Immunohistochemical Profile of Infiltrating Ductal Carcinoma Breast- Prognostic and Therapeutic Use

Abstract

BACKGROUND Breast carcinoma is the most common malignant tumour and the leading cause of death in women. Various prognostic and predictive factors are used in the management of breast cancer. Oestrogen receptor (ER), progesterone receptor (PR) & human epidermal growth receptor (HER2/neu) are prognostic as well as predictive factors. The aim of the present study was conducted to evaluate ER, PR & HER2/neu expression in invasive ductal carcinoma of the breast (not otherwise specified) by immunohistochemistry to explore the correlation of these markers to each other, as well as to various clinicopathological parameters like age of patient, histological grade, tumour size and lymph node metastasis. MATERIALS AND METHODS 100 cases of infiltrating ductal carcinoma (NOS) were taken. Slides were prepared from paraffin blocks containing cancer tissue of these patients & immunohistochemical staining was done for ER, PR, and HER2/neu expressions. Interpretation of expressions done using Allred scoring system for ER/PR & ASCO/CAP guidelines for HER2/neu. Statistical analysis was done to determine the statistical significance by applying chi-square test. RESULTS In our study, mean age was 55.28 years. Average tumour size was 4.3 cm & majority of tumours were grade II. 38 patients had axillary lymph nodes positive for metastasis. 58 cases were both ER & PR positive and 37 cases ER/PR negative. Only 7 were HER2/neu positive & 93 were HER2/neu negative. Only 2 cases were both ER as well as HER2/neu positive, 32 cases were both ER & HER2/neu negative. 66 cases showed different expressions of ER & HER/neu. ER & PR correlated significantly with age, tumour size, and tumour grade; whereas HER2/neu correlated significantly with age & tumour size only. No association was seen with axillary lymph node metastasis. ER and PR expression correlated with each other, but none was correlated with HER2/neu. CONCLUSION Assessment of hormone receptors for clinical management of a breast cancer patient is strongly recommended to provide prognostic information and therapeutic options.

Correlation ER/PR status of Breast Carcinoma with Tumor size, Tumor grade, Lymphovascular emboli, Lymph node metastasis and the distant metastasis

“…Grade II was the commonest grade amongst the 50 cases (17.5%), and 17.5 % the tumor size was between 2-4 cm. Similar was the observation was Premchand, Ashok Kumar et al 5 who studied 100 cases and majority (96.82%) of the breast carcinoma was in the age group of >40 years. 43% cases were of grade II tumor and, in 47% cases the tumor size was between 2-5 c.m.…”

“…8 Correlation of age of the patient with ER and PR status with other studies done. In our study 10% cases were of 60 years of age group and 8.5% are of >40 years of age group were ER positive, while 8% in age group of >40 were Premchand, Ashok Kumar et al 5 shows similar result like our study which has majority of ER positive (96.82%) cases were of age >40 year and 44.44% were of age >60 years. The majority of PR positive (96.55%) cases were of age >40 years and 43.10% were of age >60 years.…”

“…Ramandeep Kaur et al 9 found 66% cases in <50 years with 43% of grade II carcinomas and, in 43% cases Premchand, Ashok Kumar et al 5 shows similar result with negative correlation with lymphovascular emboli. The result with similar with Asmeron Tesfamarian Sengal et al 1 and there was significant associated between age tumor size and grade, but no associated with lymph nodes.…”

“…Correlation of expression of estrogen and progesterone with each other and to various clinicopathological parameters is very significant. 5 Estrogen and progesterone status are measured by chemical ligand binding assay are the only prognostic and predictive biomarker recommend for routine clinical use in breast cancer by American pathologist. Both are relatively weak prognostic factor, but strong predictive factor for response to the adjuvant and therapeutic hormonal therapy.…”

“…Progesterone receptor expression lengthens along with atypia of breast tissue. 5 In this study we have studied the correlation of ER/ PR status with lymph nodes metastasis, lymphovascular emboli and also with distant metastasis.…”