Prognostic factors in breast-cancer (review).

The challenge in breast cancer (BC) is to confide the heterogenous nature of BC and to find out the best individual therapeutic alternatives for clinical use. Recently a wide scale of sophisticated methods like morphometry, DNA flow cytometry and oncogene products have been introduced to predict the outcome of BC, but many of them are currently unsuitable for clinical use. At present limited experience in clinical practice, technical difficulties, sources of variation, and low cost-benefit ratio limit their use. Axillary lymph node status, tumour diameter and histological grade are classic and relevant predictors, although they suffer from subjectivity of assessments. Together with hormone receptor status they build the ground for clinical decision making. New demands make us to reconsider the general philosophy of the treatment of BC and there are two special groups of BCs in which we have an urgent need to find out new accurate prognostic factors. About 25% of axillary lymph node negative (ANN) tumours behave aggressively but on the other hand a group of axillary lymph node positive patients run a more favorable course than might be expected. In these situations under- or overtreatment could be avoided by accurate prediction. Recent results suggest that morphometric prognostic index, S-phase fraction and mitotic indices might be used in the prediction of BC in these situations since the prognostic results by these methods have been more accurate than by conventional prognostic methods.