Observations

OBSERVATIONS

A total of 40 cases diagnosed as breast carcinoma were included in the present study.

88%

INFILTRATING DUCT CA
METAPLASTIC CARCINOMA
INVASIVE PAPILLARY CARCINOMA

3% 10%

Disease distribution

All 40 cases in the present study were newly diagnosed cases, who did not receive any
therapy. Of these 40 cases, 35 were of infiltrating duct carcinoma, 4 cases was of Metaplastic
carcinoma and 1 case was of Invasive papillary carcinoma.

Figure 1: DISTRIBUTION OF CASES

42
 Observations

Age Distribution

13

9
8

20-30
31-40
41-50
51-60
>61

Figure 2: AGE DISTRIBUTION OF CASES

The patient’s age ranged from 26 to 70 years. Mean age of the patients was 48 years with
majority being in the age group of 41-50 years. Three cases of metaplastic carcinoma were in
the age group of 41-50 years while one was of 65 years of age. Mean age of patients with
metaplastic carcinoma was 52.5 years. One case of Invasive papillary carcinoma was of 65
years of age.

AGE RANGE Infiltrating duct Metaplastic Invasive

(years) carcinoma (35) carcinoma (4 ) papillary
carcinoma (1)
20-30 2(5%)
31-40 9(22.5%)
41-50 10(25%) 3(7.5%)
51-60 8(20%)
>61 6(15%) 1(2.5%) 1 (2.5%)

43
 Observations

Table 1: AGE DISTRIBUTION OF 40 CASES ACCORDING TO THE HISTOLOGICAL TYPE

Menopause

Of all the cases 55% had attained menopause. The premenopausal women formed 45% of the
total cases.

Menopausal Status No. of cases

Premenopausal 18 (45%)
Postmenopausal 22 (55%)

Table 2: MENOPAUSAL STATUS IN CASES

Pre menopausal
45%

Post menopausal
55%

Figure 3: MENOPAUSAL STATUS

Clinical Profile of Cases

The most common presenting complaint was lump, seen in 36 patients, followed by pain
(23.7%) and nipple discharge (7.9%). Other symptoms like ulceration of skin, weight loss,

44
 Observations

and fatigue were also seen. Associated clinical findings included history of hypertension in 9
(23.7%) cases and Diabetes mellitus in 4 (10.5%) cases.

Presenting Infiltrating duct Metaplastic Papillary Total

Complaints carcinoma carcinoma carcinoma
(35 cases) ( 4 Cases) (1 Case)
Lump 33(94.2%) 4 1 38(95%)
Nipple discharge 2(5%) 2(25%) - 4(10%)
Pain 21(52.5%) - - 21(52.5%)

Table 3: DISTRIBUTION OF PRESENTING COMPLAINTS IN BREAST CARCINOMA

Presenting Complaints
Infiltrating duct carcinoma metaplastic carcinoma invasive papillary carcinoma

1
4

2
No of cases

21
33

Lump Nipple discharge Pain

Figure 4: PRESENTING COMPLAINTS OF PATIENTS

Duration of lump

Maximum number of patients (50%) complained of breast lump for less than equal to 6
months duration.

DURATION OF LUMP NUMBER OF CASES (N=40)

< 6 Months 20(50%)

45
 Observations

6-12 Months 12(30%)

12– 24 Months 6(15%)

24 – 36 Months 2(5%)

Table 4: DURATION OF LUMP IN CASES

LUMP DURATION
20
20
The risk factors included
18
family history in 2 cases,
16
OCP intake in 5 cases and
14 12
history of tobacco use was
No of cases

12
elicited in 6 cases.
10
8 6
6
4 2
2
0
< 6 Months 6-12 months 12-24 months 24-36 months

Figure 5: DURATION OF LUMP

DURATION OF STAGE 1, 2 STAGE 3,4 P VALUE

LUMP
< 6 MONTHS 17 3 1.0
> 6 MONTHS 19 1

Table 5: DURATION OF LUMP WITH PATHOLOGICAL STAGE

There was no significant difference between duration of lump with pathological stage of the
tumor. Even on comparing duration of symptoms with groups of pathological stage 1 versus
stage2/3/4, there was no significant difference between the two groups. (p=0.548)

EXAMINATION FINDINGS: Besides a palpable lump, other important clinical findings

were palpable axillary lymph nodes(15), nipple/skin involvement (5), fixity of lump to chest

46
 Observations

wall(1), nipple discharge (3), satellite nodule(1) and clinicoradiological evidence of

metastasis (2).

