Surgery time interval and molecular subtype may influence Ki67 change after core needle biopsy in breast cancer patients

English version České info

Background:
To investigate the accuracy of core needle biopsy (CNB) in evaluating breast cancer estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67 status and to identify factors which might be associated with Ki67 value change after CNB.

Methods:
A retrospective study was carried out on 276 patients with paired CNB and surgically removed samples (SRS). Clinico-pathological factors as well as the surgery time interval (STI) between CNB and surgery were analyzed to determine whether there were factors associated with Ki67 value change after CNB. Five tumor subtypes were classified as follows: Luminal A, Luminal B-HER2-, Luminal B-HER2+, Triple Negative (TN), and HER2+. Ki67 value change was calculated as SRS minus CNB.

Results:
Mean STI after CNB was 4.5 (1-37) days. Good agreement was achieved for ER, PR, and HER2 evaluation between CNB and SRS. However, Ki67 expression level was significantly higher in SRS compared with CNB samples: 29.1 % vs. 26.2 % (P < 0.001). Both univariate and multivariate analysis demonstrated that STI and molecular subtype were associated with a Ki67 change after CNB. Luminal A tumors experienced more Ki67 elevation than Luminal B-HER2- diseases (6.2 % vs -0.1 %, P = 0.014). Patients with longer STI after CNB had a higher Ki67 increase: -1.1 % within 1-2 days, 2.1 % with 3-4 days, and 5.6 % more than 4 days, respectively (P = 0.007). For TN and HER2+ tumors, the Ki67 change was apt to be 0 with STI ≤ 4 days, while a >7 % Ki67 increase was noticed in patients with STI ≥ 5 days.

Conclusion:
CNB was accurate in evaluating ER, PR, HER2, and molecular subtype status. Ki67 value significantly increased after CNB, which was associated with STI and molecular subtype. Further translational research needs to consider Ki67 changes following CNB among different breast cancer molecular subtypes.

Keywords:
Breast cancer; Core needle biopsy; Ki67 change; Molecular subtype; Surgery time interval

Autoři: Xiaosong Chen ^1*; Siji Zhu ¹; Xiaochun Fei ²; David H. Garfield ³; Jiayi Wu ¹; Ou Huang ¹; Yafen Li ¹; Li Zhu ¹; Jianrong He ¹; Weiguo Chen ¹; Xiaolong Jin ²; Kunwei Shen ^1*
Působiště autorů: Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong ¹; Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 3University of Colorado Comprehensive Cancer Center, Aurora, CO 80045, USA. ²; University School of Medicine, 197 Ruijin Er Road, Shanghai 00 5, China. ²
Vyšlo v časopise: BMC Cancer 2015, 15:822
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12885-015-1853-1

© 2015 Chen et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2407/15/822

Souhrn

Keywords:
Breast cancer; Core needle biopsy; Ki67 change; Molecular subtype; Surgery time interval

Zdroje

1. Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S, et al.:Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Ann Oncol 2013, 24(Suppl 6):vi7-23. PubMed Abstract | Publisher Full Text

2. Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al.: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications.

Proc Natl Acad Sci U S A 2001, 98(19):10869-74. PubMed Abstract | Publisher Full Text

3. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, et al.:Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013.

Ann Oncol 2013, 24(9):2206-23. PubMed Abstract | Publisher Full Text

4. Chen X, Yuan Y, Gu Z, Shen K: Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis.

Breast Cancer Res Treat 2012, 134(3):957-67. PubMed Abstract | Publisher Full Text

5. Wolff AC, Berry D, Carey LA, Colleoni M, Dowsett M, Ellis M, et al.: Research issues affecting preoperative systemic therapy for operable breast cancer.

J Clin Oncol 2008, 26(5):806-13. PubMed Abstract | Publisher Full Text

6. Bonanni B, Puntoni M, Cazzaniga M, Pruneri G, Serrano D, Guerrieri-Gonzaga A, et al.: Dual effect of metformin on breast cancer proliferation in a randomized presurgical trial.

J Clin Oncol 2012, 30(21):2593-600. PubMed Abstract | Publisher Full Text

7. Dowsett M, Smith I, Robertson J, Robison L, Pinhel I, Johnson L, et al.: Endocrine therapy, new biologicals, and new study designs for presurgical studies in breast cancer.

J Natl Cancer Inst Monogr 2011, 2011(43):120-3. PubMed Abstract | Publisher Full Text

8. Dowsett M, Ebbs SR, Dixon JM, Skene A, Griffith C, Boeddinghaus I, et al.: Biomarker changes during neoadjuvant anastrozole, tamoxifen, or the combination: influence of hormonal status and HER-2 in breast cancer--a study from the IMPACT trialists.

