A new histological therapeutic classification system to predict eradicated and residual lymph nodes in breast cancer after neoadjuvant chemotherapy

Morohashi,Satoko; Yoshizawa,Tadashi; Seino,Hiroko; Hirai,Hideaki; Haga,Toshihiro; Ota,Rie; Wu,Yunyan; Yoshida,Eri; Hakamada,Kenichi; Kijima,Hiroshi

doi:10.3892/or.2016.4635

A new histological therapeutic classification system to predict eradicated and residual lymph nodes in breast cancer after neoadjuvant chemotherapy

Authors:
- Satoko Morohashi
- Tadashi Yoshizawa
- Hiroko Seino
- Hideaki Hirai
- Toshihiro Haga
- Rie Ota
- Yunyan Wu
- Eri Yoshida
- Kenichi Hakamada
- Hiroshi Kijima
View Affiliations

Affiliations: Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan, Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan, Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
Published online on: February 25, 2016 https://doi.org/10.3892/or.2016.4635
Pages: 2592-2598
Copyright: © Morohashi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The indication for neoadjuvant chemotherapy (NAC) has recently broadened to include its use in the treatment of initial stage breast cancer. Axillary lymph node metastasis after NAC in breast cancer is a poor prognostic factor. Thus, the prediction of lymph node metastasis is important to estimate the prognosis of breast cancer patients after NAC. Therefore, we focused on residual carcinoma patterns of primary breast tumors after NAC and examined the correlation between the patterns and lymph node metastasis. In this study, we examined 50 breast cancer specimens and associated dissected lymph nodes after NAC. We divided 40 cases into an eradicated lymph node group and a residual lymph node group to analyze residual carcinoma patterns of primary breast tumors. Residual carcinoma patterns were classified according to the cell density of carcinoma cells: dense, focal/nested and sporadic/in-situ. There were significant differences in residual carcinoma patterns (P<0.01) among the three pattern groups. There was a high incidence of dense patterns in the residual lymph node group and a high incidence of sporadic/in-situ patterns in the eradicated lymph node group. Analysis of residual carcinoma patterns of primary breast tumors and clinicopathological factors demonstrated that there were significant differences in tumor reduced ratio on CT (P<0.001), primary tumor area before NAC (P<0.01), primary tumor area after NAC (P<0.00001), intrinsic subtype (P<0.01), Ki-67 labeling index (P<0.01), histological grade (P<0.05) and mitotic count (P<0.01) between the dense and non-dense groups. Therefore, our results suggest that the residual carcinoma pattern is useful for predicting eradicated or residual lymph nodes and the malignant potential in breast cancer after NAC.

View Figures

View References

1	Fisher ER, Wang J, Bryant J, Fisher B, Mamounas E and Wolmark N: Pathobiology of preoperative chemotherapy: Findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer. 95:681–695. 2002. View Article : Google Scholar : PubMed/NCBI
2	Kuerer HM, Sahin AA, Hunt KK, Newman LA, Breslin TM, Ames FC, Ross MI, Buzdar AU, Hortobagyi GN and Singletary SE: Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 230:72–78. 1999. View Article : Google Scholar : PubMed/NCBI
3	Klauber-DeMore N, Ollila DW, Moore DT, Livasy C, Calvo BF, Kim HJ, Dees EC, Sartor CI, Sawyer LR, Graham M II, et al: Size of residual lymph node metastasis after neoadjuvant chemotherapy in locally advanced breast cancer patients is prognostic. Ann Surg Oncol. 13:685–691. 2006. View Article : Google Scholar : PubMed/NCBI
4	Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, Theriault RL, Singh G, Binkley SM, Sneige N, et al: Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 17:460–469. 1999.PubMed/NCBI
5	Mamounas EP, Anderson SJ, Dignam JJ, Bear HD, Julian TB, Geyer CE Jr, Taghian A, Wickerham DL and Wolmark N: Predictors of locoregional recurrence after neoadjuvant chemotherapy: Results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 30:3960–3966. 2012. View Article : Google Scholar : PubMed/NCBI
6	Huang EH, Strom EA, Perkins GH, Oh JL, Chen AM, Meric-Bernstam F, Hunt KK, Sahin AA, Hortobagyi GN and Buchholz TA: Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score. Int J Radiat Oncol Biol Phys. 66:352–357. 2006. View Article : Google Scholar : PubMed/NCBI
7	Swain SM, Sorace RA, Bagley CS, Danforth DN Jr, Bader J, Wesley MN, Steinberg SM and Lippman ME: Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. Cancer Res. 47:3889–3894. 1987.PubMed/NCBI
8	Mauri D, Pavlidis N and Ioannidis JP: Neoadjuvant versus adjuvant systemic treatment in breast cancer: A meta-analysis. J Natl Cancer Inst. 97:188–194. 2005. View Article : Google Scholar : PubMed/NCBI
9	Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, et al: Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 15:2483–2493. 1997.PubMed/NCBI
10	Julian TB, Patel N, Dusi D, Olson P, Nathan G, Jasnosz K, Isaacs G and Wolmark N: Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg. 182:407–410. 2001. View Article : Google Scholar : PubMed/NCBI
11	van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C and Duchateau L: Preoperative chemotherapy in primary operable breast cancer: Results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 19:4224–4237. 2001.PubMed/NCBI
12	Mieog JS, van der Hage JA and van de Velde CJ: Neoadjuvant chemotherapy for operable breast cancer. Br J Surg. 94:1189–1200. 2007. View Article : Google Scholar : PubMed/NCBI
13	Bloom HJ and Richardson WW: Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer. 11:359–377. 1957. View Article : Google Scholar : PubMed/NCBI
14	Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, Senn HJ, Albain KS, Andre F, Bergh J, et al: Panel members: Personalizing the treatment of women with early breast cancer: Highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 24:2206–2223. 2013. View Article : Google Scholar : PubMed/NCBI
15	Abramoff MD, Magalhães PJ and Ram SJ: Image processing with ImageJ. Biophotonics Int. 11:36–42. 2004.
16	Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, Schofield A and Heys SD: A new histological grading system to assess response of breast cancers to primary chemotherapy: Prognostic significance and survival. Breast. 12:320–327. 2003. View Article : Google Scholar : PubMed/NCBI
17	Rajan R, Poniecka A, Smith TL, Yang Y, Frye D, Pusztai L, Fiterman DJ, Gal-Gombos E, Whitman G, Rouzier R, et al: Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer. 100:1365–1373. 2004. View Article : Google Scholar : PubMed/NCBI