乳腺浸润性癌的组织学分级：免疫组化增殖评估的作用。

Histological grading of breast cancer on needle core biopsy: the role of immunohistochemical assessment of proliferation.

机构信息

Department of Pathology and School Molecular Medical Sciences, Nottingham University Hospital, Hucknall Road, Nottingham, UK.

出版信息

Histopathology. 2010 Aug;57(2):212-9. doi: 10.1111/j.1365-2559.2010.03620.x.

AIMS

Histological grade assessed on needle core biopsy (NCB) moderately concurs with the grade in the surgical excision specimen (SES) (kappa-values between 0.35 and 0.65). A major cause of the discrepancy is underestimation of mitoses in the NCB specimen. The aim was to determine the best method of assessing proliferation on NCB.

METHODS AND RESULTS

Proliferative activity of 101 invasive carcinomas of the breast on NCB and SES was assessed using mitotic counts on routine haematoxylin and eosin (H&E) sections and immunohistochemical markers Mib-1 and phosphorylated histone H3 (PPH3). H&E mitotic count in SES was considered as the gold standard. H&E mitotic count was found to be underestimated on NCB when compared with that in SES (P < 0.001), but no significant difference was detected between NCB and SES regarding Mib-1 (P = 0.13) or PPH3 (P = 0.073). Using receiver-operating characteristic curve, Mib-1 on NCB was found to agree with the gold standard significantly better than routine H&E on NCB.

CONCLUSIONS

Immunohistochemical markers in NCB showed better concordance with H&E mitotic count in SES (gold standard) than routine H&E mitotic count in NCB. Further refinement of cut-offs and scoring methods is needed.

目的

通过对针芯活检（NCB）标本进行组织学分级评估，与手术切除标本（SES）的分级结果中度一致（kappa 值在 0.35 到 0.65 之间）。不一致的主要原因是在 NCB 标本中低估了有丝分裂。本研究旨在确定评估 NCB 中增殖的最佳方法。

方法和结果

采用常规苏木精和伊红（H&E）切片中的有丝分裂计数和免疫组化标志物 Mib-1 和磷酸化组蛋白 H3（PPH3），对 101 例乳腺浸润性癌的 NCB 和 SES 中的增殖活性进行评估。SES 中的 H&E 有丝分裂计数被认为是金标准。与 SES 相比，NCB 上的 H&E 有丝分裂计数被发现低估（P < 0.001），但 NCB 与 SES 之间的 Mib-1（P = 0.13）或 PPH3（P = 0.073）之间没有差异。使用受试者工作特征曲线，NCB 上的 Mib-1 与金标准的一致性明显优于 NCB 上的常规 H&E 有丝分裂计数。