16 Examination findings
14 15
12
10
8
6 5
3
4
2
1
0 1 2

no. of cases

Figure 6: CLINICAL EXAMINATION

Oral Contraceptive Tobacco intake Family History

Present 5 (12.5%) 3 (7.5%) 4 (10%)
Absent 35 (87.5%) 37(92.5%) 36 (90%)

Table 6: RISK FACTORS FOR BREAST CARCINOMA

Risk Factors
5 The risk factors
5
4
included family
4.5
4
history in 4 cases,
3.5 3
3 OCP intake in 5 cases
No of cases

Cases
2.5
2 and history of no
1.5
1 breast feeding was
0.5
0 elicited in 3 cases.
OCP No Breast Feeding Family h/o

47
 Observations

Laterality

48% patients had left

sided tumor while 52%

48%
right
53% left presented with right sided

lump

Figure7: LATERALITY OF TUMOR

Quadrants

Most common quadrant involved in carcinoma breast was upper outer quadrant (52.5%)
followed by lower outer quadrant (20%).

QUADRANT NO. OF CASES (N=40)

Upper outer 21
Upper inner 4
Lower outer 8
Lower inner 4
Central 3

Table 7: DISTRIBUTION OF CARCINOMA CASES ACCORDING TO THE QUADRANTS INVOLVED

25

21
20

15
N o of caes

10 No of cases
8

5 4 4
3

0
Upper outer Upper inner Lower outer Lower inner Central
Quadrants

Figure 8: DISTRIBUTION OF CARCINOMA CASES ACCORDING TO THE QUADRANTS INVOLVED

48
 Observations

Table 8: SIZE OF LUMP

LUMP SIZE INFILTRATING METAPLASTIC INVASIVE

DUCT CARCINOMA PAPILLARY
CARCINOMA (35 (4) CARCINOMA (1)
NMN )
≤2 cm 3 0 0
2-5 cm 19 2 1
>5 cm 13 2 0

DIAGNOSTIC MODALITIES USED: Mammography was performed in 13 cases (32.5%).

Majority of the cases belonged to BIRADS 4/5. Besides mammography, the other common modality
included FNAC (85%) and trucut biopsy (55%). Two patients underwent lumpectomy (5%).

Type of surgery: Modified radical mastectomy was performed in 95% of the cases while lumpectomy
in 5% of the cases.

Table 9: PRIMARY DIAGNOSTIC MODALITY USED

INVESTIGATION NUMBER OF CASES

FNAC 34 (85%)

MAMMOGRAPHY 13 (32.5%)

TRUCUT 22 (55%)

LUMPECTOMY 2 (5%)

Table 10: PATIENT CLINICALLY CLASSIFIED BY TNM

STAGE TNM NO OF CASES (N=40)

0 Tis 0
I T1 N0 M0 1
IIA T1 N1 M0 1
T2 N0 M0 17
IIB T2 N1 M0 7
T3 N0 M0 5
IIIA T1 N2 M0 0

49
 Observations

T2 N2 M0 0
T3 N1-2 M0 6
IIIB T4 N0 M0 2 Figure 12: DISTRIBUTION OF

T4 N1 M0 0
CARCINOMA CASES
IV T4c N3c M1 1
ACCORDING TO THE SIZE OF
Majority of the cases were of T2 N0 M0 (42.5%) followed by
T2N1M0 (17.5%) THE TUMOR

Gross Examination

The size of the primary tumor was measured in centimeters and mean of the greatest
dimension was taken55. The tumor size varied from 2-17 cm, with the mean of 9.5 cm. 3
cases (7.5%) had a tumor size ≤ 2cm while 15 cases (37.5%) were >5 cm in size. Majority
(55%) of tumors were in the size range of 2 to 5cm. The tumor was extending to the deep
plane of resection in 5 cases (12.5%).

Size of the tumor Number of cases(n=40)

≤ 2 cm 3(7.5%)

2-5 cm 22(55%)

>5 cm 15(37.5%)

Table 11: DISTRIBUTION ACCORDING TO THE PATHOLOGICAL SIZE

Tumor size

25
22
20

15
Noof cases

10

5 3

0
50
Size of t...
 Observations

Table12: STATE OF NODAL METASTASIS

LYMPH NODE CASES (N=40)

0 23 (57.5%)
1-3 6 (15%)
4-9 7 (17.5%)
≥10 4 (10%)

Lymph node status

25 23

20

No of cases
15

10 7
6
4
5

0
Negative 1-3 nodes 4-9 nodes ≥10 nodes

Figure 13: LYMPH NODE METASTASIS

CORRELATION OF LYMPH NODE STATUS WITH GRADE OF THE TUMOR:

The lymph node status was independent of the grade of the tumor.

