- Open Access
Is preoperative core biopsy accurate in determining the hormone receptor status in women with invasive breast cancer?
© Al Sarakbi et al; licensee BioMed Central Ltd. 2005
- Received: 14 July 2005
- Accepted: 22 August 2005
- Published: 22 August 2005
The objective of this study was to determine the concordance rate between core needle biopsy (CNB) and surgical excision of invasive breast cancer regarding the oestrogen receptor (ER) and Progesterone receptor (PgR) status as determined by Immunohistochemistry (IHC).
Hormone receptor status was established using IHC (using quickscore system 0–8) on preoperative CNB and subsequent surgical excision in 93 patients with invasive breast cancer. Results were compared taking into account tumour's size, grade, and patient's age.
The ER concordance rate between CNB and surgical excisions was 95%. The PgR concordance rate was 89%. This shows that CNB has a sensitivity of 97% for ER and 95% for PgR.
There is a positive correlation of ER and PgR between CNB and surgical excision (p < 0.000001). There was no significant difference in the number of core biopsies between concordant and discordant cases.
Preoperative core biopsy is highly sensitive for the IHC detection of ER and PgR in invasive breast cancer. The concordance rate is higher for ER than PgR, which could be due to the fact that ER is more homogeneously distributed.
- core needle biopsy
- oestrogen receptors
- progesterone receptors
The core needle biopsy (CNB) is technique increasingly used for the preoperative assessment of breast lesions . Image guidance increases accuracy and reduces the number of false negative cases . The presence of malignancy and tumour's type and grade are routinely reported.
Hormone receptor status, and especially ER, provides valuable prognostic information and predicts the response to adjuvant and neo-adjuvant systemic treatment .
Traditionally, the hormone receptor status was determined by enzyme immunoassay of ER and PgR proteins. However, this has been replaced gradually by immunohistochemistry (IHC), which has shown an equal reliability .
This retrospective study examines the correlation between CNB and surgical excision in regards to the ER ad PgR status of invasive breast cancer using IHC.
In this retrospective study we looked at consecutive 95 cases of invasive breast carcinoma in 93 patients. All patients underwent CNB at their clinic appointment and proceeded for breast surgery subsequently 2–3 weeks later. Preoperative CNBs and surgical excision specimens were analysed for ER and PgR status using IHC (DAKO mab) after antigen retrieval at high temperature. All specimens were analysed using semi quantitative IHC "quick score" system (0 – 8) by the same breast pathologist. With this method, the intensity of the immunohistochemical reaction as viewed under the light microscope was recorded 0–4 (0 indicated no staining of any nuclei even at high magnification). The proportion of cells staining positively at any intensity was scored as 0 (no cell staining), 1 (1–25% cells stained), 2 (26–50% cells stained), 3 (51–75% cells stained) or 4 (when >75% cells stained). The proportion and intensity scores were added together to obtain a total score ranging from 0 to 8.
We also examined other parameters including: tumour size, grade, and patient's age.
ER/PgR status was considered positive if quick score was 2 – 8. Results were re-assessed when quick score was raised to 4 – 8 to label ER/PgR status as positive. The number of biopsies taken on each occasion was also recorded.
The mean and median age of this study group was 59.2 and 59 respectively (range 32 – 92 years). The mean tumour size was 20 mm (3.2 – 110 mm), and the median grade was 2 (1 – 3). The median number of CNBs taken at preoperative assessment was 2.6 (1 – 9). The mean IHC score for ER was 6.7 (range 0 – 8).
All patients had either mastectomy or lumpectomy as their definitive surgical treatment.
Sensitivity and specificity of CNB for ER and PgR Status.
ER status N = 95
PgR status N = 93
Sensitivity of CNB
Specificity of CNB
ER in CNB positively correlated with ER in surgical excision (r: 0.61, p < 0.000001). PgR in CNB also positively correlated with PgR in surgical excision (r: 0.66, p < 0.000001)
There was no significant difference in the number of CNBs between concordant and discordant cases.
Core needle biopsies offer a reliable and accurate assessment of hormone receptor status.
The concordance rate in our study for ER was higher than for PgR. Homogenous distribution of ER through out the tumour is a possible explanation. Heterogeneity of the ER in tumour cell populations may have important implications for analytic cell selection and for prognosis in ER-positive carcinomas. Previous studies have shown homogenous geographic distribution of ER in the tumour cell population [13, 14].
