Discordance in early breast cancer for tumour grade, Estrogen Receptor, Progesteron Receptors and Human Epidermal Receptor-2 status between core needle biopsy and surgical excisional primary tumour

Abstract

The aim of the present study was to compare the tumour grade, Estrogen Receptor (ER), Progesteron Receptor (PgR) and Human Epidermal Receptor-2 (HER-2) status in the core needle biopsy (CNB) with those observed in the subsequent excisional primary tumour (EPT). All patients diagnosed with an early breast cancer in our University Hospital Center between January 1, 2005 and December 31, 2006 were included but exclusion criteria of patients with large tumour requiring neoadjuvant chemotherapy and cases with more than one tumour (multicentricity/multifocality tumours). Histological tumour grade assessed according to Nottingham Grading System (SBRm), ER, Pgr and HER-2 tumoural status were assessed twice in CNB and in EPT. A total of 175 patients were assessed. The concordance between CNB and EPT for Grade, ER, PgR and HER2 status were 75.4% (p > 0.00001), 84% (p > 0.00002), 78.3% (p = 0.002) and 98.3% (p = 0.486) respectively. In conclusion CNB can be used with confidence for HER2 determination. For grade, PgR and ER due to substantial discordance results from CNB should be used with caution.

Accuracy of Prognostic and Predictive Markers in Core Needle Breast Biopsies Compared with Excisional Specimens

“…It is suggested that upscoring may occur in CNB compared with excisional biopsy, probably due to better fixation in CNB than in surgical specimens [8], which was not confirmed in this study. Based on very good correlation (96.7%), sensitivity (100%), and specificity (91.66%), ER can be accurately assessed in CNB, which is in agreement with previous studies [9,16].…”

In the Era of Genomics, Should Tumor Size Be Reconsidered as a Criterion for Neoadjuvant Chemotherapy?

“…The overall concordance between ER, PR, and HER2 by Oncotype DX (RT-PCR) and IHC/FISH has previously been shown to be high in prospectively designed large studies [23][24][25] using ASCO/CAP guidelines, although those concordance studies were performed using surgical specimens and not core biopsies. Importantly, discordant results with regard to ER and HER2 assessment by IHC in different laboratories are reported in the same range, and differences between core and surgical specimens are also commonly described [26]. These findings reinforce the need for quality control for pathological assessment and liberal repeated testing in discordant cases.…”

Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes

“…In cases achieving a pathological complete response with treatment, the prognostic and predictive molecular markers should be evaluated using core biopsy specimens [28]. However, it may be a concern if assessment in core needle biopsy is less reliable than in excisional biopsy owing to smaller sample size or heterogeneous tumour status [28][29][30]. If it is possible to predict triple-negative breast cancer on the basis of imaging features, this additional information could assist in both pretreatment planning and prognosis [17].…”