Investigation of the differences of breast cancer molecular subtypes in radiological and histopathological parameters and their effects on lymphovascular invasion
Abstract
Introduction: Breast cancer has heterogeneous tumor biology. Therefore, breast cancer is divided into molecular subtypes. However, molecular subtypes also show heterogeneity within themselves. In our study, we compared whether there were radiological and pathological differences between breast cancer molecular subtypes.
Methods: The data of 569 patients operated on for breast cancer in our General Surgery clinic during an 8-year period were analyzed retrospectively. After dividing the patients into groups consisting of molecular subtypes, their radiological and pathological findings were compared.
Results: According to the molecular classification of breast cancer, 47.6% of the patients were in the luminal A group, 23.9% in luminal B, 7.7% in HER2-enriched, and 12% in TN, and 8.8% in normal-like groups. DCIS and LCIS were significantly less common in the TN group than in the others (p=0.015). Tumor diameter and grade were considerably higher in the normal-like, HER2-enriched, and TN groups than in the other groups (p<0.001, p<0.001). LVI was significantly lower in luminal A and significantly higher in luminal B (p<0.001). Mortality was significantly higher in the luminal B and TN groups than in the other groups (p = 0.029).
Conclusion: The addition of the basal-like group when classifying breast cancer into molecular subtypes showed histopathological differences. More studies are needed to investigate its effects on treatment and prognosis.
Keywords: Breast cancer, Molecular subtype, Genotype, Immunohistochemistry, Survival
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References
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2. DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017;67(6):439-448.
3. American Cancer Society. (2020). Atlanta, GA: American Cancer Society, Inc. Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf.
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5. Mayoclinic. (2020). Rochester. Patient Care & Health Information. Retrieved from https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470.
6. Thorat MA, Balasubramanian R. Breast cancer prevention in high-risk women. Best Pract Res Clin Obstet Gynaecol. 2020;65:18-31.
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8. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer. 2007;109(9):1721-8.
9. Öztürk VS, Polat YD, Soyder A, Tanyeri A, Karaman CZ, Taşkın F. The Relationship Between MRI Findings and Molecular Subtypes in Women With Breast Cancer. Curr Probl Diagn Radiol. 2020;49(6):417-21.
10. Morkavuk ŞB, Güner M, Çulcu S, Eroğlu A, Bayar S, Ünal AE. Relationship between lymphovascular invasion and molecular subtypes in invasive breast cancer. Int J Clin Pract. 2020;6:e13897.
11. Pourteimoor V, Mohammadi-Yeganeh S, Paryan M. Breast cancer classification and prognostication through diverse systems along with recent emerging findings in this respect; the dawn of new perspectives in the clinical applications. Tumour Biol. 2016;37(11):14479-99.
12. Tsang JYS, Tse GM. Molecular Classification of Breast Cancer. Adv Anat Pathol. 2020;27(1):27-35.
13. Al-Thoubaity FK. Molecular classification of breast cancer: A retrospective cohort study. Ann Med Surg (Lond). 2019;49:44-48.
14. Wiechmann L, Sampson M, Stempel M, Jacks LM, Patil SM, King T, et al. Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 2009;16(10):2705-10.
15. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784-95.
16. Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS, et al. Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol. 2018;36(20):2105-22.
17. Breastcancer.org. Molecular Subtypes of Breast Cancer. (2020). Philadelphia .Retrieved from https://www.breastcancer.org/symptoms/types/molecular-subtypes.
18. Hu Z, Fan C, Oh DS, Marron JS, He X, Qaqish BF, et al. The molecular portraits of breast tumors are conserved across microarray platforms. BMC Genomics. 2006;7:96.
19. Dai X, Li T, Bai Z, Yang Y, Liu X, Zhan J, Shi B. Breast cancer intrinsic subtype classification, clinical use and future trends. Am J Cancer Res. 2015;5(10):2929-43.
20. Vuong D, Simpson PT, Green B, Cummings MC, Lakhani SR. Molecular classification of breast cancer. Virchows Arch. 2014;465(1):1-14.
