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doi: https://doi.org/10.4132/jptm.2019.10.14    [Epub ahead of print]
Analysis of the Molecular Subtypes of Preoperative Core Needle Biopsy and Surgical Specimens in Invasive Breast Cancer
Ye Sul Jeong1 , Jun Kang1 , Jieun Lee2,3 , Tae-Kyung Yoo4 , Sung Hun Kim5 , Ahwon Lee1,3
1Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Cancer Research Institute, The Catholic University of Korea, Seoul, Korea
4Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
5Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding Author: Ahwon Lee ,Tel: 82-2-2258-1621, Fax: 82-2-2258-1627, Email: klee@catholic.ac.kr
Received: August 1, 2019;  Revised: September 25, 2019  Accepted: October 14, 2019.  Published online: November 13, 2019.
ABSTRACT

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<0.001), 93.0% (Kappa: 0.824, P<0.001), 99.7% (Kappa: 0.988, P<0.001), and 78.7% (Kappa: 0.577, P<0.001), 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.
Key Words: Breast neoplasms; Core needle biopsy; Estrogen receptors; Progesterone receptors; Human epidermal growth factor receptor 2; Immunohistochemistry
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