The first one is ER, which is estrogen receptor; the second one is PR, which is progesterone receptor; the third one is HER-2, which is human epidermal growth factor receptor-2; and the fourth one is ki67. If ER and PR are positive, endocrine therapy may be more effective. If HER-2 is over-amplified (++++) suggesting that it can be treated with the targeted drug Herceptin. If it is (+) or (++), further genetic testing is needed to understand whether there is over-amplification before deciding whether targeted therapy can be used. If it is negative, it is not possible to use targeted therapy. If all three are negative for ER, PR and HER-2, that is, triple negative breast cancer is the least effective treatment. ki67 index is higher, suggesting that the tumor may proliferate faster and the malignancy is higher.