粗针穿刺及术后乳腺癌标本的免疫组织化学法检测指标与分子分型的比较研究

Comparison of core needle biopsy and surgical specimens for accurate evaluation of hormonal receptors status and molecular subtypes of breast cancer

目的:评估粗针穿刺及术后乳腺癌标本的免疫组织化学法检测指标与分子分型一致性,分析导致粗针穿刺标本的免疫组织化学法检测指标差异的因素。方法:回顾性分析2015年8月至2016年11月324例于天津医科大学肿瘤医院未经新辅助化疗行乳腺癌改良根治术患者的临床病理资料。比较粗针穿刺及术后标本经免疫组织化学法检测的指标ER、PR、HER-2、Ki-67与分子分型一致性。结果:粗针穿刺及术后乳腺癌标本的免疫组织化学法检测指标ER、PR、HER-2、Ki-67一致率分别为94.1%(305/324)、90.7%(294/324)、61.1%(198/324)、86.7%(281/324),Kappa值分别为0.84、0.76、0.38、0.34;分子分型一致率为73.4%(91/124),Kappa值为0.64。结论:乳腺癌粗针穿刺活检在免疫组织化学法检测指标ER、PR与分子分型评估中准确性较高,在HER-2、Ki-67检测中一致性较低,粗针穿刺结合术后标本的免疫组织化学法结果,可为提高分子分型的准确性及选择最佳治疗提供依据。

Objective： To explore concordance between preoperative core needle biopsy （CNB） and resection specimen （RS） in evaluating biomarkers and molecular subtypes with immunohistochemical method. Methods： A retrospective study was performed on 324 breast cancer patients who underwent modified radical mastectomy at the Tianjin Medical University Cancer Institute and Hospital between August 2015 and November 2016. All patients who had received neoadjuvant systemic therapy were excluded. The aim of this analysis was to report concordance between CNB and surgical specimens in evaluating biomarkers, such as ER, PR HER-2, Ki-67, and molecular subtypes. Results： There was concordance between estrogen receptor （ER） assessment on CNB and RS in 94.1% （305/324） of the patients （K=0.84）. Concordance of the progesterone receptor （PR） and the human epidermal growth factor receptor 2 （HER-2） assessments were observed in 90.7% （294/324, K=0.76） and 61.1% （198/324, K=0.38） patients, respectively. Evaluation of Ki-67 revealed an accordance rate of 86.7% （281/324, K=0.34）, and the concordance for immunohistochemistry detect/on for assessing breast cancer （BC） molecular subtypes was 73.4% （91/124, K=0.64）. Conclusions： Although CNB showed good accuracy for evaluating hormonal receptor status and BC molecular subtypes, its evaluation of HER-2 and Ki-67 statuses was less accurate than other biomarkers. Therefore, we should combine immunohistochemical results with both CNB and RS samples in order to improve accuracy when diagnosing molecular subtypes. Moreover, improved diagnoses can provide the basis for more effective systemic therapies.