Correlation between Biological Classification and Stromal Reaction in Breast Cancer
Background: Breast cancer is the most common cancer and a major cause of death from cancer in women. Understanding the factors, which can predict directly and indirectly the final fate of patients, can be useful in clinical decision-making and treatment choices.
Materials and Methods: In a retrospective descriptive-analytic study, 108 pathological samples of patients with primary breast cancer collected during 2011-2017 from the department of pathology in Imam Hossein Hospital (Tehran Iran). Classified regarding the association of stromal reactions in tumor tissue including necrosis rate, lymphocyte infiltrating rate, and tumor desmoplasia with different types of breast tumors including four groups of Basal like, HER2/neu, Luminal B, and Luminal A based on biological biomarkers.
Results: Mean age of the patients was 50.84±13.25 years. No significant relationship was found between age and type of groups. Majority of patients (60%) were in the pathological grade 2. A significant relationship was observed between three groups of Luminal B, and Basal-like with Grade 2 (p<0.05). Most patients suffered from intermediate desmoplasia which was significant only between three groups of Luminal B, HER2/neu and Basal-like (p<0.05). In terms of tumor necrosis, the majority of patients in the HER2/neu and Basal-like groups indicated non-extensive necrosis, which was significant (p>0.05). In both groups of Luminal A and Luminal B, most patients had no necrosis while the relationship between necrosis and pathological type of tumor was significant only in the Luminal B group (p>0.05). No significant relationship was found between the number of lymphocytes and the type of tumor.
Conclusion: This study indicated the relationship between pathological types of breast cancers based on biomarkers with pathological grade, necrosis ratio and tumor desmoplasia. Determination of the pathological type of tumor based on the status of biological markers (HER-2/neu PR, ER, Ki67) in patients with breast cancer is recommended for making decision about therapeutic plan.
Greif JM. Mammographic screening for breast cancer: An invited review of the benefits and costs. The Breast. 2010;19:268-72.
Brunicardi FC, Dana KA, Timothy RB, Dunn L, Hunter G, Raphael EP. Schwartz's principles of surgery. 8 th ed. McGraw-Hill. 2005;453-501.
Hirsch BR, Layman GH. Breast cancer screening with mammography. Curr Oncol Rep. 2011;13:63-70.
Paesmans M, Ameye L, Moreau M, Rozenberg S. Breast cancer screening in the older woman: An effective way to reduce mortality. Maturitas. 2010;66:263-7.
Yanxin S, Hong W, Ying W, Yanhuni G, Hengda C, Yingtao Z, et al. Speckle reduction approach for breast ultrasound image and its application to breast cancer diagnosis. Eur J Radiol. 2010;75(1):136-41.
Pakseresht S, Ingle GK, Bahadur AK, Ramteke VK, Singh MM, Garg S, et al. Risk factors with breast cancer among women in Dehli. Indian J Cancer. 2009;46(2):132-8.
Howell A, Sims AH, Ong KR, Harvie MN, Evans DG, Clarke RB. Mechanisms of disease: prediction and prevention of breast cancer- cellular and molecular interactions. Nat Clin Prant Oncol. 2005;2(12):635-46.
Varangot M, Barrios E, Sóñora C, Aizen B, Pressa C, Estrugo R, et al. Clinical evaluation of a panel FNA markers in the detection of disseminated tumors cells in patients with operable breast cancer. Oncol Rep. 2005;14(2):537-45.
Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I. [Breast cancer in Iran: an epidemiological review [Persian]]. The Breast Journal. 2007;13(4):383-91.
Sirus M, Ebrahimi A. [Epidemiology of tumor in women's breast in Isfahan [Persian]]. Iranian J Surg. 2009;16(3):1-6.
Arirchi I, Zarbakhsh M. Breast cancer in Iran: results of multi-center study. Asi Pac J Cancer Prev. 2004;5(1):24-7.
Behjati F, Atri M, Najmabadi H, Nouri K, Zamani M. [Prognostic value of chromosome 1 and 8 copy number in invasive ductal breast carcinoma among Iranian women: an interphase FISH analysis [Persian]]. Pathology Oncology Research. 2005;11(3):157-63.
Fentiman IS. Fixed and modifiable risk factors for breast cancet. Int J Clin Part. 2001;55(8):527-30.
Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, Watson M, Davies S, Bernard PS, Parker JS, Perou CM. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. JNCI: Journal of the National Cancer Institute. 2009 May 20;101(10):736-50.
Cheang MC, Voduc D, Bajdik C, Leung S, McKinney S, Chia SK, Perou CM, Nielsen TO. Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clinical cancer research. 2008;14(5):1368-76.
Gujam FJ, Edwards J, Mohammed ZM, Going JJ, McMillan DC. The relationship between the tumour stroma percentage, clinicopathological characteristics and outcome in patients with operable ductal breast cancer. British journal of cancer. 2014 Jul 1;111(1):157-65.
Akiko Matsumoto, Hiromitsu Jinno, Kunihiko Hiraiwa, Predictive and prognostic value of tumor-infiltrating lymphocytes in breast cancer treated with neoadjuvant chemotherapy. Journal of Clinical Oncology 33, no. 28_suppl (October 1 2015) 128-128.
Siziopikou KP, Ariga R, Proussaloglou KE, Gattuso P, Cobleigh M. The challenging estrogen receptor negative/progesterone receptor-negative/HER-2-negative patient: a promising candidate for epidermal growth factor receptor-targeted therapy Breast J. 2006;12:360-2.
Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, Wienert S, Van den Eynden G, Baehner FL, Penault-Llorca F, Perez EA. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014. Annals of oncology. 2014;26(2):259-71.
Reisa S, Gazinskab P, Hipwella JH, Mertzanidoua T, Naidooc K, Pinderd S, Hawkesa DJ. Classification of breast cancer stroma as a tool for prognosis. InSPIE Medical Imaging 2016 (pp. 979105-979105). International Society for Optics and Photonics.
Ocaña A, Diez-Gónzález L, Adrover E, Fernández-Aramburo A, Pandiella A, Amir E. Tumor-infiltrating lymphocytes in breast cancer: ready for prime time? Journal of Clinical Oncology. 2015;33(11):1298-9.
Mariam Shadan1*, Nazoora Khan2*, Mohammad Amanullah Khan2**, Hena Ansari3*Histological categorization of stromal desmoplasia in breast cancer and its diagnostic and prognostic utility SSRG International Journal of Medical Science (SSRG-IJMS) – Volume 4 Issue 6 – June 2017.
Kadivar M, Rezaee M, Jadidfard R. [Evaluation of histopathology and biologic markers in premenopausal (under 40 years) and postmenopausal (over 60 years)women with breast cancer in Hazrat-e-Rasoul and Atieh hospital]. J Iran Uni Med Sci. 2010;17:49-57. [Persian]
Shamsalinia A, Kayhanian SH, Ghafari F, Saravi MM, Najafi AM. [HER-2/neu Expression Associated with estrogen and progesterone receptor status and P53 gene in women with primary Breast Cancer]. Iran J Obstetr Gynecol Infertil. 2010;13:43-56. [Persian]
Najafi B, Fakheri T, Fadakarsogheh G. [The relation between HER-2 with other clinio-pathologic diagnostic markers in breast cancer]. Gilan Uni J. 2005;57:21-7 [Persian]
Denkert C1, von Minckwitz G2, Darb-Esfahani S3, Lederer B,Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy. Lancet Oncol. 2018;19(1):40-50.