeon Kim
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-June Paik
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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23
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Jeong YS, Kang J, Lee J, Yoo TK, Kim SH, Lee A. Analysis of the molecular subtypes of preoperative core needle biopsy and surgical specimens in invasive breast cancer. J Pathol Transl Med 2019; 54:87-94. [PMID: 31718121 PMCID: PMC6986971 DOI: 10.4132/jptm.2019.10.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background Accurate molecular classification of breast core needle biopsy (CNB) tissue is important for determining neoadjuvant systemic therapies for invasive breast cancer. The researchers aimed to evaluate the concordance rate (CR) of molecular subtypes between CNBs and surgical specimens. Methods This study was conducted with invasive breast cancer patients who underwent surgery after CNB at Seoul St. Mary’s Hospital between December 2014 and December 2017. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 were analyzed using immunohistochemistry. ER and PR were evaluated by Allred score (0–8). HER2 was graded from 0 to +3, and all 2+ cases were reflex tested with silver in situ hybridization. The labeling index of Ki67 was counted by either manual scoring or digital image analysis. Molecular subtypes were classified using the above surrogate markers. Results In total, 629 patients were evaluated. The CRs of ER, PR, HER2, and Ki67 were 96.5% (kappa, 0.883; p<.001), 93.0% (kappa, 0.824; p<.001), 99.7% (kappa, 0.988; p<.001), and 78.7% (kappa, 0.577; p<.001), respectively. Digital image analysis of Ki67 in CNB showed better concordance with Ki67 in surgical specimens (CR, 82.3%; kappa, 0.639 for digital image analysis vs. CR, 76.2%; kappa, 0.534 for manual counting). The CRs of luminal A, luminal B, HER2, and triple negative types were 89.0%, 70.0%, 82.9%, and 77.2%, respectively. Conclusions CNB was reasonably accurate for determining ER, PR, HER2, Ki67, and molecular subtypes. Using digital image analysis for Ki67 in CNB produced more accurate molecular classifications.
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Affiliation(s)
- Ye Sul Jeong
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Kang
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jieun Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ahwon Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute, The Catholic University of Korea, Seoul, Korea
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24
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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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25
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Lee J, Lee EH, Park HY, Kim WW, Lee RK, Chae YS, Lee SJ, Kim JE, Kang BI, Park JY, Park JY, Jung JH. Efficacy of an RNA-based multigene assay with core needle biopsy samples for risk evaluation in hormone-positive early breast cancer. BMC Cancer 2019; 19:388. [PMID: 31023265 PMCID: PMC6485070 DOI: 10.1186/s12885-019-5608-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gene expression profiling provides key information for prognosis of breast cancer to establish treatment strategy. However, the genetic assessment should be available before induction of treatment to be useful for clinical practice. To evaluate the reliability of using needle biopsy samples for gene assays, we compared gene-expression profiling results between core needle biopsy (CNB) samples and surgical specimens in breast cancer. METHODS Thirty-one paired, formalin-fixed, paraffin-embedded CNB and surgical specimen samples were selected from patients with hormone receptor-positive breast cancer. Total RNA was extracted from the samples and the risk classifications based on GenesWell BCT scores were compared. RESULTS The BCT scores correlated between CNB samples and surgical specimens of hormone receptor-positive breast cancer (Pearson r = 0.66). The overall concordance rate of risk classification (high/low risk) was 83.9%. However, when the breast cancer does not contain intratumoral microcalcification, the concordance rate increased as 92.0%. And, when the breast cancer formed a solitary nodule (non-multifocal), the concordance rate increased up to 95.8%. CONCLUSION Risk classification using the GenesWell BCT multigene kit with CNB samples could be considered reliable, when the breast cancer is a solitary nodule without intratumoral microcalcification. Such genetic profiling results should be helpful for establishing a treatment plan for hormone receptor-positive breast cancer before treatment induction.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Eun Hye Lee
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ryu Kyung Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yee Soo Chae
- Department of Hemato-Oncology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Soo Jung Lee
- Department of Hemato-Oncology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jee-Eun Kim
- R&D Center, Gencurix Inc., Seoul, Republic of Korea
| | | | - Jee Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji-Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
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26
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Berghuis AMS, van Deurzen CHM, Koffijberg H, Terstappen LWMM, Sleijfer S, IJzerman MJ. Real-world data on discordance between estrogen, progesterone, and HER2 receptor expression on diagnostic tumor biopsy versus tumor resection material. Breast Cancer Res Treat 2019; 175:451-458. [PMID: 30756285 PMCID: PMC6533419 DOI: 10.1007/s10549-019-05141-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE The estrogen (ER), progesterone (PR), and HER2 status are essential in guiding treatment decisions in breast cancer patients. In daily life, the ER/PR/HER2 status is expected to be commonly tested twice, i.e., at diagnosis using material from tumor needle biopsies, and after tumor resection using full tumor tissue material. This study explored the discordance of ER/PR/HER2 between tumor needle biopsies and full tumor resection material using real-world patient-level data from Dutch breast cancer patients. METHODS Pathology reports of 11,054 breast cancer patients were derived from PALGA (Dutch Pathology Registry). Discordance was calculated for multiple combinations of the ER/PR/HER2 receptor status. The influence of patient and tumor characteristics on the probability of having discordant test results was analyzed using multiple logistic regression models (separately for ER, PR and HER2). RESULTS For 1279 patients (14.4%), at least one of the receptors (ER/PR/HER2) was determined on both biopsy and tumor tissue material. The majority had concordant test results for ER (n = 916; 94.8%), PR (n = 1170; 86.7%), and HER2 (n = 881; 98.1%). Patients having an ER- and HER2-positive but PR-negative biopsy classification, BR grade III, and < 10% tumor tissue remaining after neoadjuvant therapy (NAT) have the highest probability of ER discordant test results (OR 4.991; p = 83.31%). The probability of discordance in PR is based on different sets of patient and tumor characteristics. Potential cost savings from omitting multiple tests if concordance can be perfectly predicted can be up to €205,000 yearly. CONCLUSIONS Double testing of ER/PR/HER2 is less common than expected. Discordance in ER/PR/HER2 test results between tumor needle biopsy taken at the time of diagnosis and tumor resection material is very low, especially in patients not receiving any form of neoadjuvant therapy. These results imply that a substantial number of tests can potentially be omitted in specific subgroups of breast cancer patients.
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Affiliation(s)
- A M Sofie Berghuis
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, Faculty of Science and Technology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC-University Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands. .,Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
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27
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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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