Histological Assessment of the Prognostic Factors in Female Breast Cancer

Abstract

Paraffin-embedded biopsy specimens from the primary breast carcinomas of 653 women were subjected to histopathological assessments of the potential prognostic factors. Histological type, histological grade, nuclear pleomor-phism, tubule formation, intraductal growth pattern, tumour margin circumscription, tumour necrosis and inflammatory cell reaction were semiquantita-tively analysed with special reference to disease outcome during the mean follow-up 12.8 years. Histological grade, nuclear grade and inflammatory cell reaction were related to axillary lymph node involvement at operation (p < 0.001). Intensity of the inflammatory cell reaction was directly correlated to histological grade, histological type, nuclear pleomorphism and tumour necrosis (p < 0.001). Tubule formation and tumour necrosis were significant predictors for tumour recurrence. Recurrence-free survival was related to tubule formation (p = 0.0048), histological grade (p = 0.0208) and intraductal growth pattern (p = 0.0441). Tubule formation accurately predicted the recurrence-free survival in axillary lymph node-negative tumours (p = 0.0386). In small (diameter ≤ 20 mm) axillary lymph node-negative tumours, the inflammatory cell reaction (p = 0.0377) as well as intraductal growth pattern (p == 0.0632) were related to recurrence-free survival. Cancer-related patient survival was predicted in decreasing order of significance by tubule formation (p = 0.0002), nuclear pleomorphism (p = 0.0010), intraductal growth (p = 0.0077), tumour necrosis (p = 0.0117) and histological type (p = 0.0651). In axillary lymph node-negative tumours, tubule formation (p = 0.0409), inflammatory cell infiltration (p = 0.0790) and intraductal growth (p = 0.0958) predicted the cancer-related survival. The results indicate that despite an intense search for a diversity of prognostic factors by increasingly sophisticated techniques (e.g., morphometric measurements, flow cytometry, immunohisto-chemistry, and DNA hybridization techniques), the relatively simple light microscopic assessment of the above morphological features seems to be still advocated in predicting the disease outcome in female breast cancer.

Prognostic Significance of Necrosis, Elastosis, Fibrosis and Inflammatory Cell Reaction in Operable Breast Cancer

“…Earlier studies on the possible prognostic role of necrosis yielded contrasting results. We found a prognostic potential of necrosis at uni variate analysis only, a finding consistent with those from larger series [2,5,18]. Others found no correlation at all [19], while others found a significant predictive value, independent of most prognostic factors [20].…”

“…Our data revealed a strong correlation between necro sis and high-grade or large-size tumor, thus confirming the well-recognized relationship between necrosis and rapidly growing tumors [2,16,17]. Earlier studies on the possible prognostic role of necrosis yielded contrasting results.…”

“…Under the above-men tioned conditions, inflammatory cell reaction is expected to be: (i) a marker of negative outcome in case of tumors with a prevalence of positive prognostic factors (Tl, N-, G1-G2, low S-phase), assuming that cell reaction is not effective against the tumor; (ii) a marker of positive out come in tumors with a prevalence of negative prognostic factors (T2-T3, N+, G3, high S-phase), assuming that cell reaction is effective against the tumor. Analyses con ducted without accounting for interaction between cell reaction and major prognostic factors fail to demonstrate any prognostic role of cell reaction [1,2,6,16] or obtain positive [4,9,10] or negative [8] results, by mere chance. Our finding that inflammatory cell reaction is a negative marker only among G1-G2 tumors is consistent with oth er reports.…”

“…the tumor must remain within the microenviron ment for a sufficiently long period. The former seems more frequent, as derived from data published on the pos itive correlation between cell reaction and high histologi cal grade [2,4,6,16]. No conclusive data are available on the antitumoral activity of chronic inflammatory cell reaction.…”

“…Nodal status, tumor size and grading are 'time honored' prognos tic factors predicting for survival [1][2][3]. In routine exami nation of breast specimens, pathologists provide addition al information on a series of morphologic characteristics of the primary tumor, such as necrosis, elastosis, fibrosis and inflammatory cell reaction, which might reflect rela tionships between tumor and host.…”