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Annals of Surgical Oncology

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01-01-2006 | Original Article

Preoperative Profiling of Symptomatic Breast Cancer by Diagnostic Core Biopsy

Authors: Ronan A. Cahill, AFRCSI, Daniel Walsh, FFRRCSI, Rob J. Landers, MRCP, R. Gordon Watson, FRCSI

Published in: Annals of Surgical Oncology | Issue 1/2006

Abstract

Background

Precise preoperative profiling of breast tumors could facilitate fuller consideration of (neo)adjuvant therapies.

Methods

Diagnostic core biopsy (DCB) accuracy in profiling the primary tumor was prospectively studied in 95 patients with operable breast cancer. The histological type and grade (hematoxylin and eosin staining) and membrane receptor status (semiquantitative immunohistochemistry for estrogen [ER] and progesterone [PR] receptors, as well as Her-2 antigen expression) were assigned by the DCB before surgery. These measures were then compared with those of the definitive surgical specimen available after operation.

Results

DCB correctly ascribed tumor type and grade and ER, PR, and Her-2 receptor status in most cases (correlating exactly in 97.5%, 77%, 68%, 71%, and 60%, respectively) with at least moderate concordance (weighted κ, >.41). When miscategorized, DCB consistently tended to upscore the receptor stain intensity compared with the surgical specimen (22%, 19%, and 27% had higher ER, PR, and Her-2 categorical scores, respectively). ER H-scores correlated best in specimens that stained strongly (224.4 ± 3 vs. 215.5 ± 5) and were significantly higher on DCB in those that stained either moderately (195.6 ± 8.2 vs. 156.8 ± 5.1; P < .0001) or weakly (157.1 ± 24.8 vs. 81.4 ± 4; P = .02). DCB accurately identified all tumors with clinically important ER and Her-2 expression. Furthermore, it promoted three patients into the therapeutically significant range of ER (n = 1) or Her-2 (n = 2) expression. ER negativity on DCB (n = 25) indicated a high-grade tumor (88%), although 11 (44%) patients also overexpressed Her-2. Significant Her-2 expression (n = 16) on DCB predicted the tumor as being poorly differentiated (80%) and both ER and PR negative (67%).

Conclusions

DCB accurately profiles clinically relevant measures of primary tumor cell differentiation. It also reliably categorizes patients with regard to (neo)adjuvant therapy before radical surgery is attempted.

Cross SS. Grading and scoring in histopathology. Histopathology 1998;33:99–106CrossRef

Cross SS. Kappa statistics as indicators of quality assurance in histopathology and cytopathology. J Clin Pathol 1996;49:597–9CrossRef

Silcocks PB. Measuring repeatability and validity of histological diagnosis—a brief review with some practical examples. J Clin Pathol 1983;36:1269–75CrossRef

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74CrossRef

Kaufmann M, von Minckwitz G, Smith R, et al. International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations. J Clin Oncol 2003;21:2600–8CrossRef

Mano MS, Awada AS. Primary chemotherapy for breast cancer: the evidence and the future. Ann Oncol 2004;15:1161–71CrossRef

Piper GL, Patel NA, Patel JA, Malay MB, Julian TB. Neoadjuvant chemotherapy for locally advanced breast cancer results in alterations in preoperative tumor marker status. Am Surg 2004;70:1103–6PubMed

Bosch AM, Kessels AG, Beets GL, et al. Preoperative examination of the pathological breast tumour size by physical examination, mammography and ultrasound: a prospective study on 105 invasive tumours. Eur J Radiol 2003;48:285–92CrossRef

Snelling JD, Abdullah N, Brown G, King DM, Moskovic E, Gui GP. Measurement of tumour size in case selection for breast cancer therapy by clinical assessment and ultrasound. Eur J Surg Oncol 2004;30:5–9CrossRef

10.

Podkrajsek M, Music MM, Kadivec M, et al. Role of ultrasound in the preoperative staging of patients with breast cancer. Eur Radiol 2005;15:1044–50CrossRef

11.

Zgajnar J, Frkovic-Grazio S, Besic N, et al. Low sensitivity of the touch imprint cytology of the sentinel lymph node in breast cancer patients—results of a large series. J Surg Oncol 2004;85:82–6CrossRef

12.

Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 2004;351:2817–26CrossRef

13.

Yu K, Lee C, Tan PH, et al. A molecular signature of the Nottingham prognostic index in breast cancer. Cancer Res 2004;64:2962–8CrossRef

14.

Denley H, Pinder SE, Elston CW, Lee AH, Ellis IO. Preoperative assessment of prognostic factors in breast cancer. J Clin Pathol 2001;54:20–4CrossRef

15.

Sharifi S, Peterson MK, Baum JK, Raza S, Schnitt SJ. Assessment of pathologic prognostic factors in breast core needle biopsies. Mod Pathol 1999;12:941–5PubMed

16.

Shannon J, Douglas-Jones AG, Dallimore NS. Conversion to core biopsy in preoperative diagnosis of breast lesions. Is it justified by the results? J Clin Pathol 2001;54:762–5CrossRef

17.

Cross SS. Correspondence re: Sharifi S, Peterson MK, Baum JK, Raza S, Schnitt SJ. Assessment of pathologic prognostic factors in breast core needle biopsies. Mod Pathol 1999;12:941–945. Mod Pathol 1999;12:1332

18.

Sinha PS, Bendall S, Bates T. Does routine grading of invasive lobular cancer of the breast have the same prognostic significance as for ductal cancers? Eur J Surg Oncol 2000;26:733–7CrossRef

19.

