Histological grade concordance between diagnostic core biopsy and corresponding surgical specimen in HR-positive/HER2-negative breast carcinoma

Abstract

Background:The identification and validation of suitable predictive and prognostic factors are a challenge to improve the treatment scheme selection. Discordances in histological grade can be established between core biopsy and surgical specimens. This is important in HR-positive/HER2-negative subgroup where histological grade identifies patients at high risk and is a strong determinant for treatment scheme.Methods:A total of 350 consecutive invasive breast carcinoma biopsies were assessed and compared with surgical specimens in Institut Curie, Paris, France. Clinical, radiological and pathological data were recorded.Results:Histological grade concordance rate in the HR+/HER2− group was 75%. A grade underestimation was mainly due to mitotic index misgrading (23%). Large tumours (P<0.05), premenopausal patients (P=0.005) and non-ultrasound-guided biopsies (P=0.04) were risk factors for misgrading. The highest discordance was found in tumours that required chemotherapy (39%, P<0.05), and it was related to an underestimation of histological grade on core biopsies (94%).Conclusions:Histological grade in HR+/HER2− group is important to identify patients with poor prognosis and start a systemic therapy. Histological grade discordance was correlated with an underestimation of mitotic index and factors probably associated with intratumor heterogeneity (premenopausal status, tumour size and the type of core biopsy performed). But such discordance did not appear to modify the therapeutic decision, because systemic treatment decision-making also integrates other variables. Determining histological grade in core biopsy can be especially important in HR-positive/HER2-negative subgroup where it identifies patients at high risk and is a strong determinant of the treatment scheme.

The reliability of histological grade in breast cancer core needle biopsies depends on biopsy size: a comparative study with subsequent surgical excisions

“…However, the direct association between agreement and total core length was not analysed . Two other studies did not find an association of core biopsy length and grade concordance in CNBs versus SEBs, but in one study only the nuclear grade, not the Nottingham grade, was taken into account, and one analysed only minimum and maximum lengths of the cores, and not the total core length per biopsy set …”

“…Although some authors have suggested that increasing the amount of biopsy material could improve the concordance of grade between CNBs and SEBs, the available data are inconsistent and sparse. One study reported improved grade agreement with increasing number of cores, whereas others failed to show an association between the amount of CNB material and grade agreement between CNBs and SEBs …”

Correlation between conductivity and prognostic factors in invasive breast cancer using magnetic resonance electric properties tomography (MREPT)

“…Mitosis grades from core biopsies tend to be underestimated compared with from full tumour specimens, due to the small sample size of core biopsies and the intratumoral heterogeneity of breast cancer [34]. Therefore, in vivo, non-invasive measurement of conductivity via MREPT may provide information about mitosis Contrary to tumours ≥2 cm, tumours 1-2 cm in size with high mitosis grades or high Ki-67 values had lower conductivity without statistical significance.…”

Histologisches Grading beim Mammakarzinom

“…2a,b). Entsprechend ist die Konkordanz des Grades in präoperativen Biopsien vs. korrespondierenden Resektaten auch unabhängig von Größe und Anzahl der Biopsiezylinder [33]. Gelegentlich wird über eine Unterschätzung des histologischen Grades in Stanzbiopsien berichtet [33].…”

“…Entsprechend ist die Konkordanz des Grades in präoperativen Biopsien vs. korrespondierenden Resektaten auch unabhängig von Größe und Anzahl der Biopsiezylinder [33]. Gelegentlich wird über eine Unterschätzung des histologischen Grades in Stanzbiopsien berichtet [33]. Ein Grund hierfür kann in der nicht ausreichenden Reprä-sentanz von Mitosefiguren bestehen; die Anwendung von Ki-67 an Stanzbiopsien kann den Anteil der falsch-niedrigen Grade reduzieren [34].…”