The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy

Pinder, Sarah; Murray, Susan; Ellis, Ian O.; Trihia, Helen; Elston, C.W.; Gelber, RD; Goldhirsch, Aron; Lindtner, Jurij; Cortés, Javier; Simoncini, Edda; Byrne, Michael; Golouh, Rastko; Rudenstam, Carl‐Magnus; Castiglione‐Gertsch, Monica; Gusterson, B A

doi:10.1002/(sici)1097-0142(19981015)83:8<1529::aid-cncr7>3.0.co;2-v

Cited by 84 publications

(17 citation statements)

References 19 publications

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“…Thus, higher the tumor grade, more the unfavourable receptor expression and therefore, worse the prognosis. This is also in agreement with other studies which state that tumor histologic grade is an important determinant of hormone receptor status [11][12][13][14][15]. Tatjana Ivković-Kapicl et al in corroboration with our study, observed that highergrade tumors were more likely to demonstrate HER2/neu amplification than lower grade ductal carcinomas [16].…”

Section: Discussionsupporting

confidence: 93%

Predictive and Prognostic Factors in Breast Cancer and their Association with ER PR HER2/neu Expression

Sunita¹,

Nath²

2016

J Carcinog Mutagen

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Section: Discussionsupporting

confidence: 93%

Predictive and Prognostic Factors in Breast Cancer and their Association with ER PR HER2/neu Expression

Sunita¹,

Nath²

2016

J Carcinog Mutagen

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“…The Nottingham grading was carried out by the Nottingham Group, as described previously. 39 Sections were excluded on the basis of absence of invasive tumor in the material available and lack of any positive staining in the sections. The latter was used to exclude material, because it was possible that the absence of staining was a reflection of the fixation of the material.…”

Section: Study Cohortmentioning

confidence: 99%

“…[33][34][35][36][37][38][39] The objectives of the current study were 1) to analyze Ki-67 as a substitute for mitotic counting in the Nottingham grade (NHG) system to produce a Nottingham/Ki-67 grade (NKG), thus giving an indication of the value of this measure of growth fraction compared with mitotic counts; and 2) to assess the value of Ki-67 as an individual marker of prognosis and treatment response of patients with breast carcinoma against grade and other factors in the data base.…”

mentioning

confidence: 99%

Ki‐67 expression in breast carcinoma

Trihia

Murray

Price

et al. 2003

Cancer

164

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BACKGROUNDThe number of mitoses and, thus, the proliferative capacity of a tumor is one of the most crucial variables for tumor grading. The Ki‐67 nuclear antigen may be considered as an alternative to mitotic counts in grading schemes and as a single parameter that can be used in fine‐needle aspirates and small biopsies.METHODSImmunohistochemistry using the anti‐Ki‐67 antibody MIB‐1 was performed on 434 breast carcinoma specimens from the International Breast Cancer Study Group (formerly Ludwig) Trial V. Three groups based on Ki‐67 percent were used to replace the mitotic counts component in the Nottingham grade (NHG) to produce the Nottingham/Ki‐67 grade (NKG) and to assess Ki‐67 as a single parameter.RESULTSIn both the lymph node positive subgroup and the lymph node negative subgroup, the NKG and Ki‐67 group was correlated significantly with Bloom–Richardson grade (BRG), NHG, and Nottingham type. Tumor size in the lymph node negative cohort and estrogen receptor status, progesterone receptor status, and c‐erbB‐2 expression in the lymph node positive cohort also were correlated significantly with NKG. Ki‐67 percentage was correlated significantly with c‐erbB‐2 expression in the lymph node positive cohort only. NKG was similar to BRG and NHG when it was evaluated for prognostic significance. Patients with higher categoric Ki‐67 percentages had worse overall and disease free survival in all groups except for the untreated, lymph node negative group.CONCLUSIONSKi‐67 detection represents a valuable tool and is a good objective substitute for mitotic counts when used in a grading system. When it is used alone, Ki‐67 detection provides valuable information, although it is necessary to combine this with other parameters in the study of core biopsies and fine‐needle aspirates. Cancer 2003;97:1321–31. © 2003 American Cancer Society.DOI 10.1002/cncr.11188

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“…The thought is that when predicted mortality reaches 10% or less, only a very few patients will benefit from adjuvant therapy given that adjuvant chemotherapy reduces mortality by only 20 to 30%, and the few who might benefit from therapy are balanced by the negative aspects of therapy. This is an especially compelling proposition in that tumors of different grade seem to respond differently to chemotherapy (13). Therefore, a patient outcome threshold of 90% survival serves as an illustrative landmark.…”

Section: Discussionmentioning

confidence: 99%

Histologic Grading of Breast Cancer: Linkage of Patient Outcome with Level of Pathologist Agreement

Dalton¹,

Pinder

et al. 2000

Modern Pathology

117

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In the histologic grading of invasive breast cancer with the Nottingham modification of the ScarffBloom-Richardson grading scheme (NSBR), it has been found that when pathologists disagree, they tend not to disagree by much. However, if tumor grade is to be used as an important parameter in making treatment decisions, then even this generally small degree of pathologist variability in assessing grade needs to be correlated with patient outcome.Findings from the Nottingham/Tenovus Primary Breast Cancer Study were used for patient outcome data. Kaplan-Meier survival curves were constructed for NSBR scores grouped according to the level at which pathologists tend to agree in assessing grade, from a reproducibility perspective. For example, if a given tumor were assessed by several pathologists as having either an NSBR score of 5 or 6, then what is the correct score-the intermediategrade Score 6 assessments or the low-grade Score 5 assessments? By "regrouping" the Nottingham outcome data such that data from patients with Score 5 tumors are grouped with patients having Score 6 tumors (a 5-6 group), then the level in which the pathologists agreed with each other (that the tumor was either score 5 or 6) is better matched with patient outcome.In response to the above example, it was not surprising to find that patients with Score 5-6 tumors had a probability of survival between the established low and intermediate NSBR final combined grades. However, it is the discussion of this approach that highlights that optimal use of grading requires awareness of the level of pathologist agreement and understanding the value of pathologists' reaching consensus in assessments. Also, knowledge of possible clinical decision thresholds can help in providing relevant interpretations of grading results.

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The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy

Cited by 84 publications

References 19 publications

Predictive and Prognostic Factors in Breast Cancer and their Association with ER PR HER2/neu Expression

Predictive and Prognostic Factors in Breast Cancer and their Association with ER PR HER2/neu Expression

Ki‐67 expression in breast carcinoma

Histologic Grading of Breast Cancer: Linkage of Patient Outcome with Level of Pathologist Agreement

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