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BMC Cancer
Published in: BMC Cancer 1/2013

Open Access 01-12-2013 | Research article

Preoperative core needle biopsy is accurate in determining molecular subtypes in invasive breast cancer

Authors: Xiaosong Chen, Long Sun, Yan Mao, Siji Zhu, Jiayi Wu, Ou Huang, Yafen Li, Weiguo Chen, Jianhua Wang, Ying Yuan, Xiaochun Fei, Xiaolong Jin, Kunwei Shen

Published in: BMC Cancer | Issue 1/2013

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Abstract

Background

Estrogen receptor (ER), progesterone receptor (PgR), HER2, and Ki67 have been increasingly evaluated by core needle biopsy (CNB) and are recommended for classifying breast cancer into molecular subtypes. However, the concordance rate between CNB and open excision biopsy (OEB) has not been well documented.

Methods

Patients with paired CNB and OEB samples from Oct. 2009 to Feb. 2012 in Ruijin Hospital were included. ER, PgR, HER2, and Ki67 were determined by immunohistochemistry (IHC). Patients with HER2 IHC 2+ were further examined by FISH. Cutoff value for Ki67 high expression was 14%. Molecular subtypes were constructed as follows: Luminal A, Luminal B, Triple Negative, and HER2 positive.

Results

There were 298 invasive breast cancer patients analyzed. Concordance rates for ER, PgR, and HER2 were 93.6%, 85.9%, and 96.3%, respectively. Ki67 expression was slightly higher in OEB than in CNB samples (29.3% vs. 26.8%, P = 0.046). Good agreement (κ = 0.658) was demonstrated in evaluating molecular subtypes between CNB and OEB, with a concordance rate of 77.2%. We also used a different Ki67 cutoff value (20%) for determining Luminal A and B subtypes in HR (hormone receptor) +/HER2- diseases and the overall concordance rate was 79.2%. However, using a cut-point of Ki67 either 14% or 20% for both specimens, there will be about 14% of HR+/HER2- specimens that are called Luminal A on CNB and Luminal B on OEB.