These results indicate that the hormone receptor status as determined by CNB can be reliably used to guide neo-adjuvant and adjuvant systemic therapy in patients with invasive breast cancer.
In summary, preoperative CNB is highly sensitive for the IHC detection of ER and PgR in invasive breast cancer.
- Sharifi S, Peterson MK, Baum JK, et al: Assessment of pathologic prognostic factors in breast core needle biopsies. Mod Pathol. 1999, 12 (10): 941-945.PubMedGoogle Scholar
- Shah VI, Raju U, Chitale D, et al: False-negative core needle biopsies of the breast: an analysis of clinical, radiologic, and pathologic findings in 27 concecutive cases of missed breast cancer. Cancer. 2003, 97 (8): 1824-31. 10.1002/cncr.11278. 15View ArticlePubMedGoogle Scholar
- Harris GC, Denley HE, Pinder SE, et al: Correlation of histologic prognostic factors in core biopsies and therapeutic excisions of invasive breast carcinoma. Am J Surg Pathol. 2003, 27 (1): 11-5. 10.1097/00000478-200301000-00002.View ArticlePubMedGoogle Scholar
- King TA, Cederbom GJ, Champaign JL, et al: A core breast biopsy diagnosis of invasive carcinoma allows for definitive surgical treatment planning. Am J Surg. 1998, 176 (6): 497-501. 10.1016/S0002-9610(98)00250-5.View ArticlePubMedGoogle Scholar
- Colditz GA, Rosner BA, Chen WY, et al: Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst. 2004, 96 (3): 218-28. 4View ArticlePubMedGoogle Scholar
- Ferrero-Pous M, Trassard M, Le Doussal V, et al: Comparison of enzyme immunoassay and immunohistochemical measurements of estrogen and progesterone receptors in breast cancer patients. Appl Immunohistochem Mol Morphol. 2001, 9 (3): 267-75. 10.1097/00022744-200109000-00012.PubMedGoogle Scholar
- Bridges KG, Keshgegian AA, Kumar H, et al: Influence of surgical technique on estrogen and progesterone receptor determination in breast cancer. Cancer. 1983, 51: 2317-20.View ArticlePubMedGoogle Scholar
- Sharoni T, Feldman B, Inhar I, et al: Estrogen and progesterone receptor levels are lower in specimens taken from previously biopsied breast tumour tissue. J Surg Oncol. 35: 197-200.Google Scholar
- Day T, Yeoman RR, Nelson G, et al: Influence of mastectomy technique on sex steroid receptor analysis. Am J Surg. 1988, 156: 446-9.View ArticlePubMedGoogle Scholar
- Connor CS, Tawfik OW, Joyce AJ, et al: comparison of prognostic tumor markers obtained on image-guided breast biopsies and final surgical specimens. Am J Surg. 2002, 184 (4): 322-4. 10.1016/S0002-9610(02)00953-4.View ArticlePubMedGoogle Scholar
- Jacobs TW, Siziopikou KP, Prioleau J, et al: Do prognostic marker studies on core needle biopsy specimens of breast carcinoma accurately reflect the marker status of the tumor?. Mod Pathol. 1998, 11 (3): 259-64.PubMedGoogle Scholar
- Railo M, Nordling S, Krogerus L, et al: Preoperative assessment of proliferative activity and hormonal receptor status in carcinoma of the breast: a comparison of needle aspiration and needle-core biopsies to the surgical specimen. Diagn Cytopathol. 1996, 15 (3): 205-10. 10.1002/(SICI)1097-0339(199609)15:3<205::AID-DC6>3.0.CO;2-F.View ArticlePubMedGoogle Scholar
- Layfield LJ, Saria E, Mooney EE, et al: Tissue heterogeneity of immunohistochemically detected estrogen receptor. Implications for image analysis quantification. Am J Clin Pathol. 1998, 110 (6): 758-64.PubMedGoogle Scholar
- Charpin C, Martin PM, De Victor B, et al: Multiparametric study (SAMBA 200) of estrogen receptor immunocytochemical assay in 400 human breast carcinomas: analysis of estrogen receptor distribution heterogeneity in tissues and correlations with dextran coated charcoal assays and morphological data. Cancer Res. 1988, 48 (6): 1578-86. 15PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.