Carcinoma, ductal, breast Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):97-102
DOI 10.1590/S0100-72032013000300002
PURPOSE:To compare the prognostic and predictive features between in situ and invasive components of ductal breast carcinomas. METHODS:We selected 146 consecutive breast samples with ductal carcinoma in situ (DCIS) associated with adjacent invasive breast carcinoma (IBC). We evaluated nuclear grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), cytokeratin 5/6 (CK5/6), and epidermal growth factor receptor (EGFR) in both components, in situ and invasive, and the Ki-67 percentage of cells in the invasive part. The DCIS and IBC were classified in molecular surrogate types determined by the immunohistochemical profile as luminal (RE/PR-positive/ HER2-negative), triple-positive (RE/RP/HER2-positive), HER2-enriched (ER/PR-negative/HER2-positive), and triple-negative (RE/RP/HER2-negative). Discrimination between luminal A and luminal B was not performed due to statistical purposes. Correlations between the categories in the two groups were made using the Spearman correlation method. RESULTS:There was a significant correlation between nuclear grade (p<0.0001), expression of RE/RP (p<0.0001), overexpression of HER2 (p<0.0001), expression of EGFR (p<0.0001), and molecular profile (p<0.0001) between components in situ and IBC. CK 5/6 showed different distribution in DCIS and IBC, presenting a significant association with the triple-negative phenotype in IBC, but a negative association among DCIS. CONCLUSIONS: Our results suggest that classical prognostic and predictive features of IBC are already determined in the preinvasive stage of the disease. However the role of CK5/6 in invasive carcinoma may be different from the precursor lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):97-102
DOI 10.1590/S0100-72032013000300002
PURPOSE:To compare the prognostic and predictive features between in situ and invasive components of ductal breast carcinomas. METHODS:We selected 146 consecutive breast samples with ductal carcinoma in situ (DCIS) associated with adjacent invasive breast carcinoma (IBC). We evaluated nuclear grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), cytokeratin 5/6 (CK5/6), and epidermal growth factor receptor (EGFR) in both components, in situ and invasive, and the Ki-67 percentage of cells in the invasive part. The DCIS and IBC were classified in molecular surrogate types determined by the immunohistochemical profile as luminal (RE/PR-positive/ HER2-negative), triple-positive (RE/RP/HER2-positive), HER2-enriched (ER/PR-negative/HER2-positive), and triple-negative (RE/RP/HER2-negative). Discrimination between luminal A and luminal B was not performed due to statistical purposes. Correlations between the categories in the two groups were made using the Spearman correlation method. RESULTS:There was a significant correlation between nuclear grade (p<0.0001), expression of RE/RP (p<0.0001), overexpression of HER2 (p<0.0001), expression of EGFR (p<0.0001), and molecular profile (p<0.0001) between components in situ and IBC. CK 5/6 showed different distribution in DCIS and IBC, presenting a significant association with the triple-negative phenotype in IBC, but a negative association among DCIS. CONCLUSIONS: Our results suggest that classical prognostic and predictive features of IBC are already determined in the preinvasive stage of the disease. However the role of CK5/6 in invasive carcinoma may be different from the precursor lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):602-608
DOI 10.1590/S0100-72032008001200003
PURPOSE: to evaluate the agreement between histopathologic diagnoses of breast lesions made by general pathologists and by a specialist in breast pathology. METHODS: a cohort retrospective study comparing histopathologic diagnoses of 329 cases of breast lesions received in consultation for a second opinion was carried out. The material received for consultation included slides (152 cases), paraffin blocks (59 cases) or slides and blocks (118 cases). Cases were reviewed and the original diagnoses and diagnoses from a specialist in breast pathology were compared. The main diagnoses, nuclear grade of ductal carcinoma in situ, and the histopathologic grade of invasive mammary carcinomas were evaluated. The kappa index and percentual concordance were used in the statistical analyses. RESULTS: a moderate agreement was observed between the original histopathologic diagnoses and the second opinion (kappa index=0.48; percentual concordance=59.9%). The diagnosis of malignancy was confirmed in 185/225 cases (82.2%) and diagnosis of benign lesions was confirmed in 89/104 cases (85.6%). The highest agreement was observed in the diagnosis of invasive mammary carcinomas (81%) and the highest disagreement was observed among diagnoses of ductal carcinoma in situ with microinvasion (74%), lobular carcinoma in situ (70%), and atypical epithelial hyperplasias (61%). There was a moderate agreement in the nuclear grade of ductal carcinoma in situ (kappa index=0.52; percentual concordance=68.8%), and good concordance in the histologic grade of invasive carcinomas (kappa index=0.61; percentual concordance=74.3). CONCLUSIONS: the results show higher concordance rate in the diagnosis of invasive carcinomas and lower concordance in the diagnosis of ductal carcinoma in situ with microinvasion and premalignant breast lesions, especially lobular neoplasia in situ, and atypical epithelial hyperplasias.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):602-608