Table 13: LYMPH NODE WITH GRADE OF TUMOR( N = 36)

GRADE 1 GRADE 2 GRADE 3 p VALUE

LN - 2 14 3 0.314
LN + 1 13 3

Table 14: LYMPH NODE STATUS WITH SIZE & STAGE OF TUMOR(N =40)

LYMPH NODE+ LYMPH NODE - P VALUE

≤ 5 CM 17 10 0.314(CHI SQUARE)

51
 Observations

>5 CM 6 7
STAGE I/II 5 20 0.001 (CHI SQUARE)
STAGE III/IV 12 3
There was no significant difference in size of the tumor versus lymph node status. However ,
higher stage of tumour is associated with involvement of lymph nodes( p = 0.001).

BREAST CANCER STAGING: Staging was done according to the AJCC guidelines 152.
Majority of the cases belonged to stage II (65%), followed by stage III (27.5% cases).

Table 15: PATHOLOGICAL STAGING

STAGE TNM NO. OF CASES (N=38)

0 TIS N0 M0 0
I T1 N0 M0 1
IIA T1 N1 M0 1
T2 N0 M0 6
IIB T2 N1 M0 6
T3 N0 M0 12
IIIA T1 N2 M0 0
T2 N2 M0 1
T3 N1 M0 6
T3N2M0 0
IIIB T4 N0 M0 3
T4N1M0 3
IIIC T1N3M0 0
T2N3M0 0
IV T4 N0 M1 2

52
 Observations

T4 N0 M1

T4N1M0

T4 N0 M0

T3N2M0

T3 N1 M0

T2 N2 M0 Clinical Staging
T3 N0 M0 Pathological Staging

T2 N1 M0

T2 N0 M0

T1 N1 M0

T1 N0 M0

Tis N0M0

0 2 4 6 8 10 12 14 16

Figure 14: PATHOLOGICAL STAGING

CLINICAL STAGE PATHOLOGICAL STAGE

STAGE0 0 0
STAGE I 1 2
STAGE II 28 23
STAGE III 9 13
STAGE IV 2 2

Table 16: CLINICAL VERSUS PATHOLOGICAL STAGE

The cases in stage I increased from 2.5% to 5% with a decline in stage II cases from 70% in
clinical stage to 57.5% in pathological staging. This is explained by the fact that not all
clinically palpable lymph nodes show metastasis microscopically.

HISTOLOGICAL GRADING: Allocation of histological grade was based on the

Nottingham modification of bloom Richardson grading46. Most of the cases belong to grade II

53
 Observations

(27) followed by grade III (6). Metaplastic carcinoma and invasive papillary carcinoma
cases were excluded.

Table 17: DISTRIBUTION OF CARCINOMA CASES ACCORDING TO THE HISTOLOGICAL GRADE

HISTOLOGICAL GRADE NO. OF CASES(N=36)

Grade I ( 3-5 Points) 3(7.5%)
Grade II ( 6-7 Points) 27(67.5%)
Grade III ( 8-9 Points) 6(15%)

Grade I
GradeII
Grade III

Majority of the
tumors belonged
to grade 2
Figure 15: DISTRIBUTION OF INFILTRATING DUCT CARCINOMA CASES
(67.5%)
ACCORDING TO THE HISTOLOGICAL GRADE.
followed by
grade 3 (15%)

HISTOPATHOLOGICAL PARAMETERS: The microscopic

features assessed were the presence of necrosis, fibrosis, calcification, in situ component, the
presence and grade of lymphocytic infiltrate at the centre as well as periphery and adipocytic
infiltrate, angioinvasion and perineural invasion and the type of margins.

