Meme kanseri trucut iğne biyopsi ve rezeksiyon materyallerinde yeni moleküler sınıflama, tanı ve hormon reseptörlerinin durumu tutarlı mı?

Öz

Amaç: Meme kanserinde, trucut iğne biyopsi (TİB) ve rezeksiyon materyalleri arasında, tanısal uyum, histolojik derece, moleküler alt tipleri, östrojen reseptörü (ER), progesteron reseptörü (PgR) ve insan epidermal büyüme faktörü reseptörü 2 (HER2) düzeylerinin karşılaştırılarak sonuçların literatür eşliğinde değerlendirilmesi amaçlanmıştır.
Gereç ve yöntem: 2018 Mayıs-2020 Kasım tarihleri arasında, Pamukkale Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı’nda tanı almış 64 olguya ait TİB ve aynı hastaların rezeksiyon materyalleri çalışmaya alınmıştır. Tümör tipi, derecesi, moleküler alt tipleri ve immunohistokimyasal olarak ER, PgR, HER2, Ki-67 ve moleküler FISH yöntemi ile HER2 durumuna ait patolojik bilgiler retrospektif olarak incelenmiştir.
Bulgular: TİB ile rezeksiyon materyallerinin histolojik tipi arasındaki uyum oranı %93,75’tir. ER, PgR, HER2 uyum oranları sırasıyla, %89 (kappa, 0,685, p<0,001), %81,8 (kappa, 0,645, p<0,001), %95 (kappa=8,68, p<0,001)’tir. HER2 uyum oranı, ER ve PgR reseptör uyum oranına göre daha iyidir. Ki-67’ye baktığımızda %79 oranında, orta düzeyde uyum (kappa, 0,447, p<0,001) görülmüştür. Derece karşılaştırmasında %79 uyum oranı ile iyi uyum (kappa, 0,637, p<0,001) bulunmuştur. Moleküler sınıflama arasında uyum oranı %93 olup, çok iyi uyum (kappa, 0,882, p<0,001) bulunmuştur. Lüminal A en fazla görülen tip olup, uyum oranı %97’tür.
Sonuç: Tanısal biyopsi ve rezeksiyon materyalleri arasında yüksek oranda uyum görülmüştür. TİB’lerin tümörün histopatolojik özelliklerinin belirlenmesi, tanı, tedavi ve prognozda önemi olan ER, PgR, HER2, Ki-67 immünhistokimyasal boyamalarının çalışılması için güvenilir materyaller olduğu sonucuna varılmıştır. Ayrıca Ki-67, HER2 negatif tümörlerin moleküler subtiplemesinde önemli olduğu görülmüştür.

Anahtar Kelimeler

• meme
• iğne biyopsi
• hormon reseptör
• moleküler sınıflama

Abstract

Purpose: The aim of this study was to evaluate the the concordance rate of molecular subtypes histological grade, estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) levels between the diagnostic biopsy and resection materials in breast cancer, in the light of the literature.
Materials and methods: Trucut needle biopsy (TNB) and resection materials of 64 cases, diagnosed at Department of Pamukkale University Medical Faculty Pathology, between 2018 May and 2020 November were included in this study. Tumor type, degree and pathological information on ER, PgR, HER2, Ki-67, immunohistochemically and HER2 status by molecular FISH method were analyzed retrospectively.
Results: Concordance rate between resection specimens and trucut needle biopsy is 93.75%. The concordance rates for ER, PgR, HER are 89% (kappa, 0.685, p<0.001), 81.8% (kappa, 0.645, p<0.001), 95% (kappa=8.68, p<0.001), respectively. HER2 concordance rates is better than ER and PgR receptor concordance rates. In Ki-67, a moderate agreement (kappa, 0.447, p<0.001) was observed at a rate of 79%. A good agreement 79% (kappa, 0.637, p<0.001) was found in the grade comparison. Concordance rate between molecular classification was 93% and very good agreement (kappa, 0.882, p<0.001) was found. Luminal A is the most common type and the concordance rate is 97%.
Conclusion: A high agreement was observed between diagnostic biopsy and resection materials. It was concluded that TIBs are reliable materials for determining the histopathological characteristics of the tumor, and studying the immunohistochemical staining of ER, PgR, HER2, Ki-67, which are important in diagnosis, treatment and prognosis. In addition, Ki-67 has been found to be important in molecular subtyping of HER2 negative tumors.

Keywords

• Breast
• needle biopsy
• hormone receptor
• molecular classification

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