DOI 10.1590/S0100-72032008001200003
PURPOSE: to evaluate the agreement between histopathologic diagnoses of breast lesions made by general pathologists and by a specialist in breast pathology. METHODS: a cohort retrospective study comparing histopathologic diagnoses of 329 cases of breast lesions received in consultation for a second opinion was carried out. The material received for consultation included slides (152 cases), paraffin blocks (59 cases) or slides and blocks (118 cases). Cases were reviewed and the original diagnoses and diagnoses from a specialist in breast pathology were compared. The main diagnoses, nuclear grade of ductal carcinoma in situ, and the histopathologic grade of invasive mammary carcinomas were evaluated. The kappa index and percentual concordance were used in the statistical analyses. RESULTS: a moderate agreement was observed between the original histopathologic diagnoses and the second opinion (kappa index=0.48; percentual concordance=59.9%). The diagnosis of malignancy was confirmed in 185/225 cases (82.2%) and diagnosis of benign lesions was confirmed in 89/104 cases (85.6%). The highest agreement was observed in the diagnosis of invasive mammary carcinomas (81%) and the highest disagreement was observed among diagnoses of ductal carcinoma in situ with microinvasion (74%), lobular carcinoma in situ (70%), and atypical epithelial hyperplasias (61%). There was a moderate agreement in the nuclear grade of ductal carcinoma in situ (kappa index=0.52; percentual concordance=68.8%), and good concordance in the histologic grade of invasive carcinomas (kappa index=0.61; percentual concordance=74.3). CONCLUSIONS: the results show higher concordance rate in the diagnosis of invasive carcinomas and lower concordance in the diagnosis of ductal carcinoma in situ with microinvasion and premalignant breast lesions, especially lobular neoplasia in situ, and atypical epithelial hyperplasias.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(6):310-316
DOI 10.1590/S0100-72032007000600006
PURPOSE: to evaluate the expression of cyclooxygenase-2 (COX-2) in ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), adjacent normal stroma, and epithelium. The correlation of expression levels with nuclear grade, histological grade, presence or absence of comedonecrosis, tumor size, and patient age was also analyzed. METHODS: forty-seven surgical samples obtained from mastectomy and quadrantectomy with simultaneous DCIS and IDC, stages I and II were included. Anti-COX-2 polyclonal antibodies were used to determine enzyme expression. Samples were classified from zero to three, in accordance with number and intensity of stained cells. RESULTS: COX-2 was positively expressed in IDC, DCIS, and normal epithelium in 86.7, 84.4, and 73.3% of the cases, respectively. Concerning nuclear grade (NG), COX-2 expression was positive in 80% of cases of NG-I; in 81.5 and 78.9% of NG II, and in 88.5 and 96.1% of NG III in DCIS and IDC, respectively. COX-2 expression occurred in 78.9% of DCIS with comedonecrosis and in 89.3% without comedonecrosis. As to histological grade (HG) of IDC, COX-2 was positive in 83.3% of HG-I; 89.9% of HG-II and 80% of HG-III. Concerning tumor diameter, COX-2 was present in 86.1% of IDC cases and in 83.3% of DCIS larger than 2 cm and in 11% of IDC and DCIS tumors ≤2 cm. The age range ≥50 years presented 90% expression for IDC and 86.7% for DCIS, and the expression was 92.5% for both IDC and DCIS in patients <50 years. CONCLUSIONS: our results demonstrated high correlation between COX-2 expression in IDC, DCIS and in the normal epithelium, which is consistent with the hypothesis that COX-2 over expression is an early event in breast carcinogenesis. There was no significant correlation between COX-2 expression in IDC and DCIS and nuclear grade, histological grade, presence of comedonecrosis, age group and tumor size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(6):310-316
DOI 10.1590/S0100-72032007000600006