Table19: HISTOPATHOLOGICAL FEATURES (N = 40)

PARAMETERS ASSESSED PRESENT ABSENT

NECROSIS 35 (87.5%) 5 (12.5%)

FIBROSIS 34 (85%) 6 (15%)

54
 Observations

CALCIFICATION 22 (56.4%) 17 (43.6%)

INFLAMMATORY 33(82.5%) 7(17.5%)

INFILTRATE(CENTRE)

INFLAMMATORY 38(95%) 2(5%)

INFILTRATE(PERIPHERY)

ADIPOCYTIC INFILTRATION 35 (87.5%) 5 (12.5%)

ANGIO-LMYPHATIC INVASION 16 (40%) 24 (60%)

PERINEURAL INVASION 11 (27.5%) 29 (72.5%)

SKIN INVASION 2 (5%) 38 (95%)

IN SITU COMPONENT 23(57.5%) 17(42.5%)

ELASTOSIS 25(62.5%) 15(37.5%)

Chart Title
40
35
30
25
20
15
10
5
0

PRESENT ABSENT HISTOPATHOLOGICAL FEATURES

55
 Observations

Figure 16: HISTOPATHOLOGICAL FEATURES OF TUMORS

Table 24: FIBROSIS

FIBROSIS NO OF CASES (N=40)

PRESENT 34 (85%)

ABSENT 6 (15%)

FIBROSIS
6; 15%

ABSENT
PRESENT

34; 85%

Figure 20 : FIBROSIS

INFLAMMATORY INFILTRATE

The intensity of pattern of inflammatory infiltrate was graded at centre as well as periphery as
absent (0), mild(1), moderate(2) marked(3) and with germinal centre(4). The intensity of
inflammatory infiltrate was further correlated with necrosis and grade of the tumor.

Table 20: GRADING OF LYMPHOPLASMACYTIC INFILTRATE (N=40)

GRADE OF NO OF CASES (PERIPHERY) NO OF CASES

INFLAMMATORY (CENTRE)
INFILTRATE
0 2(5%) 7(17.5%)

1 15(37.5%) 18 (45%)

56
 Observations

2 14(35%) 11 (27.5%)

3 6(15%) 2(5%)

4 3(7.5%) 2 (5%)

18
18

16 15
14
14

12 11

10
Centre
8 7 Periphery
6
6

4 3
2 2 2
2

0
0 1 2 3 4

Figure 17: GRADING OF LYMPHOPLASMACYTIC INFILTRATE (CENTRE AND PERIPHERY)

Table 21: INFLAMMATORY INFILTRATE AT CENTRE WITH GRADE OF TUMOR

LYMPHOPLASMACYTIC INFILTRATE(N=36)
PRESENT ABSENT
GRADE 1 1 2
GRADE 2 24 3
GRADE 3 5 1

The inflammatory infiltrate at centre was independent of the grade of the tumor. (p value:
0.438)

Table 21: INFLAMMATORY INFILTRATE AT PERIPHERY WITH GRADE OF TUMOR

LYMPHOPLASMACYTIC INFILTRATE(N=36)
PRESENT ABSENT
GRADE 1 3 0
GRADE 2 25 2
GRADE 3 6 0

The inflammatory infiltrate at periphery was independent of the grade of the tumor. (p value:
0.364)

57
 Observations

IDC grade 1 IDC grade 2 IDC grade3

12
1

9
3
0
0 20 0
2 1
1
ab sen t gr ad e 1 gr ad e 2 gr ad e 3 grad e 4

INFLAMMATORY INFILTRATE

Figure 18: INFLAMMATORY INFILTRATE AT CENTRE WITH HISTOLOGICAL GRADE OF TUMOR

Table 22: INFLAMMATORY INFILTRATE (CENTRE) WITH NECROSIS

INFLAMMATORY INFILTRATE (N=40)

ABSENT GRADE 1 GRADE 2 GRADE 3 GRADE 4

NECROSIS - 2 2 1 0 0

NECROSIS + 5 16 10 2 2

Presence of necrosis in the tumor showed no difference in pertinence to the presence of

inflammatory infiltrate. (p value: 0.667)

Figure 19: INFLAMMATION WITH NECROSIS

58
 Observations

20

18

16

14

12

10 16 NECROSIS -
NECROSIS +
8

6 10
5
4

2
2 2 2
0 0
1 1
0
ABSENT GRADE 1 GRADE 2 GRADE 3 GRADE 4

Table 23: INFLAMMATION WITH STAGE OF TUMOR

INFLAMMATORY Stage I/II Stage III/IV

INFILTRATE
0 4 3

GRADE I/II 18 11

GRADE III/IV 3 1

Table 26: LYMPHOPLASMACYTIC INFILTRATE AT PERIPHERY WITH KNOWN

CLINICOPATHOLGICAL PROGNOSTIC PARAMETERS( N= 38)

