Postoperative pathology of breast cancer includes: the specific name of tumor classification, tumor size, whether each margin is cleanly excised, the site and number of lymph node metastasis, and whether there is infiltration in the vascular lymphatic vessels and other tissues, but the pathology also includes immunohistochemistry, which is closely related to the patient’s prognosis, as follows.
1, ER: estrogen receptor, positive suggests a better prognosis than negative patients, the more plus signs the better.
2, PR: progesterone receptor, positive indicates a better prognosis than negative patients.
Why is the prognosis good for ER and PR positivity? This is because ER and PR exist in normal breast epithelial cells, and when the cells become cancerous, ER and PR appear partially and completely absent. If ER and/or PR are positive, the growth and proliferation of the breast cancer cells are still regulated by endocrine control, which is called hormone-dependent breast cancer; if ER and/or PR are negative, the growth and proliferation of the breast cancer cells are no longer regulated by endocrine control, which is called non-hormone-dependent breast cancer. If both are positive, the prognosis is best. If one is positive and one is negative, estrogen positive is better than progesterone positive. The prognosis is not good for both negatives. Positive cases can be treated with postoperative or preoperative endocrine therapy.
3. Her-2 (CerbB-2): Its association with prognosis is double-edged for the following reasons: human epidermal growth factor receptor 2, is a proto-oncogene. Its overexpression, i.e. the presence of a plus sign, indicates that the patient has a poor prognosis. It also suggests that patients are prone to axillary lymph node metastasis and possible deficiency of both of these hormone receptors. Its expression is positively correlated with breast cancer grade, lymph node metastasis and clinical stage, and the higher the expression rate, the worse the prognosis may be. However, those with more than two plus signs in Fish test have the possibility of biologically targeted therapy. That is, the use of trastuzumab (Herceptin).
4.What is triple negative breast cancer: ER, PR, Her-2 (CerbB-2), all three are negative, which is called “triple negative” breast cancer, with relatively poor prognosis and lack of drug treatment. Please refer to articles 1,2,3 for the specific reasons.
5. E-Cadherin: E-calcified adhesion protein is one of the transmembrane protein isoforms in the calcium adhesion protein family of molecules, which is concentrated in the adhesion junctions and plays an important role in maintaining the integrity, polarity, morphology and organization of epithelial cells. Its high expression indicates good prognosis.
Ki-67index: It is a proliferation antigen that responds to cell proliferation. Its expression is related to the occurrence and development of breast cancer and is a poor prognostic factor. The higher the value, the worse the prognosis.
7.P53: It is a tumor suppressor gene and its mutation indicates poor prognosis; breast cancer cells with high P53 mutation rate have strong proliferation, poor differentiation, high malignancy, aggressiveness and high lymph node metastasis rate.
8.CK5/6: It is a cytokeratin, the higher the histological grade and the higher the tumor stage, the higher the expression rate, and the overall positive prognosis is poor.
EGFR: Epidermal growth factor receptor, the higher the histological grade and the higher the tumor stage, the higher the expression rate, and the overall positive indicates poor clinical prognosis.
10, VEGF: Vascular endothelial growth factor, high expression suggests poor prognosis.
11.TOP-II: DNA topoisomerase II, high expression indicates higher tumor proliferation and malignancy.
12.PCNA: proliferating cell nuclear antigen, positive prognosis is not good.
13, P170: a multidrug resistance gene, its overexpression is detrimental to treatment.
14.nm23: It is a gene related to malignant metastasis, and the reduced gene expression level is a high risk factor for lymphatic metastasis of breast cancer.
15.Her-1: similar to Her-2 in front, bad positive.
16.DNA ploidy: aneuploidy predicts tumorigenesis.
17.CD44V6: It is a protein, high expression suggests poor prognosis.
18, Ck14, Ck17 and CK7: have similar reference standard with the previous Ck5/6.
19, Bcl-2: It is an apoptosis-suppressing gene, and its positive expression suggests a high degree of tumor grading and few lymph node metastases.
20, PS2: PS2 may be more useful than ER assay in predicting endocrine therapy response, and PS2 expression is the best indicator of endocrine therapy response in breast cancer.
21.P63: P63 gene itself is an oncogene, and P63 plays an important role in the occurrence and development of breast cancer; the test can provide the necessary theoretical basis for early diagnosis, timely treatment and prognosis of breast cancer.
22.Calponin: In normal, hyperplastic and atypical hyperplasia groups, almost all myoepithelial cells express P63, α-SMA and Calponin, while all glandular epithelial cells are negative for the three antibodies; it helps to determine infiltrating carcinoma, carcinoma in situ and atypical hyperplasia.
23.SMA (smooth muscle actin): smooth muscle actin is a reliable marker antibody. It disappears in a gradual process from normal breast tissue, benign lesions to carcinoma in situ, early infiltration and infiltrative carcinoma.
24.Cyclin D1: High expression of Cyclin D1 may play an important role in the occurrence and development of human breast cancer. The clinical significance of high expression in breast cancer is that the expression of Cyclin D1 is associated with tumor size, TNM stage and axillary lymph node metastasis.
25.COX-2 (cyclooxygenase-2): The expression of COX-2 is present in breast cancer tissues, and COX-2 may be a practical indicator for clinical evaluation of patient prognosis and identification of patients at high risk of postoperative recurrence.
26.34βE12: It is a cytokeratin, and its expression is related to the biological index of tumor malignancy in breast cancer. Negative expression of 34βE12 in breast cancer tissues indicates poor prognosis, which can be used to judge the malignancy and prognosis of breast cancer.
27, P120 membrane: it is abnormally expressed in breast cancer tissues and correlated with E-cadherin expression, which may play an important role in the occurrence and development of breast cancer; P120 membrane is more closely related to the occurrence and development of invasive lobular carcinoma.