The Evaluation of the Breast Biomarkers in Multifocal/Multicentric Breast Carcinomas.
Melike Pekmezci, Alia Salhadar, Prabha Rajan, Cagatay Ersahin. Loyola University Medical Center, Maywood, IL
Background: There are controversies regarding the diagnostic and therapeutic management of multifocal/multicentric (MF/MC) breast carcinomas. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki67 are well accepted biomarkers in the management of breast carcinomas. However, it is not clear whether repeating these biomarkers in each tumor focus is necessary or has diagnostic value. The purpose of this study is to evaluate whether breast carcinoma biomarkers vary among separate tumor foci of MF/MC breast carcinomas, and whether this variation correlates with the morphological features.
Design: We have reviewed MF/MC invasive breast carcinomas diagnosed between January 2001 and June 2010 at our institution. Cases with biomarker analyses performed on more than one focus were included in the study. Tumor morphology, Nottingham grade, Ki67, ER, PR and HER2 status were evaluated. ER, PR and HER2 results were classified as positive or negative. ER/PR positivity is immunohistochemical (IHC) staining of minimum 1% of the tumor cells, and HER2 positivity is IHC staining of 3+ (uniform, intense membrane staining of >30% of invasive tumor cells) or a positive flourescent in situ hybridization test. Ki67 results were classified as favorable (<10%), intermediate (10-20%) and unfavorable (>20%).
Results: Of 20 MF/MC breast carcinomas included in the study, only 2 cases had tumors with variable morphology in different foci. The tumor marker characteristics of these 2 cases were presented in table1.
|CASE 1||Tumor 1||Ductal||Grade 1||+||+||+||10-20%|
|Tumor 2||Lobular||Grade 1||+||+||+||10-20%|
|CASE 2||Tumor 1||Ductal||Grade 2||+||+||-||10-20%|
|Tumor 2||Ductal||Grade 3||-||-||-||>20%|