Introduction-Breast cancer is the most common cancer and leading cause of death in women. In India, its incidence is rapidly rising over last few decades. Present study is aimed to study the pattern of expression of hormonal receptors and Her-2/neu in invasive breast carcinoma and to correlate estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu expressions with various clinicopathological parameters. Material and methods: The present study was carried out in Department of Pathology, S.C.B. Medical College, Cuttack in the year 2013 taking consecutive 100 cases. Routine H&E staining for histological diagnosis and IHC analysis for ER, PR and Her 2/neu was carried out in all 100 cases of breast malignancies. Results: 99% of cases are invasive breast carcinoma, not otherwise specify (IDC-NOS). The age ranges from 23 years to 72 years. Majority of tumors are of grade 2 (70%) followed by grade 3 (30%). ER PR and Her-2/neu expression are seen in 45%, 35% and 30% respectively. Triple negative cases comprise 35%. Higher number of grade 2 tumor shows ER, PR positivity as compared to grade 3 tumors. Her-2/neu expression does not show any significant correlation with age or lymph node status of the patient. Conclusion: ER and PR expression in breast cancers in the current study are found to be comparable to the findings of other authors, but the frequency of HER-2/neu expression is slightly higher. Significant correlation is observed between hormonal receptor status and the grade of the tumor. Inverse relationship is found between Her-2/neu expression and ER, PR receptor status. Her-2/neu expression is increased with size and high grade of tumor.
Breast cancer is the most common cancer of women in developed countries and 12% breast cancers occur between 20 - 34 years [
This study was carried out in the year 2013 taking 100 consecutive cases. The study was done as per standard ethics. All the cases histopathologically diagnosed as invasive carcinoma were included in the study. The clinical details like age, sex, duration of symptoms, laterality, size of the tumor, axillary lymph node status and imaging findings like MRI were recorded in each case. After carrying out the detailed gross examination, all tissues were fixed in 10% buffered formalin. Multiple sections were taken from the tumor and its margins and all the lymph nodes. Histopathological study of the specimen was done by Haematoxylin and Eosin staining and as per standard protocol. Grading of the tumor was done by modified Bloom Richardson grading system. Immunohistochemistry (IHC) for ER, PR and Her-2/neu was performed on representative blocks of paraffin embedded tissue in each case. 3 - 4 micron thick sections were submitted for IHC staining. Antigen retrieval was done by HIER method using citrate buffer at ph 2.5 for ER/PR and ph 6 for Her-2/neu. The normal epithelial component present in the tissue section served as internal control for ER/PR. IDC-NOS with known Her-2/neu over expression was used as external positive control for Her-2/neu with each lot of staining. The ER+ve cells showed nuclear staining (
recorded. For PR also nuclear staining was observed (
Following scoring system was used for noting down the results of immunohistochemistry in each case.
Interpretation of IHC in Carcinoma BreastAll red score for ER and PR Evaluation in Ca Breast.
Interpretation of Her-2/Neu by IHC.
In our study, a total of 100 consecutive cases of invasive carcinoma of breast were taken. Age of the patients ranged from 23 - 73 years. Most common age group was 41 - 50 (37% cases) as shown in
All cases except one were IDC-NOS and only one case was diagnosed as medullary carcinoma. Majority (70 cases −70%) belonged to grade 2 according to B-R Grading system. However, lymph nodes were negative in maximum cases i.e. 73 negative in comparison to 27 positive cases (
Correlation of ER, PR and Her-2/neu with grade of tumor has been shown in
Age group | Cases | Percentage (%) |
---|---|---|
21 - 30 | 05 | 05 |
31 - 40 | 23 | 23 |
41 - 50 | 37 | 37 |
51 - 60 | 24 | 24 |
61 - 70 | 09 | 09 |
71 - 80 | 02 | 02 |
Total | 100 |
Histopathological features | Number | Percentage | |
---|---|---|---|
Type | IDC NOS | 99 | 99 |
Medullary carcinoma | 01 | 01 | |
Grade | 1 | Nil | |
2 | 70 | 70 | |
3 | 30 | 30 | |
Tumour size | |||
Less than 2 cm More than 2 cm | 14 86 | 14 86 | |
Lymph node status | Positive | 27 | 27 |
Negative | 73 | 73 | |
ER | Positive | 45 | 45 |
Negative | 55 | 55 | |
PR | Positive | 35 | 35 |
Negative | 65 | 65 | |
Her2/neu | Positive | 30 | 30 |
Negative | 70 | 70 |
Grade | Cases | ER positivity | PR positivity | Her2/neu positivity |
---|---|---|---|---|
2 | 70 | 40 | 28 | 06 |
3 | 30 | 05 | 07 | 24 |
Triple positive―Grade 2 - 18 cases (18%), Grade 3 - 12 cases (12%); Triple negative―Grade 2 - 20 cases (20%), Grade 3 - 15 cases (15%).
Present study comprised of 100 cases of primary breast carcinoma. Majority of cases were seen in between 4th to 6th decades, mostly perimenopausal and postmenopausal females. 86% of the cases (
In our study, Her-2/neu receptor revealed a significant inverse association with hormonal receptor status. We found that ER, PR expression was increased in Her-2/neu negative tumors as compared to Her-2/neu positive tumors. Similar results were found by Mona M Rashed et al. Triple negative breast carcinoma is characterized by lack of ER, PR and Her-2/neu expression. Our study showed 35% cases as triple negative. Study by Bhagat Vasudha M et al. showed 25.86% cases and Patil et al. showed 19.9% cases as triple negative respectively.
Triple negativity was again found in 20% of breast carcinomas with a histopathologic grade 2 cases where as it was slightly reduced i.e. 15% in grade 3 breast carcinomas. Similarly triple positivity was seen in 18% of grade 2 tumours and about 12% in grade 3 tumours.
In our institutions IDC-NOS was diagnosed in almost all cases of breast carcinomas (99%). Only 1 case of medullary carcinoma of breast was encountered among the total cases studied. Comparing the statistics of western countries, our studies show that we had infiltrating ductal carcinoma NOS as the most common breast cancer [
In present study, ER, PR and Her-2/neu expression in breast carcinoma by IHC method indicate higher rate of positive expression correlated with various clinicopathological aspects. Higher number of grade 2 tumor shows ER, PR positivity as compared to grade 3 tumors. Inverse relationship is observed between Her-2/neu expression and ER, PR receptor status. Her-2/neu expression is increased with increased grade of the tumor. ER, PR and Her-2/neu do not show any significant correlation with lymph node status and age.
PriyadarshiniBiswal,SusmitaBehera,AsarantiKar,DilleswariPradhan,PradeepKumar Behera,SubratBurma,ChandrapravaMishra, (2015) Correlation of Hormonal Receptors Estrogen Receptor, Progesterone Receptor and Her-2/Neu with Tumor Characteristics in Breast Carcinoma: Study of 100 Consecutive Cases. International Journal of Clinical Medicine,06,961-966. doi: 10.4236/ijcm.2015.612126