Introduction:The PTEN gene, a candidate tumor suppressor, is localized to chromosome 10q23 and shares extensive homology with cytoskeletal proteins auxilin and tensin. A high frequency of mutations at the PTEN locus has been described in a variety of neoplasms including breast cancer. However, the role of PTEN alternations and its association with outcome variables in breast neoplasia is not well established. Design: Formalin-fixed paraffin embedded tissues from 151 women (mean age 62 years, range 26 -98) with primary diagnosis of invasive breast cancer were evaluated for PTEN protein expression by automated immunohistochemical methods. Slides were scored semi-quantitatively based on staining intensity and distribution, and results were compared with clinical pathologic parameters. The mean follow-up was 56 months (range 1-169). Results: Seventy-three (48%) of 151 breast tumors had loss of PTEN protein expression. On univariate analysis, loss of PTEN expression (P ؍ .034), stage (P < .0001), node positive (P < .0001), and tumor grade (P ؍ .002) were associated with disease-related death. Loss of PTEN expression also predicted lymph node metastasis (P < .0001), and correlated with loss of estrogen receptor staining (P ؍ .040). Loss of PTEN did not correlate with stage, tumor grade, disease recurrence, or loss of progesterone receptor [although a trend was seen (P ؍ .092). On multivariate analysis, stage (P < .0001), lymph node metastasis (P < .0001), and tumor grade (P ؍ .002) correlated with survival. Conclusion: Loss of PTEN protein expression occurs commonly in breast cancer and correlates with disease related death, lymph node metastasis, and loss of estrogen receptor staining. Our results support the