Concordance between trucut needle biopsy and surgical specimen for estrogen receptor, progesterone receptor and human epidermal growth factor receptor status in breast cancer
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253162Keywords:
Tumor grading, Preoperative biopsy, Oncologic pathology, Invasive ductal carcinoma, Immunohistochemical analysis, Diagnostic concordance, Fluorescence in situ hybridization, Hormone receptor statusAbstract
Background: Breast cancer is the most common malignancy among women worldwide, contributing significantly to cancer-related morbidity and mortality. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2/neu) status are crucial for prognosis and treatment planning. Trucut needle biopsy is widely used for preoperative biomarker assessment; however, discrepancies with surgical specimen results may affect clinical decisions.
Methods: A cross-sectional study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, from August 2022 to January 2024, including 32 cases of invasive ductal carcinoma. Immunohistochemistry was performed on trucut biopsies and surgical specimens to assess ER, PR, and HER2/neu expression. Concordance rates, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical analysis used SPSS, with p<0.05 considered significant. Factors influencing discordance, including tumor heterogeneity, fixation techniques, and preanalytical variables, were evaluated.
Results: ER showed high concordance (90.6%), sensitivity (83.3%), specificity (100%), PPV (100%), and NPV (82.4%). PR demonstrated moderate concordance (78.1%), sensitivity (73.3%), specificity (82.4%), PPV (78.6%), and NPV (77.8%). HER2/neu showed moderate to low concordance (51.6%), sensitivity (64.7%), specificity (86.7%), PPV (84.6%), and NPV (68.4%). HER2/neu discordance was linked to intratumoral heterogeneity, staining variability, equivocal results requiring fluorescence in situ hybridization.
Conclusions: Trucut biopsy is highly reliable for ER and PR assessment but shows moderate reliability for HER2/neu, warranting confirmatory testing in borderline cases. Awareness of potential discrepancies and supplementary diagnostics can enhance preoperative accuracy and guide personalized breast cancer management.
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References
World Health Organization. Breast Cancer. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer. Accessed on 11 May 2025.
World Health Organization. Global Breast Cancer Initiative Implementation Framework Assessing, strengthening and scaling up services for the early detection and management of breast cancer. 2023. Available from: https://iris.who.int/bitstream/handle/ 10665/365784/9789240067134-eng.pdf. Accessed on 11 May 2025.
Mehrgou A, Akouchekian M. The importance of BRCA1 and BRCA2 genes mutations in breast cancer development. Med J Islam Republic Iran. 2016;15:369.
Williams SL, Birdsong GG, Cohen C, Siddiqui MT. Immunohistochemical detection of estrogen and progesterone receptor and HER2 expression in breast carcinomas: comparison of cell block and tissue block preparations. Int J Clin Exp Pathol.
Mayo Clinic. Mayo Foundation for Medical Education and Research; c1998-2024. Hormone therapy for breast cancer. https://www.mayoclinic.org/tests-procedures/hormone-therapy-for-breast-cancer/about/pac-20384943. Accessed on 3 November 2024.
Sohn HJ, Kim HS, Park SJ, Shin HC. Reliability of core needle biopsy in evaluating estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, and Ki-67 Status. J Breast Dis. 20164:70-6. DOI: https://doi.org/10.14449/jbd.2016.4.2.70
Asogan AB, Hong GS, Prabhakaran SK. Concordance between core needle biopsy and surgical specimen for oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status in breast cancer. Singapore Med J. 2017;58:145. DOI: https://doi.org/10.11622/smedj.2016062
Finlay-Schultz J, Sartorius CA. Steroid hormones, steroid receptors, and breast cancer stem cells. J Mamm Gland Biol Neoplas. 2015;20:39-50. DOI: https://doi.org/10.1007/s10911-015-9340-5
National Cancer Institute Hormone therapy for Breast Cancer. 2022. Available from: https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet. Accessed on 3 November 2024.
Dunnwald LK, Rossing MA, Li CI. Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res. 2007;9:1-0. DOI: https://doi.org/10.1186/bcr1639
Susan G. Komen. Hormone Receptor status, Available from: https://www.komen.org/breast-cancer/diagnosis/factors-that-affect-prognosis/tumor-characteristics/. Accessed on 21 February 2025.
Rubio M. About Breast Cancer. Breast Cancer Research Foundation, 2023. Available at: https://www.bcrf.org/about-breast-cancer. Accessed on 11 May 2025.
