Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer
Abstract Background When ipsilateral multifocal primary breast cancer (IMBC) is detected, standard routine is to evaluate the largest tumor with immunohistochemistry (IHC). As all foci are not routinely characterized, many patients may not receive optimal adjuvant treatment. Here, we assess the clin...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Breast Cancer Research |
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| Online Access: | https://doi.org/10.1186/s13058-023-01632-5 |
| _version_ | 1827970210632564736 |
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| author | Slavica Janeva Ellen Krabbe Toshima Z. Parris Salmir Nasic Marie Sundquist Per Karlsson Riccardo A. Audisio Roger Olofsson Bagge Anikó Kovács |
| author_facet | Slavica Janeva Ellen Krabbe Toshima Z. Parris Salmir Nasic Marie Sundquist Per Karlsson Riccardo A. Audisio Roger Olofsson Bagge Anikó Kovács |
| author_sort | Slavica Janeva |
| collection | DOAJ |
| description | Abstract Background When ipsilateral multifocal primary breast cancer (IMBC) is detected, standard routine is to evaluate the largest tumor with immunohistochemistry (IHC). As all foci are not routinely characterized, many patients may not receive optimal adjuvant treatment. Here, we assess the clinical relevance of examining at least two foci present in patients with IMBC. Methods Patients diagnosed and treated for IMBC at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2012 and 2017 were screened. In total, 180 patients with ≥ 2 invasive foci (183 specimens) were assessed with IHC and included in this study. Expression of the estrogen (ER) and progesterone (PR) receptors, Ki67, HER2, and tumor grade were used to determine the molecular surrogate subtypes and discordance among the foci was recorded. An additional multidisciplinary team board was then held to re-assess whether treatment recommendations changed due to discordances in molecular surrogate subtype between the different foci. Results Discordance in ER, PR, HER2, and Ki67 was found in 2.7%, 19.1%, 7.7%, and 16.9% of invasive foci, respectively. Discordance in the molecular surrogate subtypes was found in 48 of 180 (26.7%) patients, which resulted in therapy changes for 11 patients (6.1%). These patients received additional endocrine therapy (n = 2), chemotherapy (n = 3), and combined chemotherapy and trastuzumab (n = 6). Conclusion Taken together, when assessing at least two tumor foci with IHC, regardless of shared morphology or tumor grade between the different foci, 6.1% of patients with IMBC were recommended additional adjuvant treatment. A pathologic assessment using IHC of all foci is therefore recommended to assist in individualized treatment decision making. |
| first_indexed | 2024-04-09T18:50:24Z |
| format | Article |
| id | doaj.art-41153ac5c52c4a31bf5f1cb43f65d9f0 |
| institution | Directory Open Access Journal |
| issn | 1465-542X |
| language | English |
| last_indexed | 2024-04-09T18:50:24Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Breast Cancer Research |
| spelling | doaj.art-41153ac5c52c4a31bf5f1cb43f65d9f02023-04-09T11:30:19ZengBMCBreast Cancer Research1465-542X2023-04-0125111110.1186/s13058-023-01632-5Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancerSlavica Janeva0Ellen Krabbe1Toshima Z. Parris2Salmir Nasic3Marie Sundquist4Per Karlsson5Riccardo A. Audisio6Roger Olofsson Bagge7Anikó Kovács8Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra GötalandDepartment of Surgery, Kungälv Hospital, Region Västra GötalandDepartment of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgResearch and Development Centre, Skaraborg HospitalDepartment of Surgery, Kalmar County HospitalDepartment of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgDepartment of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra GötalandDepartment of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra GötalandDepartment of Clinical Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of GothenburgAbstract Background When ipsilateral multifocal primary breast cancer (IMBC) is detected, standard routine is to evaluate the largest tumor with immunohistochemistry (IHC). As all foci are not routinely characterized, many patients may not receive optimal adjuvant treatment. Here, we assess the clinical relevance of examining at least two foci present in patients with IMBC. Methods Patients diagnosed and treated for IMBC at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2012 and 2017 were screened. In total, 180 patients with ≥ 2 invasive foci (183 specimens) were assessed with IHC and included in this study. Expression of the estrogen (ER) and progesterone (PR) receptors, Ki67, HER2, and tumor grade were used to determine the molecular surrogate subtypes and discordance among the foci was recorded. An additional multidisciplinary team board was then held to re-assess whether treatment recommendations changed due to discordances in molecular surrogate subtype between the different foci. Results Discordance in ER, PR, HER2, and Ki67 was found in 2.7%, 19.1%, 7.7%, and 16.9% of invasive foci, respectively. Discordance in the molecular surrogate subtypes was found in 48 of 180 (26.7%) patients, which resulted in therapy changes for 11 patients (6.1%). These patients received additional endocrine therapy (n = 2), chemotherapy (n = 3), and combined chemotherapy and trastuzumab (n = 6). Conclusion Taken together, when assessing at least two tumor foci with IHC, regardless of shared morphology or tumor grade between the different foci, 6.1% of patients with IMBC were recommended additional adjuvant treatment. A pathologic assessment using IHC of all foci is therefore recommended to assist in individualized treatment decision making.https://doi.org/10.1186/s13058-023-01632-5Multifocal breast cancerMulticentric breast cancerBiomarkersBreast cancer subtypesAdjuvant treatmentSynchronous |
| spellingShingle | Slavica Janeva Ellen Krabbe Toshima Z. Parris Salmir Nasic Marie Sundquist Per Karlsson Riccardo A. Audisio Roger Olofsson Bagge Anikó Kovács Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer Breast Cancer Research Multifocal breast cancer Multicentric breast cancer Biomarkers Breast cancer subtypes Adjuvant treatment Synchronous |
| title | Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer |
| title_full | Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer |
| title_fullStr | Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer |
| title_full_unstemmed | Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer |
| title_short | Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer |
| title_sort | clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer |
| topic | Multifocal breast cancer Multicentric breast cancer Biomarkers Breast cancer subtypes Adjuvant treatment Synchronous |
| url | https://doi.org/10.1186/s13058-023-01632-5 |
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