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01-12-2015 | Breast Oncology

Back to Basics: Traditional Nottingham Grade Mitotic Counts Alone are Significant in Predicting Survival in Invasive Breast Carcinoma

Authors: James M. Chang, MD, Ann E. McCullough, MD, Amylou C. Dueck, PhD, Heidi E. Kosiorek, MS, Idris T. Ocal, MD, Thomas K. Lidner, MD, Richard J. Gray, MD, Nabil Wasif, MD, MPH, Donald W. Northfelt, MD, Karen S. Anderson, MD, PhD, Barbara A. Pockaj, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Abstract

Background

Newer multigene molecular profiling assays for breast carcinoma rely heavily on the quantification of genes of proliferation, whereas traditional histological grading reports the mitotic count. The mitotic activity of invasive breast carcinomas may be undervalued; therefore, an evaluation of the prognostic significance of mitotic score in predicting prognosis was performed.

Methods

Retrospective analysis of a single institutional cohort of newly diagnosed estrogen receptor positive (ER+), HER2 negative (HER2−) unilateral invasive breast carcinomas was performed. Mitotic scores from the 3-part Nottingham combined histological grade were compared with clinical parameters. Mitoses were counted on Olympus BX50 microscopes and assigned scores of 1–3 based on observed mitoses.

Results

A total of 1292 ER+, HER2− invasive breast carcinoma patients were identified, with a median follow-up time of 2.6 years (range 0–14 years). Higher mitotic score was significantly associated with younger age, larger tumor size, angiolymphatic invasion, node-positive disease, higher stage, and the use of hormonal and cytotoxic chemotherapy. Mitotic score was significant in modeling time to local/regional recurrence (p = 0.02), recurrence-free survival/RFS (p < 0.001), and overall survival/OS (p = 0.01) with higher mitotic scores associated with worse outcomes. Higher mitotic score correlated significantly with intermediate/high risk Oncotype Dx recurrence scores (p = 0.009).

Conclusions

First-generation molecular profiling assays for estrogen receptor positive invasive breast carcinomas derive much of their predictive power from quantifying genes of proliferation into a single score. Sometimes overlooked in the profusion of molecular data, the time-tested, mitotic count in the Nottingham combined histological grade is a good single-parameter predictor of survival.

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Title: Back to Basics: Traditional Nottingham Grade Mitotic Counts Alone are Significant in Predicting Survival in Invasive Breast Carcinoma
Authors: James M. Chang, MD
Ann E. McCullough, MD
Amylou C. Dueck, PhD
Heidi E. Kosiorek, MS
Idris T. Ocal, MD
Thomas K. Lidner, MD
Richard J. Gray, MD
Nabil Wasif, MD, MPH
Donald W. Northfelt, MD
Karen S. Anderson, MD, PhD
Barbara A. Pockaj, MD
Publication date: 01-12-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4616-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Back to Basics: Traditional Nottingham Grade Mitotic Counts Alone are Significant in Predicting Survival in Invasive Breast Carcinoma

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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