Immunohistochemical and Clinicopathological Factors Associated with Axillary Lymph Node Metastasis in Breast Cancer Patients of Northern Pakistan

Background: Breast cancer is the most common type of tumors in Pakistani women, with axillary lymph node (ALN) positivity reported to be one of the most important prognostic factors.This study shows the distribution of various clinical and pathological variables including age, tumor size, grade, histologic subtype, and hormone receptor status among Pakistani women with and without ALN metastasis.Materials and Methods: A total of 245 cases of primary breast cancer from Northern Pakistan were analyzed in this study. Their clinical, pathological and immunohistochemical parameters, including estrogen receptor (ER), progesterone receptor (PR) and Her-2/Neu status, were extracted from previous histopathological reports and stratified based on the occurrence of ALN metastasis. Results: Occurrence of ALN metastasis was significantly different between older age patients above 50 years and younger age patients age <50 years [χ² (1, N=245) =14.6, p<0.001]. There was an increased number of metastases in large sized tumors >5cm in size (80%, n=60), [χ² (2, N=245) =23.1, p<0.001] and tumors with higher nuclear grade III (78.4%, n=40), [χ² (1, N=245) =5.1, p=0.02]. ALN metastasis was inversely associated with expression of estrogen receptor [χ² (1, N=245) =12.5, p<0.001], and progesterone receptor [χ² (1, N=245) = <0.001, p=0.99], while it was directly associated with Her-2/Neu expression [χ² (1, N=245) =5.63, p=0.01]. Conclusion: In Pakistani women, ALN metastasis was significantly associated with older age, tumor size, and high-grade tumors showing Her2/Neu expression and was inversely associated with ER, PR expression in breast tumors.

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Estrogen Receptor, Progesterone Receptor, and Her-2/neu Oncogene Expression in Breast Cancers Among Bangladeshi Women

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v28i3.6509 ◽

1970 ◽

Vol 28 (3) ◽

pp. 157-162 ◽

Cited By ~ 2

Author(s):

MG Mostafa ◽

MT Larsen ◽

RR Love

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Lymph Node ◽

Progesterone Receptor ◽

Axillary Lymph Node ◽

Histological Grade ◽

Axillary Lymph ◽

Breast Cancers ◽

Her 2 ◽

Neu Oncogene

Two-thirds of all women who develop breast cancer each year live in Asia. In many countries, including Bangladesh, there are few data on the pathological characteristics of breast tumours. The objectives of this study were a) to describe the estrogen receptor (ER), progesterone receptor (PR), and the expression of Her-2/neu oncogene expression status in a large series of breast cancers occurring in Bangladeshi women and b) to correlate these findings with the patients' age at diagnosis, tumour histological grade, and presence of axillary lymph node metastatic disease.Method: One thousand forty two cases were evaluated in a referral practice. Tumour sections were stained immunohistochemically using Dako 1D5 (ER) and Dako 636 (PR) and semiquantitatively scored for ER and PR expression. Three hundred thirty five of these cases were also stained using Dako c-erb2 oncoprotein and scored for Her-2/neu over-expression.Results: Estrogen Receptor expression was positive in 69.0%, PR expression was positive in 72.3%, and Her-2/ neu was over-expressed (IHC score 3+) in 28.4% of the cases. Her-2/neu over-expression did not consistently correlate with ER and PR expression. ER and PR expression were inversely associated with tumour histological grade. Cases with axillary lymph node metastases had higher rates of ER and PR expression. No significant association was observed with patient’s age.Conclusion: Estrogen Receptor, PR, and Her-2/neu expression frequencies and prognostic factor associations in Bangladeshi women with breast cancer referred for tumour marker testing are very similar to those reported in Western countries. These findings have important implications for ensuring optimal testing capacity for all patients with these tumours, to allow for appropriate choices of treatment. DOI: 10.3329/jbcps.v28i3.6509J Bangladesh Coll Phys Surg 2010; 28: 157-162

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Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.20106 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 20106-20106

Author(s):

R. K. Shahid ◽

I. Ahmad ◽

S. Yadav ◽

A. Sami ◽

K. Haider ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Lymph Node ◽

Lymph Nodes ◽

Primary Tumor ◽

Axillary Lymph Node ◽

Primary Breast Cancer ◽

Fish Analysis ◽

Axillary Lymph ◽

Her 2

20106 Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER. No significant financial relationships to disclose.

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