GRADE 1-2 GRADE 3-4 p VALUE

( CHI
SQUARE
TEST)

MENOPAUSE PRE 10 6 0.243

POST 19 3

TUMOR SIZE ≤ 5 cm 19 6 0.506

> 5 cm 10 3

LYMPH NODE + 15 2 0.293

- 14 7

TUMOR 1&2 19 6 0.085

STAGE

59
 Observations

3&4 12 3

TYPE IDC , NOS 26 7 0.460

METAPLASTIC 2 2
CARCINOMA

INVASIVE 1 0
PAPILLARY
CARCINOMA

GRADE 1 3 0 0.364

2 22 5

3 4 2

ER NEGATIVE 18 6 0.664

POSITIVE 11 3

PR NEGATIVE 19 6 0.587

POSITIVE 10 3

HER 2 NEU NEGATIVE 14 6 0.335

POSITIVE 17 3

Lymphocytic infiltrate at periphery was independent of menopausal status, tumour size,

lymph node metastasis, pathological stage, histological type, grade and hormone receptor
status of the tumor.

Table 18: TYPE OF MARGINS

TYPE OF MARGINS NO OF CASES (N=40)

INFILTRATIVE 24 (60%)

PUSHING 16 (40%)

60
 Observations

TYPE OF MARGINS

16; 40%

INFILTRATING
PUSHING

24; 60%

Figure 19 : TYPE OF MARGINS

Table 26: TYPE OF MARGINS WITH KNOWN CLINICOPATHOLGICAL PROGNOSTIC PARAMETERS

INFILTRATING PUSHING p VALUE

( CHI
SQUARE
TEST)

MENOPAUSE PRE 15 7 0.222

POST 9 9

TUMOR SIZE ≤ 5 cm 14 13 0.210

> 5 cm 10 3

LYMPH NODE + 11 6 0.557

- 13 10

TUMOR 1&2 12 13 0.078

STAGE

3&4 12 3

TYPE IDC , NOS 21 14 0.910

METAPLASTIC 2 2
CARCINOMA

INVASIVE 1 0
PAPILLARY
CARCINOMA

61
 Observations

GRADE 1 3 0 0.527

2 14 13

3 5 1

ER NEGATIVE 14 11 0.375

POSITIVE 10 5

PR NEGATIVE 16 10 0.747

POSITIVE 8 6

HER 2 NEU NEGATIVE 11 8 0.898

POSITIVE 13 8

Type of margins were independent of menopausal status, tumour size, lymph node
metastasis, pathological stage, histological type, grade and hormone receptor status of the
tumor.

ADIPOSE TISSUE INVASION:

The prognostic impact of adipose tissue invasion was studied with age of the patient, tumor
size and lymph node status. Majority of the cases revealed grade 1 adipocytic infiltrate
(32.6%)

Table 25: ADIPOCYTIC INFILTRATION

ADIPOCYTIC INFILTRATE NO. OF CASES

PRESENT 35 (87.5%)

ABSENT 5 (12.5%)

Figure 21: ADIPOCYTIC INFILTRATION

62
 Observations

ADIPOCYTIC INFILTRATION
35
35
30
25 No. of cases
20
15
10 5
5
0
PRESENT
ABSENT

Table 26: ATI WITH AGE, TUMOR SIZE AND LYMPH NODE STATUS OF THE PATIENT

ATI + ATI - p VALUE

( CHI
SQUARE
TEST)

MENOPAUSE PRE 15 2 0.351

POST 18 3

TUMOR SIZE ≤ 5 cm 22 5 0.013

> 5 cm 13 0

LYMPH NODE + 16 1 0.223

- 17 4

TUMOR STAGE 1&2 20 5 0.028

3&4 15 0

TYPE IDC , NOS 31 4 0.687

METAPLASTIC 3 1
CARCINOMA

INVASIVE 1 0
PAPILLARY
CARCINOMA

63
 Observations

GRADE 1 3 0 0.575

2 23 4

3 6 0

ER NEGATIVE 23 2 0.267

POSITIVE 12 3

PR NEGATIVE 22 4 0.452

POSITIVE 13 1

HER 2 NEU NEGATIVE 16 3 0.699

POSITIVE 19 2

FIGURE 22: ATI WITH TUMOR SIZE AND STAGE OF TUMOR

25
22
20
20

15
15 13
PRESENT
ABSENT
10

5 5
5

0 0
0
≤5 CM >5 CM Stage 1&2 Stage 3&4

Adipocytic infiltrate was observed in the larger tumor (p value=0.013) and in the higher
stage (p value=0.028) as compared to the small size and lower stage respectively.