Mohapatra S, Seepana J, Haddad A, Spiro T, Daw H. Survival after adjuvant and neoadjuvant chemotherapy in elderly patients with triple negative breast cancer: a Cleveland Clinic experience. Cancer Res. 2017;15:5-16. DOI: https://doi.org/10.1158/1538-7445.SABCS16-P5-16-22
Dutta O, Chowdhury AR, Sarkar N, Ghosh S. Concordance between core needle biopsy and surgical specimens in determining molecular biological subtypes of breast cancer by immunohistochemistry. J Med Sci. 2023;9:182. DOI: https://doi.org/10.46347/jmsh.v9i2.23.53
De Waard F, Baanders‐van Halewijn EA. A prospective study in general practice on breast‐cancer risk in postmenopausal women. Int J Cancer. 1974:153-60. DOI: https://doi.org/10.1002/ijc.2910140203
Mudduwa LK. Quick score of hormone receptor status of breast carcinoma: Correlation with the other clinicopathological prognostic parameters. Indian J Pathol Microbiol. 20091;52:159-63. DOI: https://doi.org/10.4103/0377-4929.48906
Karaman H, Senel F, Tasdemir A, Özer I, Dogan M. A single centre experience in Turkey for comparison between core needle biopsy and surgical specimen evaluation results for HER2, SISH, estrogen receptors and progesterone receptors in breast cancer patients. J Cancer Res Therap. 2022;1:1789-95. DOI: https://doi.org/10.4103/jcrt.JCRT_601_20
Witzel I, Loibl S, Von Minckwitz G, Eidtmann H, Fehm T, Khandan F, et al. Predictive value of HER2 serum levels in patients treated with lapatinib or trastuzumab- a translational project in the neoadjuvant GeparQuinto trial. Br J Cancer. 2012;107(6):956-60. DOI: https://doi.org/10.1038/bjc.2012.353
Spyratos F, Martin PM, Hacene K. Prognostic value of a solubilized fraction of EGF receptors in primary breast cancer using an immunoenzymatic assay- a retrospective study. Breast Cancer Res Treat. 1994;29:85-95. DOI: https://doi.org/10.1007/BF00666184
Onitilo AA, Engel JM, Greenlee RT, Mukesh BN. Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clinical medicine & research. 2009;7(1-2):4-13. DOI: https://doi.org/10.3121/cmr.2009.825
Lui Z, Minckwitz G. ER and PR expression in breast cancer subtypes. Breast Cancer Res. 2022;24:13.
Harvey-Jones EJ, Lord CJ, Tutt ANJ. Systemic therapy for hereditary breast cancers. Hematol Oncol Clin North Am. 2023;37:203-24. DOI: https://doi.org/10.1016/j.hoc.2022.08.018
Li Z, Wei H, Li S, Wu P, Mao X. The role of progesterone receptors in breast cancer. Drug Design Develop Therapy. 2022;26:305-14. DOI: https://doi.org/10.2147/DDDT.S336643
Bloom JG, Richardson WW. Histological grading and prognosis in breast cancer. Br J Cancer. 1957;11:359-77. DOI: https://doi.org/10.1038/bjc.1957.43
Almasri NM, Hamad MA. Immunohistochemical evaluation of human epidermal growth factor receptor 2 and estrogen and progesterone receptors in breast carcinoma in Jordan. Breast Cancer Res. 2005;7:1-7. DOI: https://doi.org/10.1186/bcr1200
Mouttet D, Laé M, Caly M, Gentien D, Carpentier S, Peyro-Saint-Paul H, et al. Estrogen-receptor, progesterone-receptor and HER2 status determination in invasive breast cancer. Concordance between immuno-histochemistry and MapQuant™ microarray based assay. PLoS One. 2016;11(2):e0146474. DOI: https://doi.org/10.1371/journal.pone.0146474
Berberabe A. Level of ER, PR Positivity correlates with improved PFS in metastatic breast cancer. Target Therap Oncol. 2022;11(10):37.
Garza-Gangemi AM, Clemente-Gutiérrez U, Velázquez-Fernández D, Medina-Franco H. Concordance of pathologic and immunohistochemical markers between core needle biopsy and surgical specimens in invasive breast cancer. Breast Res. 2015;1(1).
Ricci MD, Calvano Filho CM, Oliveira Filho HR, Filassi JR, Pinotti JA, Baracat EC. Analysis of the concordance rates between core needle biopsy and surgical excision in patients with breast cancer. Revist Assoc Med Brasil. 2012;58:532-6. DOI: https://doi.org/10.1016/S0104-4230(12)70245-2
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