Prognostic relevance of DNA flow cytometry in breast cancer revisited: The 25-year experience of the Portuguese Institute of Oncology of Lisbon

Abstract

Abstract. The potential prognostic significance of DNA flow cytometric measurements (DNA ploidy and S-phase fraction) in breast cancer remains in dispute. Inconclusive data, primarily due to the lack of consistent standardization and quality control programs, have limited its translation into clinical practice. The aim of the present review, based on the 25-year experience of the Portuguese Institute of Oncology of Lisbon, is to assess the clinical relevance and application of DNA flow cytometry for the prognosis of breast cancer. Overall, data from Portuguese Institute of Oncology of Lisbon indicate that DNA flow cytometry provides significant prognostic information that is biologically relevant and clinically useful for the management of patients with breast cancer. Furthermore, this data has demonstrated the independent value of DNA aneuploidy as a prognostic indicator of poor clinical outcome in various subgroups of patients with early or locally advanced breast cancer at short-and long-term follow-up. Notably, aneuploidy identifies subsets of patients with grade (G)1 or G2 tumours who exhibit a poor clinical outcome. These patients may benefit from adjuvant chemotherapy, particularly those with luminal A and luminal B/human epidermal growth factor-2-negative endocrine-responsive breast cancer. In conclusion, data from Portuguese Institute of Oncology of Lisbon reinforces the clinical importance and utility of DNA flow cytometric analysis, particularly DNA ploidy, in the prognostic assessment and therapeutic planning for patients with breast cancer.

Evaluation of DNA ploidy and S‐phase fraction in fine needle aspirates from breast carcinoma

“…Another advantage is that FNA minimizes the artifacts due to autolysis or ischemia, as in biopsy samples. Estimation of DNA ploidy and SPF aids in identification of patients who are candidates for presurgical chemotherapy 1,5 …”

“…Tumors are categorized according to the DNA index (DI) as follows: 1 Diploid, DI = 0.95‐1.05; Hypodiploid, DI < 0.95; Hyperdiploid, DI > 1.05‐1.92; Tetraploid, DI > 1.92‐2.04; Hypertetraploid DI > 2.04 and Multiploid, ≥2 DIs. For the purpose of statistical analysis, all tumors with DI < 0.95 and > 1.05 were taken as aneuploid.…”

“…Breast cancer exhibits a great cellular heterogeneity, which makes its clinical behavior as well as the metastatic potential different even in patients with same pathological grade 1 . Accurate assessment of prognosis requires identification of markers that can reliably predict the natural history of disease, allow determination of optimal treatment strategy, and predict outcome after such interventions.…”

The role of automated cytometry in the new�era of cancer immunotherapy (Review)

“…Tumor proliferative activity (S-phase fraction) has been studied less extensively, but it might also be an outcome predictor in some tumor types. In addition, through ploidy and proliferative activity measurements, flow cytometric studies have focused on the possibility to provide a biological rationale to assist oncologists in selecting the treatment for some tumors, i.e., to predict the outcome of specific treatment regimens (43,44). However, the peculiar technical capabilities of FCM did substantially fail in the above mentioned applications and showed a relatively little impact in clinical oncology.…”

Significance of numerical chromosome abnormalities in children with acute leukaemias detected by flow cytometry

“…During recent years, DNA aneuploidy determined by FC was a widely used parameter in the prognostication of many solid tumours and haematological malignancies [11][12][13]. Nowadays, flow cytometry FC is routinely used for rapid assessment of the immunophenotype of leukaemic cells, and minimal residual disease (MRD) detection enables also the assessment of the ploidy of leukemic blasts and measurement of DNA content in parallel.…”