However adipocytic infiltrate was independent of menopausal status, lymph node metastasis,
histological type, grade and hormone receptor status of the tumor.

TUMOUR BUDDING:

Tumour buds have been defined as comprising five tumour cells or less. 3 For tumour
budding,H and E section with broadest margin was selected. Immunohistochemistry with
Pancytokeratin was performed as per avidin biotin technique to highlight the tumour buds.
Areas were screened for highest number of tumour buds. Tumour buds were recorded in 20X

64
 Observations

objective in each case at invasive front in the stroma. Cases were separated into 2 groups
according to tumor budding density as low grade (<10) and high grade (≥10).50

GRADE :

GRADING OF TUMOUR BIDDING

20
18
n
o 16
14
o GRADE
f 12

c 10
a 8
s
e 6
s
4
2
0
absent low grade high grade

Figure 15: GRADING OF TUMOUR BUDDING

Table 26: TUMOUR BUDDING WITH MENOPAUSE, TUMOR SIZE AND LYMPH NODE STATUS OF THE
PATIENT

TUMOUR TUMOUR p VALUE

BUDDING : BUDDING : ( CHI
LOW GRADE HIGH GRADE SQUARE
TEST)

MENOPAUSE PRE 15 7 0.243

POST 9 9

TUMOR SIZE ≤ 5 cm 14 13 0.03

> 5 cm 3 10

LYMPH + 13 10 0.601
NODE

- 11 6

65
 Observations

TUMOR 1&2 13 12 0.046

STAGE

3&4 3 12

TYPE IDC , NOS 21 14 0.659

METAPLASTIC 2 2
CARCINOMA

INVASIVE 1 0
PAPILLARY
CARCINOMA

NECROSIS ABSENT 1 4 0.283

PRESENT 23 15

EMBOLI ABSENT 15 6 0.02

PRESENT 6 13

GRADE 1 3 0 0.233

2 3 0

3 14 13

ER NEGATIVE 14 11 0.505

POSITIVE 10 5

PR NEGATIVE 16 10 0.787

POSITIVE 8 6

HER 2 NEU NEGATIVE 11 8 0.991

POSITIVE 13 8

FIGURE 22: TUMOUR BUDDING WITH TUMOR SIZE AND STAGE OF TUMOR

66
 Observations

16 15
14
14 13 13 13
12 12
12
10
10

8 LOW GRADE
6 6 HIGH GRADE
6

4 3 3

0
≤5 CM >5 CM Stage 1&2 Stage 3&4 EMBOLI- EMBOLI +

Higher grade tumour budding was observed in the larger tumor (p value=0.03), in the higher
stage (p value=0.046) and in the tumour having lymphovascular emboli (p value = 0.03) as
compared to the small size, lower stage and the tumour with no evidence of lymphovascular
emboli respectively.

However Tumour budding was independent of menopausal status, lymph node metastasis,
histological type, grade and hormone receptor status of the tumor.

Table 27: VARIOUS HISTOLOGICAL FEATURES

S.NO CHANGES IN ADJACENT BREAST NO OF CASES (N=43)

.

1 COLUMNAR CELL CHANGE/HYPERPLASIA 15

2 FOREIGN BODY GIANT CELL REACTION 2

3 FLAT EPITHELIAL ATYPIA 5

3 NON TB GRANULOMAS 2

4 INTRATUMOUR FIBROADENOMA 1

6 APOCRINE CHANGE 2

TUMOR MARKERS EXPRESSION WITH CLINICAL AND MORPHOLOGICAL

PARAMETERS

67
 Observations

IMMUNOHISTOCHEMISTRY: For ER and PR expression, a quick scoring from 0 to 2

was done in all the cases11.

Table 28: QUICK SCORING OF ER & PR

ER (N=40) PR (N=40)

0 25 (62.5%) 26(65%)

1 2 (5%) 0 (0%)

2 13 (32.5%) 14 (35%)

However, on using cut off criteria of 10% nuclear positivity, ER expression was obtained in
37.5% (15/40) cases and PR expression was obtained in 35% (14/40) cases. The areas of slide
showing maximum nuclear expression were chosen for scoring and areas of cytoplasmic
staining were disregarded for scoring.

