Research Papers:
Clinical significance of evaluating hormone receptor and HER2 protein using cell block against metastatic breast cancer: a multi-institutional study
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Abstract
Akira Matsui1, Yuya Murata2, Norikazu Masuda3, Kiyoshi Mori4, Masato Takahashi5, Katsushige Yamashiro6, Kenjirou Aogi7, Shigeto Maeda8, Masahiro Itou9, Shinji Ozaki10, Kazuya Kuraoka11, Yasuyuki Satou12, Shu Ichihara13, Eriko Tokunaga14, Kenichi Taguchi15, Takanori Watanabe16, Hiroyoshi Suzuki17, Aiko Nagayama1 and Rieko Nishimura13,18
1 Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo 152-8902, Japan
2 Department of Clinical Laboratory, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo 152-8902, Japan
3 Department of Breast Surgery, National Hospital Organization Osaka National Hospital, Chuou-ku, Osaka-shi, Osaka 540-0006, Japan
4 Department of Clinical Laboratory, National Hospital Organization Osaka National Hospital, Chuou-ku, Osaka-shi, Osaka 540-0006, Japan
5 Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Shiraisi-ku, Sapporo-shi, Hokkaido 003-0804, Japan
6 Department of Pathology, National Hospital Organization Hokkaido Cancer Center, Shiraisi-ku, Sapporo-shi, Hokkaido 003-0804, Japan
7 Department of Breast Surgery, National Hospital Organization Shikoku Cancer Center, Minamiumemoto, Matsuyama-shi, Ehime 791-0280, Japan
8 Department of Surgery, National Hospital Organization Nagasaki Medical Center, Oomura-shi, Nagasaki 856-8562, Japan
9 Department of Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Oomura-shi, Nagasaki 856-8562, Japan
10 Department of Breast Surgery, National Hospital Organization Kure Medical Center, Kure-shi, Hiroshima 737-0023, Japan
11 Department of Pathology, National Hospital Organization Kure Medical Center, Kure-shi, Hiroshima 737-0023, Japan
12 Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, Naka-ku, Nagoya-shi, Aichi 460-0001, Japan
13 Department of Pathology, National Hospital Organization Nagoya Medical Center, Naka-ku, Nagoya-shi, Aichi 460-0001, Japan
14 Department of Breast Surgery, National Hospital Organization Kyushu Cancer Center, Minami-ku, Fukuoka-shi, Fukuoka 811-1395, Japan
15 Department of Pathology, National Hospital Organization Kyushu Cancer Center, Minami-ku, Fukuoka-shi, Fukuoka 811-1395, Japan
16 Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Miyagino-ku, Sendai-shi, Miyagi 983-8520, Japan
17 Department of Pathology, National Hospital Organization Sendai Medical Center, Miyagino-ku, Sendai-shi, Miyagi 983-8520, Japan
18 Department of Clinical Laboratory, National Hospital Organization Shikoku Cancer Center, Minamiumemoto, Matsuyama, Ehime 791-0280, Japan
Correspondence to:
| Akira Matsui, | email: | [email protected] |
Keywords: metastatic breast cancer; receptor discordance; cell block; cytological specimen; prognosis
Received: May 01, 2019 Accepted: July 29, 2019 Published: October 01, 2019
ABSTRACT
Hormone receptor and human epidermal growth factor receptor 2 (HER2) protein tests in metastatic breast cancer tissue are recommended in the guidelines of the American Society of Clinical Oncology/American Pathology Association. As part of a multi-institutional study by the National Hospital Organization, we conducted an investigation to examine these molecular markers, using cytological specimens as a substitute for tissue specimens from breast cancer metastasis. To confirm the usefulness of receptors tested in metastatic lesions, the treatment course of registered metastatic breast cancer patients was analyzed. During the April 2015 to March 2016 registration period, there were 62 registrations. Types of metastatic lesions include pleural fluid (44 samples), ascites (14 samples), lymph nodes (2 samples), pericardial fluid (1 sample), and dorsal subcutaneous mass (1 sample). A stable test result was obtained by adopting the receptor examination method, using cell block for immunostaining cytological specimens. The discordance rates of estrogen receptor (ER), progesterone receptor (PR), and HER2 protein expression were 18.2% (95% confidence interval (CI): 7.9–28.8%), 36.4% (95% CI: 23.7–49.1%), and 8.2% (95% CI: 0.1–16.3%), respectively, between the primary tumor and metastatic lesion. Patients who changed from primary negative to metastatic positive ER status had taken a significantly longer time for metastatic foci to appear. Patients with positive ER status in metastatic lesions had significantly better prognosis than ER-negative cases (P = 0.030) by the Log-Rank test. The ER status of the metastatic lesion and the metastatic site were independent prognostic factors by Cox multivariate analysis. Receptor examination with cytological specimens in metastatic lesions has been useful as it provides guidance for the treatment of metastatic breast cancer.
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