Extensive intraductal component positive carcinoma of breast: two year study with special reference to ER/PR/HER2NEU/Ki67 in a tertiary care centre of Barak Valley
DOI:
https://doi.org/10.18203/2320-6012.ijrms20202252Keywords:
Ductal carcinoma in situ, Extensive intraductal carcinoma, Invasive carcinomaAbstract
Background: Extensive intraductal component positive carcinoma (EICPC) of breast is defined by Schnitt et al as-
A. 25% or more of Ductal carcinoma in situ (DCIS) is present along the invasive lesion and DCIS is also present outside the area of invasive carcinoma. B. EICPC also include carcinomas in which DCIS is associated with a “small” (approximately 10 mm or less) invasive carcinoma or carcinomas. In Extensive Intraductal Carcinoma (EIDC) most of the cases were associated with recurrence when surgical margin status is not evaluated or focally involved. Our objective was to study the prevalence of EIDC and expression of estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor (HER2NEU)/Ki67(antigen identified by monoclonal antibody KI67) in those cases.
Methods: It was a retrospective cross sectional study conducted over a period of 2017 to August 2019.All the histologically confirmed cases of EIDC was retrieved from the institute.
Results: Out of 65 cases of invasive carcinoma 17 (26.1%) cases were positive for EICPC. Age of patients ranged from 27 to 73years with mean age of 43 years and 5 patients (29.4%) were postmenopausal. Most of the cases i.e. 6(35.2%) had a ER+/PR+/HER2NEU- status with most of the cases having high 6(47%)Ki-67 index. According to the BLOOM RICHARDSON GRADING 14 cases were grade II (82.3%) and 3 cases were grade I (17.7%) and in pT and pN staging majority were stage pT1 - 7 (41.1%). Most of the cases were mastectomy cases 11 (64.4%) with a base free status except in one lumpectomy case where margin was involved.
Conclusions: In this study majority of the cases were ER+//PR+/HER2NEU- with most of the cases having high Ki67 index. Evaluation of EIDC, along with the negative margin status is important to prevent recurrence.
References
Kumar V, Abbas A, Aster J, Perkins J, Robbins S. Robbins basic pathology. 9th ed. Philadelphia, Pa: Elsevier; 2018:1400-1700.
Cowell C, Weigelt B, Sakr R, Ng C, Hicks J, King T, et al. Progression from ductal carcinoma in situ to invasive breast cancer: Revisited. Molecular Oncol. 2013;7(5):859-69.
Holland R, Connolly J, Gelman R, Mravunac M, Hendriks J, Verbeek A, et al. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clini Oncol. 1990;8(1):113-8.
Barbalaco Neto G, Rossetti C, Fonseca F, Valenti V, de Abreu L. Ductal carcinoma in situ in core needle biopsies and its association with extensive in situ component in the surgical specimen. Inter Arch Med. 2012;5(1):19.
Aryadan N, Nayanar SK, Krishnan A, Aravind S, Philip KJ, Adarsh D, Jones J. Extensive Intraductal Component (EIC) Positive Carcinoma of Breast-FourYears’ Experience at a Cancer Centre. 2017;2017.
Figure 5- uploaded by Monica de Baca. Available at: https://www.researchgate.net/figure/Extensive-Intraductal-Component-EIC-A-EIC-positive-carcinomas-are-defined-by-the_fig5_242597126 Accessed 8 September 2019.
Iqbal B, Buch A. Hormone receptor (ER, PR, HER2/neu) status and proliferation index marker (Ki-67) in breast cancers: Their onco-pathological correlation, shortcomings and future trends. Medical J Dr DY Patil University. 2016;9(6):674.
Yiu CC, Loo WT, Lam CK, Chow LW. Presence of extensive intraductal component in patients undergoing breast conservative surgery predicts presence of residual disease in subsequent completion mastectomy. Chinese Med J. 2009 Apr 1;122(8):900-5.
Jacquemier J, Kurtz J, Amalric R, Brandone H, Ayme Y, Spitalier J. An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy. British J Cancer. 1990;61(6):873-6.
Cedolini C, Bertozzi S, Londero AP, Seriau L, Andretta M, Agakiza D, et al. Impact of the presence and quantity of ductal Carcinoma in situ component on the outcome of invasive breast cancer. Int J Clin Exp Pathol. 2015;8(10):13304-13.
Holland P, Gandhi A, Knox W, Wilson M, Baildam A, Bundred N. The importance of complete excision in the prevention of local recurrence of ductal carcinoma in situ. Brit J Cancer. 1998;77(1):110-4.
Schnitt S, Abner A, Gelman R, Connolly J, Recht A, Duda R, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994;74(6):1746-51.