Her2neu expression was also scored from 1 to 3 and a weak to strong complete membranous
staining in more than 10% of the tumor cells (score 2 and 3) was considered positive11

Table 29: ER EXPRESSION WITH CLINICOPATHOLOGICAL PROFILE

ER+ ER- p VALUE

MENOPAUSAL PRE 8 14 0.870 (CHI SQUARE)

STATUS

POST 7 11

TUMOR SIZE ≤5 cm 12 15 0.191 (CHI SQUARE)

>5 cm 3 10

LYMPH NODE NEG 6 17 0.083(CHI SQUARE)

POS 9 8

TUMOR GRADE 1 2 1 0.138(CHI SQUARE)

2 12 15

3 0 6

68
 Observations

PATHOLOGICA I/II 8 17 0.354(CHI SQUARE)

L STAGE III/IV 7 8

ER expression was observed in 36.36% of premenopausal women as compared to 38.88% of

post menopausal patients although no statistical significance could be obtained (p=0.870). No
significant difference was obtained between ER expression with tumor size, grade, nodal
status and stage of the tumor. However it was observed that 46.66% of grade1/2 tumors were
ER positive as compared to grade 3 tumors which were all ER negative.

No statistical significance could be computed between ER expression and margins, necrosis

and ATI.

Table 30: ER EXPRESSION WITH PR AND HER2NEU

ER+ ER- p VALUE

PR+ 10 4 0.01
PR- 5 21
HER2+ 10 11 0.060
HER2- 5 14

A positive correlation was seen between ER and PR expression (p=0.01) and no correlation
was seen between ER and Her2neu expression (p = 0.06) .

Figure 23: POSITIVE CORRELATION OF ER AND PR

25

21
20

15

ER+
10 ER-
10

5 4 5

0
0.8 1 1.2 1.4 1.6 1.8 2 2.2

69
 Observations

ER EXPRESSION IN NORMAL BREAST: ER α is expressed in approximately 15-30%

of luminal epithelial cells62. ER β is expressed in 85% of normal luminal epithelial and
myoepithelial cells, as well as in fibroblasts and other stromal cells within the normal human
breast63

PR EXPRESSION WITH CLINICOPATHOLOGICAL PROFILE:

PR expression was obtained in 35% (14/40) cases using the 10% cut off criterion. No
significant difference was demonstrated with menopausal status, tumor size, nodal status,
grade and stage of tumor.

Table 31: PR EXPRESSION WITH CLINICOPATHOLOGICAL FEATURES

PR+ PR- p VALUE

MENOPAUSAL PRE 6 16 0.257(CHI SQUARE)

STATUS POST 8 10
TUMOR SIZE ≤5 cm 10 17 0.697 (CHI SQUARE)
>5 cm 4 9
LYMPH NODE NEG 6 17 0.169( CHI SQUARE)
POS 8 9
TUMOR GRADE 1 2 1 0.163 (CHI SQUARE)
2 11 16
3 0 6
PATHOLOGICAL I/II 5 20 0.010 (CHI SQUARE)
STAGE III/IV 9 6

Table 32: PR EXPRESSION WITH HER2NEU

PR+ PR- p VALUE

70
 Observations

HER2+ 8 13 0.576 (CHI SQUARE)

HER2- 6 13

No significant association could be demonstrated between PR and HER2NEU expression.

Figure 24: COMPARISON OF ER WITH PR

No.of cases Majority of the cases (57%) were

23%
negative for both ER and PR

followed by ER+PR+(23%).
ER+PR+
ER+PR-
ER-PR+
ER-PR-
57% 11%

9%

PR EXPRESSION IN NORMAL BREAST: PR is expressed in 15-30% of normal luminal

epithelial cells and not elsewhere in the breast75.

HER2/NEU SCORING:

Her2neu scoring11 was done as follows: 1: 55% (22/40); 2: 12.5% (5/40); 3: 32.5% (13/40)
and score 2 and 3 together were considered positive. Using this criterion, Her2 neu
expression was observed in 18 cases (45%).

71
 Observations

HER2/NEU EXPRESSION IN NORMAL BREAST: Her2neu is not expressed at all in the

normal mammary gland49. It was absent in the normal breast ductal epithelial cells.

72