Winter Meeting 2011 - The Pathological Society of Great Britain ...

P13
Papillary Carcinoma of the Breast - Predicting Behaviour
P NP Gandhi 1 ; AHS Lee 1 ; F Climent 2 ; RD Macmillan 3 ; IO Ellis 4 ;
EA Rakha 1
1 Nottingham University Hospitals, Nottingham, United Kingdom; 2 Hospital
Universitari de Bellvitge, Barcelona, Spain; 3 Nottingham Breast Institute,
Nottingham, United Kingdom; 4 University of Nottingham, Nottingham,
United Kingdom
Papillary carcinomas are a rare morphological type of breast cancer. Controversy remains
over whether these lesions are in-situ or invasive cancers, and the role of myoepithelial
cell in differentiating between them. In this study, we reviewed 167 cases of papillary
carcinoma diagnosed at the Department of Histopathology Nottingham, UK. Of these
cases, 106 were consultation cases in which lymph node status and/or follow-up data were
unavailable. In the 61 cases where clinical and follow-up data were available, 48 lesions
were pure papillary carcinomas while 13 cases showed associated invasive carcinoma of
different histologic type; the latter were excluded from the analysis. Lymph nodes were
sampled in 18 of the 48 pure papillary cancers and in 3 of these cases micrometastatic
disease was identified (with 1 involved node per case). In an additional case, regional
recurrence in the lymph nodes was identified after a period of 2 years (2 out of 13 nodes
were positive). None of the cases were reported to have distant metastases during the
period of follow-up (average 10 years). In all 4 cases of papillary carcinoma with positive
nodes, the primary tumour showed a high nuclear grade. Importantly, the absence of
myoepithelial cells cannot differentiate between papillary carcinomas which have the
potential for metastatic disease and those which remain localised. In conclusion, our study
supports the concept that some forms of papillary carcinoma, particularly those of high
cytonuclear grade behave as an invasive variant of breast carcinoma which is associated
with an excellent prognosis. Sentinel node biopsy may be warranted in these cases.
P15
Immunohistochemical Profiling of Ductal Carcinoma In Situ of
the Breast
P J Brown; C Gillett; SE Pinder
Guy’s Hospital, Kings College London, London, United Kingdom
Purpose of the study: Molecular profiling has given rise to distinct groups of invasive
breast cancer. Basal-like, Luminal A, Luminal B and Her2 cancers can be identified using
immunohistiochemistry (IHC) as a surrogate protocol to these genomic methods. Ductal
carcinoma in situ (DCIS) is a precursor lesion that may or may not result in progression
into these cancer subtypes. Like invasive breast cancer, it is becoming apparent that DCIS
is not a single entity but multiple disease subtypes. We have applied a panel of antibodies
(ER, PR, Her2, EGFR, CK5, CK14) to cases of DCIS to determine if IHC can be used to
assign these precursor lesions into similar cancer subgroups.
Methods: A consecutive series of DCIS (n= 280) was used to construct tissue microarrays
(TMAs) comprised of 2.00mm cores to retain tissue morphology. IHC was carried out
using seven antibodies on an automated staining system. Two observers scored TMAs.
ER and PR were scored using the Allred method, Her2 with the Dako Herceptest
recommendations. All other antibodies were scored as percentage of positive cells.
Summary of Results: DCIS positive cases: ER 70%, PR 52%, Her2 22%, CK5 33% & CK14
36% EGFR 2%. Frequency distributions were calculated and non parametric tests gave
significant P-values for ER v Her2 (< 0.0001), PR v Her2 (< 0.0001), and EGFR v ER and
PR (< 0.0001, 0.0017), CK14 v Ck5 (< 0.0001), ER v PR (< 0.0001).
Conclusions: DCIS profiling using an IHC panel show some features common to
molecular profiling of invasive breast cancers. Our series shows similarities with other
published profiling data on DCIS. Further studies will determine the clinical relevance of
this immunoprofile.
P14
Comparison of ER Assessment Using Three Antibodies
Optimised for use with an Automated IHC Stainer System
P L Bosshard-Carter 1 ; JP Brown 2 ; C Gillett 2 ; SE Pinder 2
1 Kings College London, London, United Kingdom;
2 Guy’s Hospital, Kings College London, London, United Kingdom
Purpose of the study: Immunohistochemical (IHC) assessment of oestrogen receptor (ER)
in breast cancer has a significant predictive value in identifying poor patient response to
tamoxifen or aromatase inhibitor therapy. Recent changes in guidelines have suggested
that patients with very low positive ER status determined by IHC (1% of cells) could still
benefit from treatment. We have evaluated three ER clones (1D5, 6F11, SP1) in invasive
breast cancers to determine any difference in staining patterns and subsequent effect on
clinical treatment.
Method: A consecutive series of invasive breast carcinomas (n= 250) were used to
construct tissue microarrays (TMAs). IHC was carried out using all three clones on an
automated staining system. Two observers scored TMAs independently using the Allred
ER scoring method. Clinical cut-offs (Allred < 3 = negative) were evaluated with positive
scores subdivided into low and high ER expression levels (Allred 3-6 & 7-8 respectively).
Summary of results. Mean Allred scores for each antibody were 5.23 (6F11), 4.80 (1D5) &
4.77 (SP1). Negative ER values were: 1D5 = 22.6%, 6F11 = 25.4%, SP1 = 26.9%. Low ER
expression levels: 1D5 = 5.6%, 6F11 = 7.3 %, SP1 = 13.3%. High ER expression levels: 1D5
= 71.8%, 6F11 = 67.3%, SP1 = 59.8%.
Conclusions: Most ER values are at Allred score extremes (0,7,8) and result in no
significant difference in current clinical practice. However, variation exists, in small
numbers, between clones at current clinical cut-off thresholds (Allred