Identifying breast cancer patients who require a double-check of preoperative core needle biopsy and postoperative surgical specimens to determine the molecular subtype of their tumor
Identifying breast cancer patients who require a double-check of preoperative core needle biopsy and postoperative surgical specimens to determine the molecular subtype of their tumor
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DOI：
10.4174/astr.2019.97.5.223
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发表时间：
2019-11-01
影响因子：
1.4
通讯作者：
Paik, Hyun-June
中科院分区：
文献类型：
--
作者：
Park, Je Hyung;Kim, Hyun Yul;Paik, Hyun-June
目的：空芯针穿刺活检（CNB）是一种广泛应用于乳腺癌诊断和免疫组化结果分析的方法。几项研究显示CNB和手术标本（SS）之间的IHC结果一致或不一致。双重检查（CNB和SS）对所有患者进行双重检查效率低且成本高。方法：收集2009年4月至2018年6月期间在釜山国立大学阳三医院接受乳腺癌手术的患者的病历（n = 620）。根据激素受体（HR）和人表皮生长因子受体-2（HER 2）将分子亚型分类如下：HR+/HER 2+、HR+/HER 2-、HR-/HER 2+、HR-/HER 2-。对包括年龄、肥胖、组织学分级、术前CEA、CA 15 -3、T分期、N分期和绝经状态在内的临床病理因素进行评估，以确定它们是否与亚型变化相关。（P < 0.001;比值比[OR]，3.693; 95%置信区间[CI]，1.941-7.025），术前CEA >= 5 ng/mL（P = 0.042; OR，2.399; 95% CI，1.009-5.707）和较高的T分期（P = 0.015; OR，2.241; 95% CI，1.152-4.357）与亚型变化显著相关。在多变量分析中，亚型变化在高级别乳腺癌中更常见（P < 0.001; OR为1.077; 95%CI为1.031-1.113）且CEA ≥ 5（P = 0.032; OR为2.658; 95%CI为1.088-6.490）。中高度恶性肿瘤或CEA >= 5 ng/mL的患者需要进行复查，以确定乳腺癌的分子亚型。
Purpose: Core needle biopsy (CNB) is a widely used procedure for breast cancer diagnosis and analyzing results of immunohistochemistry (IHC). Several studies have shown concordance or discordance in IHC results between CNB and surgical specimens (SS). A double-check (CNB and SS) is inefficient and costly to perform a double-check on all patients. Therefore, it is important to determine which patients would benefit from a double-check.Methods: We collected the medical records of patients who underwent breast cancer surgery at Pusan National University Yangsan Hospital between April 2009 and June 2018 (n = 620). Molecular subtypes were classified as follows by hormone receptors (HR) and human epidermal growth factor receptor-2 (HER2): HR+/HER2+, HR+/HER2-, HR-/HER2+, HR-/HER2-. Clinicopathological factors including age, obesity, histological grade, preoperative CEA, CA15-3, T stage, N stage, and menopausal status were assessed to determine whether they were associated with subtype change.Results: Increasing histological grade (P < 0.001; odds ratio [OR], 3.693; 95% confidence interval [CI], 1.941-7.025), preoperative CEA >= 5 ng/mL (P = 0.042; OR, 2.399; 95% CI, 1.009-5.707) and higher T stage (P = 0.015; OR, 2.241; 95% CI, 1.152-4.357) were significantly associated with subtype change. On multivariable analyses, subtype changes were more common in high-grade breast cancer (P < 0.001; OR, 1.077; 95% CI, 1.031-1.113) and CEA >= 5 (P = 0.032; OR, 2.658; 95% CI, 1.088-6.490).Conclusion: Patients with moderate-to high-grade tumors or CEA >= 5 ng/mL are required a double-check to determine the molecular subtype of breast cancer.