Conclusion

CNB was accurate in determining ER, PgR, and HER2 status as well as non-Luminal molecular subtypes in invasive breast cancer. Ki67 should be retested on OEB samples in HR+/HER2- patients to accurately distinguish Luminal A from B tumors.
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Literature
1.
Ferlay J, Parkin DM, Steliarova-Foucher E: Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010, 46: 765-781. 10.1016/j.ejca.2009.12.014.CrossRefPubMed
2.
Bruening W, Fontanarosa J, Tipton K, Treadwell JR, Launders J, Schoelles K: Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med. 2010, 152 (4): 238-246. 10.7326/0003-4819-152-1-201001050-00190.CrossRefPubMed
3.
Aebi S, Davidson T, Gruber G, Cardoso F, ESMO Guidelines Working Group: Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2011, 22 (Suppl 6): vi12-vi24.PubMed
4.
Chen X, Yuan Y, Gu Z, Shen K: Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis. Breast Cancer Res Treat. 2012, 134 (3): 957-967. 10.1007/s10549-012-1990-z.CrossRefPubMed
5.
Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, et al: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001, 98: 10869-10874. 10.1073/pnas.191367098.CrossRefPubMedPubMedCentral
6.
Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ, Panel members: Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen international expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol. 2011, 22 (8): 1736-1747. 10.1093/annonc/mdr304.CrossRefPubMedPubMedCentral
7.
Cahill RA, Walsh D, Landers RJ, Watson RG: Preoperative profiling of symptomatic breast cancer by diagnostic core biopsy. Ann Surg Oncol. 2006, 13 (1): 45-51. 10.1245/ASO.2006.03.047.CrossRefPubMed
8.
Lorgis V, Algros MP, Villanueva C, Chaigneau L, Thierry-Vuillemin A, Nguyen T, Demarchi M, Bazan F, Sautiere JL, Maisonnette-Lescot Y, et al: Discordance in early breast cancer for tumour grade, estrogen receptor, progesteron receptors and human epidermal receptor-2 status between core needle biopsy and surgical excisional primary tumour. Breast. 2011, 20 (3): 284-287. 10.1016/j.breast.2010.12.007.CrossRefPubMed
9.
Arnedos M, Nerurkar A, Osin P, A’Hern R, Smith IE, Dowsett M: Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). Ann Oncol. 2009, 20 (12): 1948-1952. 10.1093/annonc/mdp234.CrossRefPubMed
10.
Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, et al: American society of clinical oncology/college of American pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010, 28 (16): 2784-2795. 10.1200/JCO.2009.25.6529.CrossRefPubMedPubMedCentral
11.
Harris L, Fritsche H, Mennel R, Norton L, Ravdin P, Taube S, Somerfield MR, Hayes DF, Bast RC, American Society of Clinical Oncology: American society of clinical oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2007, 25 (33): 5287-5312. 10.1200/JCO.2007.14.2364.CrossRefPubMed
12.
Dowsett M, Nielsen TO, A’Hern R, Bartlett J, Coombes RC, Cuzick J, Ellis M, Henry NL, Hugh JC, Lively T, et al: Assessment of Ki67 in breast cancer: recommendations from the international Ki67 in breast cancer working group. J Natl Cancer Inst. 2011, 103 (22): 1656-1664. 10.1093/jnci/djr393.CrossRefPubMedPubMedCentral
13.
Hanley KZ, Birdsong GG, Cohen C, Siddiqui MT: Immunohistochemical detection of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression in breast carcinomas: comparison on cell block, needle-core, and tissue block preparations. Cancer. 2009, 117 (4): 279-288.PubMed
14.
Park SY, Kim KS, Lee TG, Park SS, Kim SM, Han W, Noh DY, Kim SW: The accuracy of preoperative core biopsy in determining histologic grade, hormone receptors, and human epidermal growth factor receptor 2 status in invasive breast cancer. Am J Surg. 2009, 197 (2): 266-269. 10.1016/j.amjsurg.2007.11.024.CrossRefPubMed
15.
Mann GB, Fahey VD, Feleppa F, Buchanan MR: Reliance on hormone receptor assays of surgical specimens may compromise outcome in patients with breast cancer. J Clin Oncol. 2005, 23 (22): 5148-5154. 10.1200/JCO.2005.02.076.CrossRefPubMed
16.
Zidan A, Christie Brown JS, Peston D, Shousha S: Oestrogen and progesterone receptor assessment in core biopsy specimens of breast carcinoma. J Clin Pathol. 1997, 50 (1): 27-29. 10.1136/jcp.50.1.27.CrossRefPubMedPubMedCentral
17.
