Breast cancer stromal elastosis is associated with mammography screening detection, low Ki67 expression and favourable prognosis in a population-based study

Abstract

BackgroundMammography screen-detected breast cancers have a better prognosis than predicted from established prognostic markers. A search for additional features that are characteristic for these tumours and their prognosis is needed to reduce overtreatment, a recognized challenge in breast cancer patient management today. Here, we have investigated the occurrence and importance of tumour elastosis.MethodsWe performed a population based retrospective study of breast cancers detected in the Norwegian Breast Cancer Screening Programme in Vestfold County during 2004–2009. In total, 197 invasive screen-detected cancers and 75 interval cancers in patients aged 50–69 years were compared with regard to standard clinico-pathological parameters and tumour shape, as well as ER, PR, HER2 and Ki67 expression. In particular, the presence of elastotic material in tumours was graded on a 4-tiered scale (score 0–3).ResultsScreen-detected cancers had a significantly higher content of stromal elastosis than interval cancers (p < 0.001). High content of elastosis (score 3) correlated strongly with stellate tumour shape, low histological grade, and ER+/HER2- status. Further, high elastosis score was significantly associated with lower Ki67 expression. In survival analyses, cases with high elastosis demonstrated increased recurrence free (p = 0.03) and disease-specific survival (p = 0.11) compared to cases with low elastosis.ConclusionThere is a strong correlation between the presence of tumour elastosis, stellate tumour shape and mammography detection of breast cancers. To our knowledge, this is the first time elastosis has been studied in relation to breast cancer detection method. Presence of elastosis is associated with low tumour cell proliferation (Ki67) and a good prognosis.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_230

Extra-nodal extension is a significant prognostic factor in lymph node positive breast cancer

“…A population-based cohort of 816 breast cancer cases recruited from two counties in Norway (Hordaland and Vestfold) with mean age 59 years (range 50–69) and who participated in the prospective Norwegian Breast Cancer Screening Program (NBCSP) during 1996–2009 was initially identified [ 15 – 17 ]. Hordaland and Vestfold counties have approximately 730,000 inhabitants, representing about 15% of the population in Norway.…”

“…Data on the paired primary tumor, including tumor diameter, histologic type, histologic grade, hormone receptor status, HER2 status, and molecular subtype were available [ 15 – 17 ] ( S1 and S3 Tables). The molecular subtype was determined according to St. Gallen 2013 with some modifications; cut-off point for the positivity of ER and PR was 10% according to national guidelines at the time [ 17 ].…”

Evaluation of Tumor Cell Proliferation by Ki-67 Expression and Mitotic Count in Lymph Node Metastases from Breast Cancer

“…The cohort (n = 816) represents women diagnosed with primary invasive breast cancer (mean age 59 years, range 50–69) who resided in two counties in Norway (Hordaland, Vestfold) and participated in the prospective population-based Norwegian Breast Cancer Screening Program during 1996–2009 [ 10 , 30 , 31 ]. Hordaland and Vestfold counties have approximately 730,000 inhabitants, this represents about 15% of the total population in Norway.…”

The clinicopathological significance of Ki67 in papillary thyroid carcinoma: a suitable indicator?

“…Ki67 is generally used as a prognostic indicator and as a tool for diagnostic and research purposes. Many publications have reported high expression of Ki67 in several types of carcinoma [ 1 – 3 ]. Many studies investigating the Ki67 expression and clinical outcomes have been published within the last decade.…”