Meme Karsinomlarında Nükleer Morfometrinin Klinikopatolojik Prognostik Parametreler ve İmmünohistokimyasal ER, PR ve Cerb-B2 Ekspresyonları ile İlişkisi

Abstract

Amaç: Bilgisayarlı histomorfometrik analiz, meme karsinomlarını da içeren pek çok tümörün ayırıcı tanısında kullanılan bir araç olup, malign tümörlerin derecelendirmesinde, prognoz ve tedavi yanıtının değerlendirilmesinde de denenmiştir. Bu çalışmada meme karsinomlarında nükleer morfometrik değişkenler ile klinikopatolojik prognostik parametreler ve immünohistokimyasal ER, PR, Cerb-B2 ekspresyonları arasındaki ilişkiyi araştırmak amaçlanmıştır.

Araçlar ve Yöntem: Çalışmada meme karsinomu tanısı alan 105 olguda, ortalama nükleus alanı (ONA), ortalama nükleus çevresi (ONÇ), ortalama nükleus uzun çapı (ONUÇ) ve ortalama nükleus kısa çapı (ONKÇ) dahil olmak üzere çeşitli nükleer morfometrik parametreler açısından değerlendirildi. Dijital görüntü analiz sistemi kullanılarak Hematoksilen-eosin ile boyanmış lamlar üzerinde, lezyon başına elli tümör hücre çekirdeğinde ölçümler yapıldı. Elde edilen veriler ile klinikopatolojik prognostik parametreler arasındaki ilişki istatistiksel yöntemler ile değerlendirildi.

Bulgular: Histolojik gruplar arasında, invaziv duktal karsinomada (IDK), diğer tümör gruplarına göre ONUÇ (p=0.04) daha yüksek saptanmştır. Derece 3 IDK olgularında, derece 1 IDK olgularına göre ONKÇ (p=0.04); İnvaziv Lobler Karsinom olgularına göre de ONA (p<0.01), ONÇ (p=0.02), ONUÇ (p=0.01) ve ONKÇ (p=0.02) daha yüksek saptanmıştır. Tümör nekrozuna sahip olgularda, tümör nekrozu olmayan olgulara göre ONA (P=0.01), ONÇ (p<0.01), ONUÇ (P=0.01) ve ONKÇ (P<0.01) daha yüksek saptanmıştır. Immünohistokimyasal olarak, Cerb-B2 pozitif meme karsinomlu olgular, Cerb-B2 negatif olgulara göre ONA (P<0.01), ONÇ (p=0.01), ONUÇ (P<0.01) ve ONKÇ (P=0.01) daha yüksek saptanmıştır.

Sonuç: Özellikle nükleus alanına dayalı nükleer morfometrik değerlendirme; tümör derecesi, histolojik subtip ve tümör nekrozu yanısıra Cerb-B2 ekspresyon profili ile ilişkili olduğundan prognostik değerlendirmede yol gösterici olabilir.

Keywords

• görüntü sitometrisi
• immünohistokimya
• karsinom
• meme
• prognoz

Relation of Nuclear Morphometry with Clinicopathologic Prognostic Parameters and Immunohistochemical ER, PR and Cerb-B2 Expressions in Breast Carcinoma

Abstract

Purpose: Computerized histomorphometric analyses have been widely used as a diagnostic tool for the differential diagnosis of various tumors including breast carcinoma, as well as the grading of malignant tumors and evaluation of prognosis and therapeutic response. The aim of the present study is to determine the association between nuclear morphometric variables and clinicopathologic prognostic parameters including ER, PR, and Cerb-B2 expressions in breast carcinoma.

Materials and Methods: A hundred and five patients with breast carcinoma were evaluated in terms of various nuclear morphometric parameters, including mean nuclear area (MNA), mean nuclear perimeter (MNP), mean nuclear long diameter (MNLD), and mean nuclear short diameter (MNSD). Fifty tumor cell nuclei, per lesion, on Hematoxylen eosin-stained slides were measured using a digital image analysis system. The relation between calculated data and clinicopathologic prognostic parameters were assessed with statistical methods.

Results: Among histologic subtypes, invasive ductal carcinoma (IDC) had higher MNLD than other tumors group (p=0.04). Grade III IDC had higher MNA (p=0.04) and MNSD (p=0.02) than grade I IDC and higher MNA (p=0.01), MNP (p=0.02), MNLD (p=0.01), and MNSD (p=0.02) than invasive lobular carcinoma. MNA (p=0.01), MNP (p=0.009), MNLD (p=0.01), and MNSD (p=0.006) were higher in tumors having necrosis than tumors without necrosis. Immunohistochemically, Cerb-B2 positive tumors exhibited higher MNA (p=0.001), MNP (p=0.001), MNLD (p=0.001) and MNSD (p=0.001) than Cerb-B2 negative tumors.

Conclusion: Nuclear morphometric assessment, especially using MNA, is a valuable tool due to its significant association with clinicopathologic prognostic parameters including tumor grade, histologic subtype, tumor necrosis and Cerb-b2 expression profile.

Keywords

• breast
• carcinoma
• image cytometry
• immunohistochemistry
• prognosis

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