From the Department of Pathology, Mount Sinai Hospital and Icahn School of Medicine, New York, New York. Drs Bleiweiss and Nayak are now with the the Department of Pathology and Laboratory Medicine, Perelman School of Medicine & Hospital, University of Pennsylvania, Philadelphia.
Arch Pathol Lab Med. 2019 Feb;143(2):190-196. doi: 10.5858/arpa.2017-0494-OA. Epub 2018 Sep 7.
CONTEXT.—: The College of American Pathologists guidelines recommend testing additional tumor foci in multifocal invasive breast carcinomas for the biomarkers estrogen receptor (ER), progesterone receptor, and HER2 only if the carcinomas show different morphologies or grades.
OBJECTIVE.—: To assess clinical significance of testing for biomarkers in additional tumor foci in multifocal invasive breast tumors.
DESIGN.—: Retrospective analysis of 118 patients diagnosed with ipsilateral synchronous multifocal breast carcinomas from January 2015 through March 2016 at Mount Sinai Hospital (New York, New York).
RESULTS.—: Eighty-six cases were tested for at least 1 of the 3 biomarkers in additional tumor foci. Fifteen cases (17%) showed discordant staining between the 2 foci for at least one biomarker. Of the 7 of 67 ER-discordant cases (10%), 4 (57%) showed major variation from negative to positive expression, including 3 cases in which a smaller tumor focus was strongly positive for ER whereas the index tumor was negative. Similarly, within the 7 of 67 progesterone receptor-discordant cases (10%), 4 (57%) showed major variation from negative to positive, and in 3 cases with major discordance, the index tumor was negative for progesterone receptor, whereas a smaller focus was positive. A difference in HER2 expression was noted in 5 of 86 cases (6%). In only 5 of the 15 patients (33%) with discordant results, biomarker testing on additional foci would have been offered per the College of American Pathologists recommendations because of differences in histology or grading. Of the remaining 10 patients, 7 (70%) with positive results on smaller foci would have been deprived of appropriate adjuvant systemic treatment if the smaller focus had not been tested.
CONCLUSIONS.—: We propose that negative values expressed in the primary tumor be repeated routinely on additional ipsilateral synchronous tumors.
美国病理学家学院指南建议，仅当多灶性浸润性乳腺癌的癌组织具有不同的形态或分级时，才对额外肿瘤灶的雌激素受体（ER）、孕激素受体和 HER2 等生物标志物进行检测。
评估多灶性浸润性乳腺癌中额外肿瘤灶进行生物标志物检测的临床意义。
对 2015 年 1 月至 2016 年 3 月期间在纽约西奈山医院诊断为同侧同步多灶性乳腺癌的 118 例患者进行回顾性分析。
86 例患者对至少 1 种生物标志物在额外肿瘤灶中进行了检测。15 例（17%）至少有 1 种生物标志物在 2 个焦点之间存在不一致的染色。在 67 例 ER 不一致的病例中，有 7 例（10%）表现出从阴性到阳性表达的明显变化，包括 3 例较小的肿瘤焦点 ER 阳性而指数肿瘤阴性。同样，在 67 例孕激素受体不一致的病例中，有 7 例（10%）表现出从阴性到阳性的明显变化，在 3 例有明显差异的病例中，指数肿瘤孕激素受体阴性，而较小的焦点阳性。在 86 例患者中，有 5 例（6%）HER2 表达存在差异。在 15 例存在不一致结果的患者中，只有 5 例（33%）根据美国病理学家学院的建议进行了额外肿瘤灶的生物标志物检测，因为存在组织学或分级差异。在其余 10 例患者中，7 例（70%）较小肿瘤灶呈阳性结果，如果不进行较小肿瘤灶的检测，他们将被剥夺适当的辅助全身治疗。
我们建议在同侧同步多灶性肿瘤中常规重复原发性肿瘤中的阴性值。
