Role of Immunophenotypes in Carcinoma Breast

Abstract

Background: Nottingham's modification of Bloom-Richardson histopathological grading system (NGS) for carcinoma breast is a time-tested prognostic indicator; however, of lately, breast cancer has been evaluated through molecular techniques, particularly assessing the gene expression profiling and establishing molecular or immunophenotypes. The present-day utility of NGS needs to be reassessed with the modern predictive markers, this may help refine breast cancer classification specifically to help improve the treatment protocol.

Objective: The objective was to compare breast cancer immunophenotypes with prognostic factors such as age (based on menstrual status), tumor size, lymph node (LN) status, also to compare the NGS grade with the molecular immunphenotypes of breast cancer.

Materials and methods: The present work was carried out in the Histopathology and Immunohistochemistry section of Department of Pathology, of a central Indian medical college and rural hospital from January 2013 to July 2016. It was a prospective analytical study. A tota1 of 114 female patients presenting in the outpatient department of surgery with lump in breast were included in the present study. All patients underwent modified radical mastectomy for tumor resection. Tumor masses and LNs were subjected to routine hematoxylin and eosin staining as well as immunohistochemistry then examined by a senior pathologist. Comparisons were made between molecular immunophenotypes with patient age, tumor size, and LN status, further NGS grade of breast cancer was compared with immunophenotypes.

Results: The study found that the molecular immunophenotypes when compared with clinical prognostic parameters, i.e; age (based on menstrual status of female), LN involvement in patients of breast carcinoma showed inconsequential correlation, the tumor size showed significant correlation. However, when histopathological grades were compared with molecular immunophenotypes, a significant correlation was seen.

Conclusion: NGS grade being an excellent predictive prognostic tool should be continued for assessing the grades in breast cancer patients. The molecular markers correlate with the histopathological grading and indirectly aid the oncologist in assessing the aggressiveness, these immunophenotypes are not helpful as suitable prognostic tools. As the molecular phenotypes definitely indicate the hormonal receptor status in breast cancer patients, they become mandatory in guiding oncologists for planning the treatment strategy and protocol.

Keywords: Carcinoma; Nottingham's Modification of Bloom Richardson's Grading system; histopathology; immunohistochemistry; immunophenotypes; lymph node; tumor node metastasis.

Figure 1

Hematoxylin and eosin-stained section (×40 view) from tumor mass of breast shows histopathological features of infiltrating ductal carcinoma (not otherwise specified type), Nottingham's modification of Bloom–Richardson histopathological grading system Grade I (a), Nottingham's modification of Bloom–Richardson histopathological grading system Grade II (b), Nottingham's modification of Bloom–Richardson histopathological grading system Grade III (c). H and E, section ×4 view of lymph node shows metastatic deposits of ductal malignancy (d)

Figure 2

Immunohistochemistry-stained section (×10 view) from breast tissue mass shows intense brown color-stained nuclei signifying estrogen receptor positive (a) and progesterone receptor positive; (b) immunohistochemistry-stained section (×10 view) from breast tissue mass shows intense brown nuclear positivity signifying Ki-67 labeling index >14%; (c) immunohistochemistry-stained section (×40 view) from breast tissue mass shows strong complete membrane staining in >30% signifying HER/2 neu positive (d)

Figure 3

Immunophenotypes versus prognostic markers (age, tumor size, and lymph node status)