PURPOSE: to evaluate the expression of cyclooxygenase-2 (COX-2) in ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), adjacent normal stroma, and epithelium. The correlation of expression levels with nuclear grade, histological grade, presence or absence of comedonecrosis, tumor size, and patient age was also analyzed. METHODS: forty-seven surgical samples obtained from mastectomy and quadrantectomy with simultaneous DCIS and IDC, stages I and II were included. Anti-COX-2 polyclonal antibodies were used to determine enzyme expression. Samples were classified from zero to three, in accordance with number and intensity of stained cells. RESULTS: COX-2 was positively expressed in IDC, DCIS, and normal epithelium in 86.7, 84.4, and 73.3% of the cases, respectively. Concerning nuclear grade (NG), COX-2 expression was positive in 80% of cases of NG-I; in 81.5 and 78.9% of NG II, and in 88.5 and 96.1% of NG III in DCIS and IDC, respectively. COX-2 expression occurred in 78.9% of DCIS with comedonecrosis and in 89.3% without comedonecrosis. As to histological grade (HG) of IDC, COX-2 was positive in 83.3% of HG-I; 89.9% of HG-II and 80% of HG-III. Concerning tumor diameter, COX-2 was present in 86.1% of IDC cases and in 83.3% of DCIS larger than 2 cm and in 11% of IDC and DCIS tumors ≤2 cm. The age range ≥50 years presented 90% expression for IDC and 86.7% for DCIS, and the expression was 92.5% for both IDC and DCIS in patients <50 years. CONCLUSIONS: our results demonstrated high correlation between COX-2 expression in IDC, DCIS and in the normal epithelium, which is consistent with the hypothesis that COX-2 over expression is an early event in breast carcinogenesis. There was no significant correlation between COX-2 expression in IDC and DCIS and nuclear grade, histological grade, presence of comedonecrosis, age group and tumor size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):721-727
DOI 10.1590/S0100-72032006001200006
PURPOSE: to evaluate the clinical, radiological therapeutic and anatomo-pathological aspects in a series of patients with breast ductal carcinoma in situ (DCIS), attended in three public hospitals in Belo Horizonte (MG). METHODS: 179 cases of DCIS, that were selected from all the patients who had been diagnosed with breast cancer between 1985 and 2000, were studied retrospectively. After reviewing all the tissue sections, it was possible to collect all the clinical data, mammogram and treatment information of 85 cases. RESULTS: most patients were not symptomatic and the diagnosis had been done by mammogram (68.2%), being the microcalcification the most common radiological alteration. There has been a progressive increase in the diagnosis of DCIS along the years, following the introduction of periodical mammographic screening. The initial histopathological diagnosis and the review agreed in 72.9% of cases. In three cases, the original diagnosis of DCIS was not confirmed, being classified as atypical hyperplasia. Mammogram microcalcifications were confirmed in the pathological analysis in 95.6% of cases. Half of the patients was treated with mastectomy. All lymph nodes from axillary dissection were negative for metastases. CONCLUSIONS: The present study is in agreement with the recent literature, which shows an increase in the diagnosis of DCIS since 1990. There has been a great interobserver variation since the initial pathological diagnosis, which tended to malignancy and the present review. There were a great number of radical treatments, such as mastectomy and axillary dissection, which would probably be replaced by conservative treatment and sentinel lymph node biopsy nowadays, according to recent knowledge.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):721-727
DOI 10.1590/S0100-72032006001200006
PURPOSE: to evaluate the clinical, radiological therapeutic and anatomo-pathological aspects in a series of patients with breast ductal carcinoma in situ (DCIS), attended in three public hospitals in Belo Horizonte (MG). METHODS: 179 cases of DCIS, that were selected from all the patients who had been diagnosed with breast cancer between 1985 and 2000, were studied retrospectively. After reviewing all the tissue sections, it was possible to collect all the clinical data, mammogram and treatment information of 85 cases. RESULTS: most patients were not symptomatic and the diagnosis had been done by mammogram (68.2%), being the microcalcification the most common radiological alteration. There has been a progressive increase in the diagnosis of DCIS along the years, following the introduction of periodical mammographic screening. The initial histopathological diagnosis and the review agreed in 72.9% of cases. In three cases, the original diagnosis of DCIS was not confirmed, being classified as atypical hyperplasia. Mammogram microcalcifications were confirmed in the pathological analysis in 95.6% of cases. Half of the patients was treated with mastectomy. All lymph nodes from axillary dissection were negative for metastases. CONCLUSIONS: The present study is in agreement with the recent literature, which shows an increase in the diagnosis of DCIS since 1990. There has been a great interobserver variation since the initial pathological diagnosis, which tended to malignancy and the present review. There were a great number of radical treatments, such as mastectomy and axillary dissection, which would probably be replaced by conservative treatment and sentinel lymph node biopsy nowadays, according to recent knowledge.