21. Parker JS, Mullins M, Cheang MC, Leung S, Voduc D, Vickery T, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol. 2009;27(8):1160-7.
22. Jenkins EO, Deal AM, Anders CK, Prat A, Perou CM, Carey LA, et al. Age-specific changes in intrinsic breast cancer subtypes: a focus on older women. Oncologist. 2014;19(10):1076-83.
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25. Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LA, et al. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. 2014;106(5):dju055.
26. Yersal O, Barutca S. Biological subtypes of breast cancer: Prognostic and therapeutic implications. World J Clin Oncol. 2014;5(3):412-24.
27. Sihto H, Lundin J, Lehtimäki T, Sarlomo-Rikala M, Bützow R, Holli K, et al. Molecular subtypes of breast cancers detected in mammography screening and outside of screening. Clin Cancer Res. 2008;14(13):4103-10.
28. Li J, Chen Z, Su K, Zeng J. Clinicopathological classification and traditional prognostic indicators of breast cancer. Int J Clin Exp Pathol. 2015;8(7):8500-5.
29. Salhia B, Tapia C, Ishak EA, Gaber S, Berghuis B, Hussain KH, et al. Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology. BMC Womens Health. 2011;11:44.
30. Zhou W, Jirström K, Amini RM, Fjällskog ML, Sollie T, Lindman H, et al. Molecular subtypes in ductal carcinoma in situ of the breast and their relation to prognosis: a population-based cohort study. BMC Cancer. 2013;13:512.
31. Rezai M, Kraemer S, Kimmig R, Kern P. Breast conservative surgery and local recurrence. Breast. 2015;24 Suppl 2:S100-7.
32. Desai AA, Hoskin TL, Day CN, Habermann EB, Boughey JC. Effect of Primary Breast Tumor Location on Axillary Nodal Positivity. Ann Surg Oncol. 2018;25(10):3011-18.
33. Lale A, Yur M, Özgül H, Alkurt EG, Yıldırım N, Aygen E, et al. Predictors of non-sentinel lymph node metastasis in clinical early stage (cT1-2N0) breast cancer patients with 1-2 metastatic sentinel lymph nodes. Asian J Surg. 2020 Apr;43(4):538-49.
34. Al-Thoubaity FK. Molecular classification of breast cancer: A retrospective cohort study. Ann Med Surg (Lond). 2019;49:44-48.
35. Alnegheimish NA, Alshatwi RA, Alhefdhi RM, Arafah MM, AlRikabi AC, Husain S. Molecular subtypes of breast carcinoma in Saudi Arabia. A retrospective study. Saudi Med J. 2016;37(5):506-12.
36. Chas M, Boivin L, Arbion F, Jourdan ML, Body G, Ouldamer L. Clinicopathologic predictors of lymph node metastasis in breast cancer patients according to molecular subtype. J Gynecol Obstet Hum Reprod. 2018;47(1):9-15.
37. Zhou W, He Z, Xue J, Wang M, Zha X, Ling L, et al. Molecular subtype classification is a determinant of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes. PLoS One. 2012;7(4):e35881.
38. Kulkarni A, Stroup AM, Paddock LE, Hill SM, Plascak JJ, Llanos AAM. Breast Cancer Incidence and Mortality by Molecular Subtype: Statewide Age and Racial/Ethnic Disparities in New Jersey. Cancer Health Disparities. 2019;3:e1-e17.
Authors
Yazıcıoğlu, M. Ömer, Kocaöz, S. ., Çomçalı, B. ., Savaş, F., Özdemir, B. A., Taşbaşı, A. M., Menekşe, E., Ceylan, C., & Korukluoğlu, B. (2022). Investigation of the differences of breast cancer molecular subtypes in radiological and histopathological parameters and their effects on lymphovascular invasion . Journal of Current Medical Research and Opinion, 5(08), 1342−1352. https://doi.org/10.52845/CMRO/2022/5-8-10
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