Foley Niamh M, Coll J M, Lowery A J, Hynes S O, Kerin M J, Sheehan M, Brodie C, Sweeney K J
Department of Surgery, University College Hospital Galway, Galway, Ireland.
Pathol Oncol Res. 2018 Oct;24(4):881-884. doi: 10.1007/s12253-017-0304-5. Epub 2017 Sep 11.
Expression of the ER and PR receptors is routinely quantified in breast cancer as a predictive marker of response to hormonal therapy. Accurate determination of ER and PR status is critical to the optimal selection of patients for targeted therapy. The existence of an ER-/PR+ subtype is controversial, with debate centred on whether this represents a true phenotype or a technical artefact on immunohistochemistry (IHC). The aim of this study was to investigate the true incidence and clinico-pathological features of ER-/PR+ breast cancers in a tertiary referral symptomatic breast unit. Clinico-pathological data were collected on invasive breast cancers diagnosed between 1995 and 2005. IHC for ER and PR receptors was repeated on all cases which were ER-/PR+, with the same paraffin block used for the initial diagnostic testing. Concordance between the diagnostic and repeat IHC was determined using validated testing. Complete data, including ER and PR status were available for 697 patients diagnosed during the study period. On diagnostic IHC, the immunophenotype of the breast tumours was: ER+/PR+ in 396 (57%), ER-/PR- in 157 (23%), ER+/PR- in 88 (12%) and ER-/PR+ in 56 (8.6%) patients. On repeat IHC of 48/56 ER-/PR+ tumours 45.8% were ER+/PR+, 6% were ER+/PR- and 43.7% were ER-/PR- None of the cases were confirmed to be ER-/PR+. The ER-/PR+ phenotypic breast cancer is likely to be the result of technical artefact. Prompt reassessment of patients originally assigned to this subtype who re-present with symptoms should be considered to ensure appropriate clinical management.
雌激素受体（ER）和孕激素受体（PR）的表达情况通常在乳腺癌中进行定量分析，作为激素治疗反应的预测指标。准确确定ER和PR状态对于靶向治疗患者的最佳选择至关重要。ER-/PR+亚型的存在存在争议，争论的焦点在于这是一种真正的表型还是免疫组织化学（IHC）中的技术假象。本研究的目的是在一家三级转诊有症状乳腺科中调查ER-/PR+乳腺癌的真实发病率和临床病理特征。收集了1995年至2005年间诊断的浸润性乳腺癌的临床病理数据。对所有ER-/PR+病例，使用与初始诊断检测相同的石蜡块，重复进行ER和PR受体的免疫组织化学检测。使用经过验证的检测方法确定诊断性免疫组织化学和重复性免疫组织化学之间的一致性。在研究期间诊断的697例患者中，包括ER和PR状态在内的完整数据可用。在诊断性免疫组织化学检测中，乳腺肿瘤的免疫表型为：ER+/PR+396例（57%），ER-/PR-157例（23%），ER+/PR-88例（12%），ER-/PR+56例（8.6%）。在对48/56例ER-/PR+肿瘤进行重复性免疫组织化学检测时，45.8%为ER+/PR+，6%为ER+/PR-，43.7%为ER-/PR-，没有病例被确认为ER-/PR+。ER-/PR+表型的乳腺癌可能是技术假象的结果。对于最初被归为此亚型且再次出现症状的患者，应考虑及时重新评估，以确保适当的临床管理。
