Taucher S, Rudas M, Gnant M, Thomanek K, Dubsky P, Roka S, Bachleitner T, Kandioler D, Wenzel C, Steger G, Mittlböck M, Jakesz R
Department of Surgery, Vienna University Medical School, Waehringer Guertel 18-20, Vienna A-1090, Austria.
Endocr Relat Cancer. 2003 Mar;10(1):91-8. doi: 10.1677/erc.0.0100091.
The objective of this analysis was to determine the accuracy of steroid receptor measurement in large core needle biopsies compared with surgically removed specimens and the influence of preoperative chemotherapy on hormone receptor status. We consecutively performed 722 large core needle biopsies in palpable lesions of the breast. The diagnosis of breast cancer was confirmed upon biopsy in 450 patients; 236 women underwent immediate surgery, and 214 patients received preoperative chemotherapy. We assessed estrogen (ER) and progesterone receptor (PR) in biopsy tissue and surgically removed specimens and calculated accuracy, sensitivity, specificity, the weighted kappa value and Spearman's rank correlation. The modulation of steroid receptor status in preoperatively treated patients was tested by Cochran-Mantel-Haenszel statistics. The accuracy of ER evaluation in the biopsy material of patients without intervening chemotherapy was 91%, sensitivity and specificity were 94% and 80% respectively. Accuracy, sensitivity and specificity were 86% in patients treated preoperatively. In terms of PR assessment, we obtained slightly inferior results: accuracy, sensitivity and specificity were 80%, 73% and 85% respectively in patients without preoperative treatment, and 79%, 48% and 92% respectively in patients undergoing preoperative therapy. Following preoperative chemotherapy, patients showed a significant increase in ER-negative (P=0.02) and PR-negative (P=0.0005) measurements. We have concluded from our results that ER and PR receptor measurement in core needle biopsy is a reliable basis in clinical practice for selecting patients for neoadjuvant endocrine treatment. Preoperative cytotoxic chemotherapy induced a significant extent of variation in the steroid receptor expression of breast cancer cells.
本分析的目的是确定与手术切除标本相比，在粗针大活检中类固醇受体测量的准确性以及术前化疗对激素受体状态的影响。我们连续对722例可触及的乳腺病变进行了粗针大活检。450例患者经活检确诊为乳腺癌；236名女性立即接受了手术，214例患者接受了术前化疗。我们评估了活检组织和手术切除标本中的雌激素（ER）和孕激素受体（PR），并计算了准确性、敏感性、特异性、加权kappa值和Spearman等级相关性。采用Cochran-Mantel-Haenszel统计方法检测术前治疗患者类固醇受体状态的调节情况。未接受介入化疗患者活检材料中ER评估的准确性为91%，敏感性和特异性分别为94%和80%。术前接受治疗的患者准确性、敏感性和特异性分别为86%。在PR评估方面，我们得到的结果略差：未接受术前治疗的患者准确性、敏感性和特异性分别为80%、73%和85%，接受术前治疗的患者分别为79%、48%和92%。术前化疗后，患者ER阴性（P=0.02）和PR阴性（P=0.0005）测量值显著增加。我们从结果中得出结论，粗针活检中ER和PR受体测量是临床实践中选择新辅助内分泌治疗患者的可靠依据。术前细胞毒性化疗导致乳腺癌细胞类固醇受体表达出现显著程度的变化。
