Hormonal receptor status, Ki-67 and HER2 expression: Prognostic value in the recurrence of ductal carcinoma in situ of the breast?

Poulakaki, Nikiforita; Makris, Georgios‐Marios; Battista, Marco-Johannes; Böhm, Daniel; Petraki, Kalliopi; Bafaloukos, Dimitrios; Sergentanis, Theodoros N.; Siristatidis, Charalampos; Chrelias, Charalampos; Papantoniou, Nikolaos

doi:10.1016/j.breast.2015.10.007

Cited by 28 publications

(17 citation statements)

References 33 publications

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“…While these results are supported by previous studies which linked both ER/PRstatus [114] and HER2+ status [28,114,115] to increased risk of recurrence, a recent study in a cohort of 230 DCIS cases found no significant correlation between these markers and recurrence [116]. This divergence highlights the need for further work before the potential clinical utility of hormone and HER2 receptor status can be confirmed.…”

Section: Challenges In the Management Of Dcis: The Need For Predictivsupporting

confidence: 61%

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast

Martínez-Pérez

Turnbull

Ekatah

et al. 2017

Cancer Treatment Reviews

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Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient.

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Section: Challenges In the Management Of Dcis: The Need For Predictivsupporting

confidence: 61%

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast

Martínez-Pérez

Turnbull

Ekatah

et al. 2017

Cancer Treatment Reviews

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“…Currently, HER2 amplification is not routinely tested in DCIS because its clinical or prognostic relevance is not yet elucidated. 38,39 HER2 amplification is strongly associated with HNG, and as mentioned above, HNG DCIS is independently associated with increased recurrence and progression to invasive disease. 2,33,38 Two thirds of the imaging biomarkers that correlated with HER2 amplification were identified on the first postcontrast or subtracted first postcontrast sequences.…”

Section: Metricsmentioning

confidence: 71%

“…38,39 HER2 amplification is strongly associated with HNG, and as mentioned above, HNG DCIS is independently associated with increased recurrence and progression to invasive disease. 2,33,38 Two thirds of the imaging biomarkers that correlated with HER2 amplification were identified on the first postcontrast or subtracted first postcontrast sequences. This finding is revealing given that DCIS tends to demonstrate persistent enhancement kinetics and, therefore, DCIS often enhances most intensely on the delayed (fourth) postcontrast images.…”

Section: Metricsmentioning

confidence: 71%

“…Nevertheless, we found no statistically significant correlation of percentage enhancement with HER2 amplification status. Currently, HER2 amplification is not routinely tested in DCIS because its clinical or prognostic relevance is not yet elucidated (38,39). HER2 amplification is strongly associated with HNG, and as mentioned above, HNG DCIS is independently associated with increased recurrence and progression to invasive disease (2,33,38).…”

Section: Discussionmentioning

confidence: 99%

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Computer‐aided heterogeneity analysis in breast MR imaging assessment of ductal carcinoma in situ: Correlating histologic grade and receptor status

Chou

Gombos

Chikarmane

et al. 2017

Magnetic Resonance Imaging

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Purpose To identify breast magnetic resonance (MR) imaging biomarkers to predict histologic grade and receptor status of ductal carcinoma in situ (DCIS). Materials and Methods Informed consent was waived in this Health Insurance Portability and Accountability Act-compliant Institutional Review Board-approved study. Case inclusion was conducted from 7332 consecutive breast MR studies from 1/1/2009–12/31/2012. Excluding studies with benign diagnoses, studies without visible abnormal enhancement, and pathology containing invasive disease yielded 55 MR-imaged pathology-proven DCIS seen on 54 studies. Twenty-eight studies (52%) were performed at 1.5T; 26 (48%) at 3T. Regions-of-interest representing DCIS were segmented for pre-contrast, first and fourth post-contrast, and subtracted first and fourth post-contrast images on the open-source 3D Slicer software. Fifty-seven metrics of each DCIS were obtained, including distribution statistics, shape, morphology, Renyi dimensions, geometrical measure and texture, using the 3D Slicer HeterogeneityCAD module. Statistical correlation of heterogeneity metrics with DCIS grade and receptor status was performed using univariate Mann-Whitney test. Results Twenty-four of the 55 DCIS (44%) were high nuclear grade (HNG); 44 (80%) were estrogen receptor (ER) positive. Human epidermal growth factor receptor-2 (HER2) was amplified in 10/55 (18%), non-amplified in 34/55 (62%), unknown/equivocal in 8/55 (15%). Surface area-to-volume ratio showed significant difference (p<0.05) between HNG and non-HNG DCIS. No metric differentiated ER status (0.113

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“…A meta-analysis of published literature found an association between high Ki-67 expression and risk of recurrence in women with DCIS regardless of the nuclear grade, type of treatment, age, and the cutoff value chosen. 68,69 Rakovitch et al 70 found that HER2overexpressing and Ki-67 high HG-DCIS was associated with an increased risk of recurrence regardless of nuclear grade and age. Balleine et al 71 found that a combination of nuclear grade and Ki-67 was able to correctly classify DCIS into prognostic groups in 95.7% of cases.…”

Section: Other Molecular Biomarkersmentioning

confidence: 99%

Morphologic and Molecular Features of Breast Ductal Carcinoma in Situ

Sanati

2019

The American Journal of Pathology

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Ductal carcinoma in situ (DCIS) encompasses a highly heterogeneous group of lesions that differ with regard to their clinical presentations, histologic features, biomarker profiles, genetic abnormalities, and potential for progression. DCIS is a nonobligatory precursor for invasive carcinoma. With the advent of screening mammography, the incidence of DCIS has significantly increased. There is an argument that many of these lesions will not progress to invasive carcinoma within the lifetime of a patient. In addition, many studies have found enormous heterogeneity within DCIS. There is a need for biomarkers that can stratify patients with DCIS into different prognostic groups based on the biology of the disease. Estrogen and progesterone receptors are the established biomarkers that are used for clinical decision making. In addition, a number of biomarkers, such as human epidermal growth factor receptor 2 protein, p53 tumor suppressor gene, Ki-67 proliferation marker, and tumor-infiltrating lymphocytes, carry prognostic significance, although their use is considered investigational and has not been transferred to clinical practice. On the molecular level, low-grade and high-grade DCIS have different molecular alterations, and the intrinsic molecular subtypes that exist in invasive carcinoma also exist in DCIS with prognostic implications. In this article, we review the morphologic features, prognostic biomarkers, and molecular features of DCIS.

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Hormonal receptor status, Ki-67 and HER2 expression: Prognostic value in the recurrence of ductal carcinoma in situ of the breast?

Cited by 28 publications

References 33 publications

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast

Computer‐aided heterogeneity analysis in breast MR imaging assessment of ductal carcinoma in situ: Correlating histologic grade and receptor status

Morphologic and Molecular Features of Breast Ductal Carcinoma in Situ

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