Comparison of Oestrogen Receptor, Progesterone Receptor, and Human Epiderman Growth Factor Receptor-2 Expression in Primary Breast Cancer and Lymph Node Metastasis at the Korle-Bu Teaching Hospital, Accra, Ghana
Date
2013-07
Authors
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University of Ghana
Abstract
Introduction: Determination of oestrogen receptor (ER), progesterone receptor (PR) and
human epidermal growth factor receptor-2 (Her-2/neu) has become part of the diagnostic
tests for breast cancer. Results of ER and PR are used to select breast cancer patients who
are most likely to respond to hormonal therapy whereas Her-2/neu results are used to
select patients with invasive breast cancer most likely to respond to targeted therapy.
Immunohistochemical (IHC) determination of ER, PR and HER-2/neu is usually done on
the primary breast cancer tissue. Re-evaluation of ER, PR and HER-2/neu on metastatic
breast tumour is sometimes done when metastasis occurs. The axillary lymph nodes are
the most common site of metastasis of breast cancer. Characteristics of primary breast
cancer may change when metastasis occurs. This may affect the expression of proteins
including ER, PR and HER-2/neu. The choice of the appropriate sample for the IHC
determination of ER, PR and HER-2/neu when metastasis occurs may therefore be
clinically relevant.
Aim: The aim of this research was to compare the expression of ER, PR and the over-
expression of HER- 2/neu between primary breast cancer and metastatic deposits in
corresponding lymph nodes in women with breast cancer at the Korle-Bu Teaching
Hospital.
Methodology: The study involved 54 archived tissue blocks of primary breast cancer
tissue and corresponding metastatic deposits in lymph nodes of women with invasive
breast cancer. The cases were submitted to the Pathology Department of The Korle-Bu
Teaching Hospital between January and December 2009. Sections were taken from the
tissue blocks and stained immunohistochemically with antibodies for ER, PR and HER-
2/neu. Stained sections were reported as either positive or negative according to the
guidelines of the American Society of Clinical Oncology/College of American
Pathologists (ASCO/CAP).
Results: The mean age ± SD of women diagnosed with breast cancer with lymph node
metastases was 49.89 ± 10.70 years with a median age of 51 years. The percentage of
retrieved axillary lymph nodes that were involved with breast cancer cells ranged from
8% to 100%. The mean percentage of lymph nodes retrieved from the axilla was 57.87
with a median of 62.71 and a range of 92. About 22% (12 out of 54) of the cases had
100% lymph nodes involved with breast cancer cells and 3.7% (2 out of 54) had 8% of
retrieved lymph nodes involved with breast cancer cells. About 20% (11 out of 54) had
grade I, 42.6% (23 out of 54) had grade II, and 37% (20 out of 54) had grade III breast
tumours respectively. In the primary breast cancer tumour, 31.5% (17 out of 54) of the
cases were ER positive, 68.5% (37 out of 54) were ER negative, 25.9% (14 out of 54)
were PR positive and 74.1% (40 out of 54) were PR negative. HER-2/neu was positive in
25.9% (14 out of 54) and negative in 74.1% (40 out of 54) of the cases. In the
corresponding lymph nodes, 33.3% (18 out of 54) were ER positive, 66.7% (36 out of 54)
were ER negative, 29.6% (16 out of 54) were PR positive, and 70.4% (38 out of 54)
were PR negative. HER-2/neu was positive in 29.6% (16 out of 54) and negative in
70.4% (38 out of 54) of the cases. There was 94.4% and 92.5% concordance for ER and
PR respectively between primary tumour and lymph nodes. The concordance rate for
HER-2/neu was 96.3%. There was no statistical difference (p> 0.05) in ER, PR and HER-
2/neu between primary breast cancer and metastatic deposits in lymph nodes.
Conclusion: There were minor changes in the expression of ER, PR and HER-2/neu
between primary breast tumour and metastatic deposits in lymph nodes.
Description
Thesis (MPHIL) - University of Ghana, 2013