Taucher S, Rudas M, Mader RM, Gnant M, Dubsky P, Roka S, Bachleitner T, Kandioler D, Steger G, Mittlböck M, et al: Prognostic markers in breast cancer: the reliability of HER2/neu status in core needle biopsy of 325 patients with primary breast cancer. Wien Klin Wochenschr. 2004, 116 (1–2): 26-31.CrossRefPubMed
18.
de Azambuja E, Cardoso F, de Castro G, Jr CM, Mano MS, Durbecq V, Sotiriou C, Larsimont D, Piccart-Gebhart MJ, Paesmans M: Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. Br J Cancer. 2007, 96 (10): 1504-1513. 10.1038/sj.bjc.6603756.CrossRefPubMedPubMedCentral
19.
Hugh J, Hanson J, Cheang MC, Nielsen TO, Perou CM, Dumontet C, Reed J, Krajewska M, Treilleux I, Rupin M, et al: Breast cancer subtypes and response to docetaxel in node-positive breast cancer: use of an immunohistochemical definition in the BCIRG 001 trial. J Clin Oncol. 2009, 27 (8): 1168-1176. 10.1200/JCO.2008.18.1024.CrossRefPubMedPubMedCentral
20.
Penault-Llorca F, André F, Sagan C, Lacroix-Triki M, Denoux Y, Verriele V, Jacquemier J, Baranzelli MC, Bibeau F, Antoine M, et al: Ki67 expression and docetaxel efficacy in patients with estrogen receptor-positive breast cancer. J Clin Oncol. 2009, 27 (17): 2809-2815. 10.1200/JCO.2008.18.2808.CrossRefPubMed
21.
Anderson H, Hills M, Zabaglo L, A’hern R, Leary AF, Haynes BP, Smith IE, Dowsett M: Relationship between estrogen receptor, progesterone receptor, HER-2 and Ki67 expression and efficacy of aromatase inhibitors in advanced breast cancer. Ann Oncol. 2011, 22 (8): 1770-1776. 10.1093/annonc/mdq700.CrossRefPubMed
22.
Ellis MJ, Tao Y, Luo J, A’Hern R, Evans DB, Bhatnagar AS, Chaudri Ross HA, von Kameke A, Miller WR, Smith I, et al: Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. J Natl Cancer Inst. 2008, 100 (19): 1380-1388. 10.1093/jnci/djn309.CrossRefPubMedPubMedCentral
23.
Whitfield ML, George LK, Grant GD, Perou CM: Common markers of proliferation. Nat Rev Cancer. 2006, 6: 99-106. 10.1038/nrc1802.CrossRefPubMed
24.
Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, Baehner FL, Walker MG, Watson D, Park T, et al: A multigene assay to predict recurrence of tamoxifentreated, node-negative breast cancer. N Engl J Med. 2004, 351: 2817-2826. 10.1056/NEJMoa041588.CrossRefPubMed
25.
Paik S, Tang G, Shak S, Kim C, Baker J, Kim W, Cronin M, Baehner FL, Watson D, Bryant J, et al: Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006, 24: 3726-3734. 10.1200/JCO.2005.04.7985.CrossRefPubMed
26.
Fishman JE, Milikowski C, Ramsinghani R, Velasquez MV, Aviram G: S-guided core-needle biopsy of the breast: how many specimens are necessary?. Radiology. 2003, 226 (3): 779-782. 10.1148/radiol.2263011622.CrossRefPubMed
27.
Greer LT, Rosman M, Mylander WC, Hooke J, Kovatich A, Sawyer K, Buras RR, Shriver CD, Tafra L: Does breast tumor heterogeneity necessitate further immunohistochemical staining on surgical specimens?. J Am Coll Surg. 2013, 216 (2): 239-251. 10.1016/j.jamcollsurg.2012.09.007.CrossRefPubMed
28.
Nizzoli R, Bozzetti C, Naldi N, Guazzi A, Gabrielli M, Michiara M, Camisa R, Barilli A, Cocconi G: Comparison of the results of immunocytochemical assays for biologic variables on preoperative fine-needle aspirates and on surgical specimens of primary breast carcinomas. Cancer. 2000, 90 (1): 61-66. 10.1002/(SICI)1097-0142(20000225)90:1<61::AID-CNCR9>3.0.CO;2-N.CrossRefPubMed
29.
Karn T, Metzler D, Ruckhäberle E, Hanker L, Gätje R, Solbach C, Ahr A, Schmidt M, Holtrich U, Kaufmann M, et al: Data-driven derivation of cutoffs from a pool of 3,030 Affymetrix arrays to stratify distinct clinical types of breast cancer. Breast Cancer Res Treat. 2010, 120 (3): 567-579. 10.1007/s10549-009-0416-z.CrossRefPubMed
30.
Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, et al: Molecular portraits of human breast tumours. Nature. 2000, 406: 747-752. 10.1038/35021093.CrossRefPubMed
Metadata
Title
Preoperative core needle biopsy is accurate in determining molecular subtypes in invasive breast cancer
Authors
Xiaosong Chen
Long Sun
Yan Mao
Siji Zhu
Jiayi Wu
Ou Huang
Yafen Li
Weiguo Chen
Jianhua Wang
Ying Yuan
Xiaochun Fei
Xiaolong Jin
Kunwei Shen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2013
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-13-390

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