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)

ArticleinAnnals of Oncology 20(12):1948-52 · August 2009with16 Reads
DOI: 10.1093/annonc/mdp234 · Source: PubMed
Abstract
Analysis of estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC) is increasingly being conducted in core needle biopsies (CNBs) taken at diagnosis but the concordance with the excisional biopsy (EB) is poorly documented. Patients with EBC presenting to The Royal Marsden Hospital from June 2005 to September 2007 who had CNB and subsequent EB were included. ER and PgR were determined by immunohistochemistry (IHC) and graded from 0 to 8 (Allred score). HER2 was determined by IHC and scored from 0 to 3+. FISH analysis was carried out in HER2 2+ cases and in discordant cases. In all, 336 pairs of samples were compared. ER was positive in 253 CNBs (75%) for 255 EBs (76%) and was discordant in six patients (1.8%). PgR was positive in 221 CNBs (66%) and 227 (67.6%) EBs being discordant in 52 cases (15%). HER2 was positive in 41 (12.4%) of the 331 CNBs in which it was determined compared with 44 (13.3%) EBs and discordant in four cases (1.2%). CNB can be used with confidence for ER and HER2 determination. For PgR, due to a substantial discordance between CNB and EB, results from CNB should be used with caution.
    • "f 94.1% for ER and 77.9% for PR, with a κ value of 0.82 and 0.66 respectively. [21] Numerous studies have reported similar results ranging from 61.7% to 99% for ER and 61.5% to 91.3% for PR status. [31] However, the concordance rate for PR status is generally lower than ER status and it tends to be a common denominator among many published reports. [31]Table 1 demonstrates a comparison of our results with those of a meta-analysis of 21 articles involving over 2000 patients for both ER and PR. [18] Our results regarding ER are not to disparate, however our results for PR are ominously different. This could be due to the retrospective nature of our study. We observed 24 discordant cases,"
    [Show abstract] [Hide abstract] ABSTRACT: Background and aim: Core needle biopsies (CNB) are now routinely performed for the clinical approach of patients with suspected breast cancer (BC). We explored the degree of concordance between CNB and surgical excised specimens (SES) regarding histological type, grade and immunohistochemistry (IHC) status. Patients and methods: We included 162 patients who underwent CNB before surgical resection. Immunohistochemistry for ER, PR, HER2 and Ki-67 was performed. Kappa test was used to obtain the concordance rate between CNB and SES regarding their histological type, grade and IHC profile. Sensitivity, specificity, PPV and NPV were calculated for CNB, considering SES as gold standard. Results: The concordance rate for histological type was 82.76% (κ = 0.49; p < 0.00). The general agreement for ER was 87.3% (κ = 0.71; p < 0.00). Nine cases were positive to PR in CNB and negative in SES, while the opposite occurred in 15 cases. We detected the highest concordance rate for HER2 expression (91.6%, κ = 0.74; p < 0.00). The calculated NPV was 98.5% for HER2 expression. Conclusions: We demonstrate that a CNB is a reliable tool for the diagnostic work-up of BC patients. A HER2 negative result should be reassuring for the clinician; however every hormone receptor negative in CNB should be regularly re-tested.
    Full-text · Article · Apr 2015 · PLoS ONE
    • "This mechanism is considered to be the main cause for the switch of HR (+) to HR (−) after NCT. However, falsenegative identification of the HR status and the HER2 status in CNB due to intratumoral heterogeneity has been reported previously [28]. The conversion from HR (−) to HR (+) and HER2 (−) to HER2 (+) may be due to the availability of tumor material for CNB because CNB may represent only a small proportion of clones of different phenotypes. "
    [Show abstract] [Hide abstract] ABSTRACT: The hormone receptor (HR) status and human epidermal growth hormone receptor 2 (HER2) status of patients with breast cancer may change following neoadjuvant chemotherapy (NCT). This prospective observational study aimed to evaluate the prognostic impact of receptor conversion in breast cancer patients treated with NCT.Of the 423 consecutive patients who had residual disease in the breast after NCT, 55 (13.0%) changed from HR (+) to HR (-), 23 (5.4%) changed from HR (-) to HR (+), 27 (6.4%) changed from HER2 (+) to HER2 (-), and 13 (3.1%) changed from HER2 (-) to HER2 (+). A total of 54 (12.8%) changed to the triple-negative (TN) tumor phenotype. The loss of HR positivity was an independent prognostic factor for worse disease-free survival (DFS) and worse overall survival (OS) in multivariate survival analysis. Furthermore, the switch to the TN phenotype after NCT was another independent prognostic factor for worse survival for both DFS and OS. In conclusion, patients with breast cancer may experience changes in HR status, HER2 status and tumor phenotype after NCT. The loss of HR positivity and the switch to the TN phenotype after NCT were associated with a worse patient outcome.
    Full-text · Article · Mar 2015
    • "To our knowledge, no information is available on the effect of tissue fixation on IGF- 1R staining. However, several studies have shown that the concordance rates for comparable markers like ER, PR, HER2 and Ki67 are high between biopsies and surgical resection material.353637 Third, differences in IGF-1R expression may occur naturally during the course of disease , for example due to disease progression. "
    [Show abstract] [Hide abstract] ABSTRACT: The insulin-like growth factor 1 receptor (IGF-1R) may be involved in the development of resistance against conventional cancer treatment. The aim of this study was to assess whether IGF-1R expression of breast tumors changes during neoadjuvant therapy and to study whether these changes were associated with survival. Paraffin embedded tumor tissue was collected from pretreatment biopsies and surgical resections of 62 breast cancer patients who were treated with neoadjuvant chemotherapy or endocrine therapy. IGF-1R expression was determined immunohistochemically and compared before and after treatment. High membranous IGF-1R expression at diagnosis correlated significantly with ER positivity, low tumor stage (stage I/II) and longer overall survival (p < 0.05). After neoadjuvant treatment, membranous IGF-1R expression remained the same in 41 (65%) tumors, was upregulated in 11 (18%) tumors and downregulated in 11 (18%) tumors. Changes in membranous IGF-1R expression were associated with overall survival (log-rank test: p = 0.013, multivariate cox-regression: p = 0.086). Mean overall survival time for upregulation, no change, and downregulation in IGF-1R expression was 3.0 ± 0.5 years, 7.3 ± 1.0 years and 15.0 ± 1.8 years, respectively. Changes in other parameters were not significantly associated with survival. Neoadjuvant therapy can induce changes in IGF-1R expression. Upregulation of IGF-1R expression after neoadjuvant treatment is a poor prognostic factor in breast cancer patients, providing a rationale for incorporating anti-IGF-1R drugs in the management of these patients.
    Full-text · Article · Feb 2015
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