East Ellen G, Pang Judy C, Kidwell Kelley M, Jorns Julie M
From the Department of Pathology and.
Biostatistics, University of Michigan, Ann Arbor.
Am J Clin Pathol. 2015 Dec;144(6):952-9. doi: 10.1309/AJCPFWXP54OLILMU.
To determine the frequency of estrogen receptor (ER), progesterone receptor (PR), and HER-2/neu (HER2) testing multiple foci of ipsilateral invasive breast carcinoma at our institution and to evaluate resulting change in treatment recommendation.
We identified 165 consecutive cases of multifocal invasive breast cancer over a 10-year period (2005-2014). Clinicopathologic features and treatment recommendation were assessed by slide and chart review.
Seventy (42.4%) of 165 patients had two or more foci tested. In the first 6 years (2005-2010), frequency of testing two or more foci was 31.6% and increased to 70.6% in 2014. Seven (10%) of 70 had a clinically significant difference in ER/PR and/or HER2 status, five (7.1%) with a difference in HER2, one (1.4%) in ER/PR, and one (1.4%) in both ER/PR and HER2. All cases with difference in status had different histology and/or the largest focus was the most positive one.
Our findings support current recommendations to evaluate additional smaller tumor foci in multifocal invasive breast cancer if the focus is of different grade or histology. Additional features, including specific histology, grade, and ER, PR, and HER2 status of the largest focus, should also be considered when selecting cases for which testing of additional foci may be of benefit.
确定在我们机构对同侧浸润性乳腺癌多个病灶进行雌激素受体（ER）、孕激素受体（PR）和HER-2/neu（HER2）检测的频率，并评估由此导致的治疗建议变化。
我们确定了10年期间（2005 - 2014年）连续的165例多灶性浸润性乳腺癌病例。通过玻片和病历审查评估临床病理特征和治疗建议。
165例患者中有70例（42.4%）对两个或更多病灶进行了检测。在最初6年（2005 - 2010年），检测两个或更多病灶的频率为31.6%，到2014年增至70.6%。70例中有7例（10%）在ER/PR和/或HER2状态上存在临床显著差异，其中5例（7.1%）在HER2方面有差异，1例（1.4%）在ER/PR方面有差异，1例（1.4%）在ER/PR和HER2方面均有差异。所有状态有差异的病例组织学不同和/或最大病灶为阳性程度最高的病灶。
我们的研究结果支持当前的建议，即如果多灶性浸润性乳腺癌病灶的分级或组织学不同，应对其他较小的肿瘤病灶进行评估。在选择可能受益于检测其他病灶的病例时，还应考虑其他特征，包括最大病灶的特定组织学、分级以及ER、PR和HER2状态。