Moore MM, Borossa G, Imbrie JZ, et al. Association of infiltrating lobular carcinoma with positive surgical margins after breast-conserving therapy. Ann Surg 2000;231:877–82CrossRef

20.

Schnitt SJ, Jacobs TW. Current status of Her-2 testing: caught between a rock and a hard place. Am J Clin Pathol 2001;116:806–10CrossRef

21.

Ring AE, Smith IE, Ashley S, Fulford LG, Lakhani SR. Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer. Br J Cancer 2004;91:2012–7CrossRef

22.

Rubin MA, Gage WR, Fedor HH, De Marzo AM. Inadequate formalin fixation decreases reliability of p27 immunohistochemical staining: probing optimal fixation time using high-density tissue microarrays. Hum Pathol 2002;33:756–60CrossRef

23.

Lee SH, Chung MA, Quddus MR, Steinhoff MM, Cady B. The effect of neoadjuvant chemotherapy on oestrogen and progesterone receptor expression and hormone receptor status in breast cancer. Am J Surg 2003;186:348–50. CrossRef

24.

Ross JS, Fletcher JA, Linette GP, et al. The Her-2/neu gene and protein in breast cancer 2003: biomarker and target of therapy. Oncologist 2003;8:307–25CrossRef

25.

Eccles SA. The role of c-erbB-2/Her2/neu in breast cancer progression and metastases. J Mammary Gland Biol Neoplasia 2001;6:393–406CrossRef

26.

Yarden Y. Biology of Her2 and its importance in breast cancer. Oncology 2001;61(Suppl 2):1–13CrossRef

27.

Piccart M, Lohrisch C, DiLeo A, Larsimont D. The predictive value of Her-2 in breast cancer. Oncology 2001;61(Suppl 2):73–82CrossRef

28.

Konecny G, Pauletti G, Pegram M, et al. Quantitative association between Her-2/neu and steroid hormone receptors in hormone-receptor positive primary breast cancer. J Natl Cancer Inst 2003;95:142–53CrossRef

29.

Dowsett M. Overexpression of Her-2 as a resistance mechanism to hormonal therapy for breast cancer. Endocr Relat Cancer 2001;8:191–5CrossRef

30.

Carlomagno C, Perrone F, Gallo C, et al. c-erb B2 overexpression decreases the benefit of adjuvant tamoxifen in early-stage breast cancer without ancillary lymph node metastases. J Clin Oncol 1996;14:2702–8CrossRef

31.

Schmid P, Wischnewsky MB, Sezer O, Bohm R, Possinger K. Prediction of response to hormonal treatment in metastatic breast cancer. Oncology 2002;63:309–16CrossRef

32.

Ellis MJ, Coop A, Singh B, et al. Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1 and/or ErbB-2 positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomised trial. J Clin Oncol 2001;19:3808–16CrossRef

33.

Muss HB, Thor AD, Berry DA, et al. c-erb-B2 expression and response to adjuvant therapy in women with node-positive early breast cancer. N Engl J Med 1994;330:1260–6CrossRef

34.

Baselga J, Seidman AD, Rosen PP, Norton L. Her2 overexpression and paclitaxel sensitivity in breast cancer: therapeutic implication. Oncology 1997;11(Suppl 2):43–8PubMed

35.

Ligibel JA, Winer EP. Trastuzumab/chemotherapy combinations in metastatic breast cancer. Semin Oncol 2002;29(Suppl 11):38–43CrossRef

36.

Hortobagyi GN. Overview of treatment results with trastuzumab (Herceptin) in metastatic breast cancer. Semin Oncol 2001;28(Suppl 18):43–7CrossRef

37.

McKeage K, Perry CM. Trastuzumab: a review of its use in the treatment of metastatic breast cancer overexpressing Her-2. Drugs 2002;62:209–43CrossRef

38.

Engel J, Eckel R, Kerr J, et al. The process of metastasisation for breast cancer. Eur J Cancer 2003;39:1794–806CrossRef

39.

Collett K, Skjaerven R, Maehle BO. The prognostic contribution of estrogen and progesterone receptor status to a modified version of the Nottingham Prognostic Index. Breast Cancer Res Treat 1998;48:1–9CrossRef

40.

Cooke T, Reeves J, Lannigan A, Stanton P. The value of human epidermal growth factor receptor-2 (HER2) as a prognostic marker. Eur J Cancer 2001;37(Suppl 1):3–10CrossRef

41.

D’Eredita G, Giardina C, Martellotta M, Natale T, Ferrarese F. Prognostic factors in breast cancer: the predictive value of the Nottingham Prognostic Index in patients with a long-term follow-up that were treated in a single institution. Eur J Cancer 2001;37:591–6CrossRef

42.

Emens LA, Davidson NE. The follow-up of breast cancer. Semin Oncol 2003;30:338–48CrossRef

Title: Preoperative Profiling of Symptomatic Breast Cancer by Diagnostic Core Biopsy
Authors: Ronan A. Cahill, AFRCSI
Daniel Walsh, FFRRCSI
Rob J. Landers, MRCP
R. Gordon Watson, FRCSI
Publication date: 01-01-2006
Publisher: Springer New York
Published in: Annals of Surgical Oncology / Issue 1/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/ASO.2006.03.047

At a glance: The STEP trials

Springer Medicine

Preoperative Profiling of Symptomatic Breast Cancer by Diagnostic Core Biopsy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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