Comparison of Core Needle Biopsy and Excision Specimens for the Accurate Evaluation of Breast Cancer Molecular Markers: a Report of 1003 Cases

Chen, Jie; Zu, Wang; Lv, Qing; Du, Zhenggui; Tan, Qiuwen; Zhang, Di; Xiong, Bingjun; Zeng, Helin; Gou, Jing

doi:10.1007/s12253-017-0187-5

Cited by 21 publications

(34 citation statements)

References 34 publications

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“…In 1003 patients included, Chen et al detected much lower concordance rates with kappa values for ER, PR, Her2neu, and Ki67 of 0.52, 0.44, 0.45, and 0.20, respectively. They suggested a careful interpretation of the immunohistochemical CNB results [10]. Chen et al recommended to retest Ki67 after analyzing 298 invasive breast cancers, because the discordance rate between luminal A-like and luminal B-like tumors was only 14%, comparable to the results of this study [11].…”

Section: Discussionsupporting

confidence: 68%

“…A discrepancy between the immunohistochemical staining of small CNB samples compared to the surgical specimens may be caused by tumor heterogeneity, i.e., a non-representative specimen. Moderate-to-good concordance rates have been reported in several publications for each marker separately, resulting in controversy regarding the need for re-testing of these markers on surgical specimens [10][11][12][13][14][15]. In this study, the concordance rates of the surrogate molecular classification based on immunohistochemical staining on CNB are compared to the classification of the surgical specimens.…”

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confidence: 99%

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Concordance of the molecular subtype classification between core needle biopsy and surgical specimen in primary breast cancer

Pölcher

Braun

Tischitz

et al. 2021

Arch Gynecol Obstet

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Background Molecular profiling of breast cancer (BC) classifies several intrinsic subtypes based on different patterns of gene expression. Multigene assays estimate the risk of recurrence and help to select high-risk patients for adjuvant chemotherapy. However, these tests are associated with significant costs. Immunohistochemistry (IHC) offers a surrogate classification for molecular subtypes by determining estrogen (ER) and progesterone receptors (PR), human epidermal growth factor (Her2neu), as well as the proliferation marker Ki67. Core needle biopsy (CNB) is well established in BC diagnosis and allows a pre-operative assessment of biomarkers. The aim of this study was to analyze the concordance of these markers between CNB and surgical specimens to assess whether re-testing of the surgical specimen is mandatory. Materials and methods Within a 3-year period, patients with primary BC and paired samples of CNB and surgical specimens were analyzed retrospectively. Concordance rates of ER, PR, Her2neu, Ki67, and the surrogate classification for molecular subtypes were calculated using the Landis and Koch agreement grades. Results Out of 2254 patients with primary breast cancer, 1307 paired specimens without pre-operative treatment were available for analysis Concordance rates for ER, PR, Her2neu, and Ki67 status showed substantial-to-almost perfect agreement grades (κ = 0.91, 0.75, 0.89, and 0.61, respectively). Though substantial concordance was also found for the subtype classification (κ = 0.70), the molecular subtype changed in 18.5% of patients based on the testing of the surgical specimen, mainly from luminal A-like to luminal B-like. Conclusions Though the concordance rates for single markers were convincing, a significant proportion of the molecular subtypes differed between CNB and the surgical specimen. Re-testing of PR and Ki67 is mandatory to ensure optimal treatment decisions. Further research is necessary to define safe, efficient, and cost-effective predictive models in adjuvant breast cancer therapy.

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Section: Discussionsupporting

confidence: 68%

mentioning

confidence: 99%

Concordance of the molecular subtype classification between core needle biopsy and surgical specimen in primary breast cancer

Pölcher

Braun

Tischitz

et al. 2021

Arch Gynecol Obstet

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“…Identifying HER2-positive breast cancer patients by CNB is important, as neoadjuvant HER2-targeted therapy is an effective option for these patients. In this study, the CR for HER2 status, as determined by HER2 IHC or reflex HER2 SISH, was as high as 99.7% (kappa, 0.988), which was higher than most previous reports (ranging from 61%-97.3%) [10,[18][19][20][21][22][23][24][25][26][27][28][29]. The reason for this high CR could partially be due to performing reflex HER2 SISH for all HER2 IHC equivocal cases to determine final HER2 status strictly following ASCO/CAP guidelines.…”