J Clin Oncol 2005, 23(11):2477-92. PubMed Abstract | Publisher Full Text

9. Dowsett M, Smith IE, Ebbs SR, Dixon JM, Skene A, A'Hern R, et al.: Prognostic value of Ki67 expression after short-term presurgical endocrine therapy for primary breast cancer.

J Natl Cancer Inst 2007, 99(2):167-70. PubMed Abstract | Publisher Full Text

10. von Minckwitz G, Schmitt WD, Loibl S, Muller BM, Blohmer JU, Sinn BV, et al.: Ki67 measured after neoadjuvant chemotherapy for primary breast cancer.

Clin Cancer Res 2013, 19(16):4521-31. Publisher Full Text

11. Chen X, Sun L, Mao Y, Zhu S, Wu J, Huang O, et al.: Preoperative core needle biopsy is accurate in determining molecular subtypes in invasive breast cancer.

BMC Cancer 2013, 13:390. PubMed Abstract | BioMed Central Full Text

12. Greer LT, Rosman M, Mylander WC, Hooke J, Kovatich A, Sawyer K, et al.: Does breast tumor heterogeneity necessitate further immunohistochemical staining on surgical specimens?

J Am Coll Surg 2013, 216(2):239-51. PubMed Abstract | Publisher Full Text

13. Gandini S, Guerrieri-Gonzaga A, Pruneri G, Serrano D, Cazzaniga M, Lazzeroni M, et al.:Association of molecular subtypes with Ki-67 changes in untreated breast cancer patients undergoing pre-surgical trials.

Ann Oncol 2014, 25(3):618-23. PubMed Abstract | Publisher Full Text

14. Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, et al.: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.

N Engl J Med 2004, 351(27):2817-26. PubMed Abstract | Publisher Full Text

15. Wolff AC, Hammond ME, Schwartz JN, Hagerty KL, Allred DC, Cote RJ, et al.: American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer.

J Clin Oncol 2007, 25(1):118-45. PubMed Abstract | Publisher Full Text

16. Levin DC, Parker L, Schwartz GF, Rao VM: Percutaneous needle vs surgical breast biopsy: previous allegations of overuse of surgery are in error.

J Am Coll Radiol 2012, 9(2):137-40. PubMed Abstract | Publisher Full Text

17. Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, et al.: Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer.

J Natl Cancer Inst 2009, 101(10):736-50. PubMed Abstract | Publisher Full Text

18. Zong Y, Zhu L, Wu J, Chen X, Huang O, Fei X, et al.: Progesterone Receptor Status and Ki-67 Index May Predict Early Relapse in Luminal B/HER2 Negative Breast Cancer Patients: A Retrospective Study.

PLoS One 2014, 9(8):e95629. PubMed Abstract | Publisher Full Text

19. Milde-Langosch K, Karn T, Muller V, Witzel I, Rody A, Schmidt M, et al.: Validity of the proliferation markers Ki67, TOP2A, and RacGAP1 in molecular subgroups of breast cancer.

Breast Cancer Res Treat 2013, 137(1):57-67. PubMed Abstract | Publisher Full Text

20. Tagliabue E, Agresti R, Carcangiu ML, Ghirelli C, Morelli D, Campiglio M, et al.: Role of HER2 in wound-induced breast carcinoma proliferation.

Lancet 2003, 362(9383):527-33. PubMed Abstract | Publisher Full Text

21. Carey LA, Barry WT, Pitcher B, Hoadley KA, Cheang MC, Anders CK, et al.: Gene expression signatures in pre- and post-therapy (Rx) specimens from CALGB 40601 (Alliance), a neoadjuvant phase III trial of weekly paclitaxel and trastuzumab with or without lapatinib for HER2-positive breast cancer (BrCa).

J Clin Oncol 2014, 32(suppl 15):506.

22. Gagliato DM, Gonzalez-Angulo AM, Lei X, Theriault RL, Giordano SH, Valero V, et al.:Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer.

J Clin Oncol 2014, 32(8):735-44. Publisher Full Text

23. von Minckwitz G, Fontanella C: Selecting the neoadjuvant treatment by molecular subtype: how to maximize the benefit?

Breast 2013, 22(Suppl 2):S149-51. Publisher Full Text

24. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al.:Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update.

J Clin Oncol 2013, 31(31):3997-4013. PubMed Abstract | Publisher Full Text