Publication: Discordance of intrinsic subtype between primary tumor and lymph node metastasis in breast cancer patients
Authors
Tomoko Yamamoto ; Yoji Nagashima ; Takako Kamio ; Kiyomi Horiuchi ; Takahiro Okamoto ; Yoko Omi
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Publisher
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DOI
https://doi.org/10.14670/HH-18-989
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info:eu-repo/semantics/article
Description
Abstract
The heterogeneity of cancer cells between
primary breast tumors and lymph node (LN) metastases
at the initial therapy remains unclear. This study aimed
to determine whether intrinsic subtypes of LN metastasis
differ from those of primary breast tumors and how
much additional information is obtained.
Ninety-three breast cancer cases with LN metastasis
were enrolled in the study. Immunohistochemistry for
ER, PgR, HER2, and Ki-67 was performed for primary
breast tumors and the largest LN metastases. The
intrinsic subtype was determined as luminal A (ER+,
PgR+, HER2-, Ki-67 index ≤20%), luminal B (ER+,
HER2-, PgR- or PgR+, and Ki-67 index >20%), luminal
B HER2 rich (ER+, HER2+), HER2 (ER-, HER2+), and
triple-negative (ER-, PgR-, HER2-). The discordance
ratios for intrinsic subtypes between the primary tumor
and LN metastasis were analyzed.
The discordance ratios for ER, PgR, HER2, and Ki
67 were 0/93 (0%), 7/93 (7.5%), 2/93 (2.2%), and 10/93
(10.8%), respectively. The discordance ratio for the
intrinsic subtype was 9/93 (9.7%). Considering the
intrinsic subtype of LN metastasis, the effects of
additional chemotherapy and anti-HER2 therapy could
be expected in 4/93 (4.3%) and 1/93 (1.1%) patients,
respectively.
The discordance ratio for the intrinsic subtype
between the primary breast tumor and LN metastasis
was 9.7%. Considering the intrinsic subtype of LN
metastasis, additional medical therapy could be expected
to be effective in 5/93 (5.4%) breast cancer cases with
LN metastasis. Immunohistochemistry of metastatic LNs
may be useful for planning adjuvant therapy when the
analysis of the primary site is inconclusive.
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