Section: Discussioncontrasting

confidence: 57%

Analysis of the molecular subtypes of preoperative core needle biopsy and surgical specimens in invasive breast cancer

Jeong

Kang

Lee

et al. 2020

J Pathol Transl Med

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Background: Accurate molecular classification of breast core needle biopsy (CNB) tissue is important for determining neoadjuvant systemic therapies for invasive breast cancer. The researchers aimed to evaluate the concordance rate (CR) of molecular subtypes between CNBs and surgical specimens. Methods: This study was conducted with invasive breast cancer patients who underwent surgery after CNB at Seoul St. Mary's Hospital between December 2014 and December 2017. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 were analyzed using immunohistochemistry. ER and PR were evaluated by Allred score (0-8). HER2 was graded from 0 to +3, and all 2+ cases were reflex tested with silver in situ hybridization. The labeling index of Ki67 was counted by either manual scoring or digital image analysis. Molecular subtypes were classified using the above surrogate markers. Results: In total, 629 patients were evaluated. The CRs of ER, PR, HER2, and Ki67 were 96.5% (kappa, 0.883; p < .001), 93.0% (kappa, 0.824; p < .001), 99.7% (kappa, 0.988; p < .001), and 78.7% (kappa, 0.577; p < .001), respectively. Digital image analysis of Ki67 in CNB showed better concordance with Ki67 in surgical specimens (CR, 82.3%; kappa, 0.639 for digital image analysis vs. CR, 76.2%; kappa, 0.534 for manual counting). The CRs of luminal A, luminal B, HER2, and triple negative types were 89.0%, 70.0%, 82.9%, and 77.2%, respectively. Conclusions: CNB was reasonably accurate for determining ER, PR, HER2, Ki67, and molecular subtypes. Using digital image analysis for Ki67 in CNB produced more accurate molecular classifications.

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“…The characteristics of the included 22 studies are presented in Table 1. The majority of the studies were performed in Asia (11, 50%), 20,[24][25][26][27][28][29][30][31][32][33] or Europe (9, 41%). [34][35][36][37][38][39][40][41][42] Only one (4.5%) study was from South America 43 and one (4.5%) from North America.…”

Section: G E N E R a L C H A R A C T E R I S T I C S O F T H E S T U D I E Smentioning

confidence: 99%

Concordance between core needle biopsy and surgical excision specimens for Ki‐67 in breast cancer – a systematic review of the literature

et al. 2021

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Concordance between core needle biopsy and surgical excision specimens for Ki-67 in breast cancera systematic review of the literature Aims: The biomarkers oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) are routinely measured in patients with breast cancer with international consensus on how they should be interpreted. There is evidence to support use of other biomarkers to give more detailed predictive and prognostic information. Ki-67 is one example, and measures the proliferative activity of cancer cells. It is important that this can be performed at diagnosis of breast cancer for patients who do not have initial surgical treatment (mainly older women) and those receiving neoadjuvant therapies. Methods and results: A systematic review was performed to assess concordance of measurement of Ki-67 between core needle biopsy (CNB) samples and surgical excision (SE) samples in patients with invasive breast cancer. MEDLINE and Embase databases were searched. Studies were eligible if performed within the last 10 years; included quantitative measurement of Ki-67 in both CNB and SE samples with no prior breast cancer treatment; measured concordance between two samples; and had full text available. A total of 22 studies, including 5982 paired CNB and SE samples on which Ki-67 was measured, were appraised. Overall, there appeared to be concordance; however, reliability was unclear. Where given, the Cohen's kappa coefficient (j) of correlation between samples ranged from 0.261 to 0.712. The concordance rate between CNB and SE where measured as a percentage had a range from 70.3 to 92.7% Conclusions: Assessment of level of concordance of Ki-67 between CNB and SE samples is hampered by different methodologies. International consensus on Ki-67 measurement is urgently needed.

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Comparison of Core Needle Biopsy and Excision Specimens for the Accurate Evaluation of Breast Cancer Molecular Markers: a Report of 1003 Cases

Cited by 21 publications

References 34 publications

Concordance of the molecular subtype classification between core needle biopsy and surgical specimen in primary breast cancer

Concordance of the molecular subtype classification between core needle biopsy and surgical specimen in primary breast cancer

Analysis of the molecular subtypes of preoperative core needle biopsy and surgical specimens in invasive breast cancer

Concordance between core needle biopsy and surgical excision specimens for Ki‐67 in breast cancer – a systematic review of the literature

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