| Objective: The aim of this analysis was to report concordance between preoperative core needle biopsy(CNB)and resection specimen(RS)in evaluating biomarkers and molecular subtypes.To investigate the effect of neoadjuvant chemotherapy on breast cancer biomarkers,and predict the value of these biomarkers in neoadjuvant chemotherapy.Methods: A retrospective study was performed on 433 breast cancer patients at the Tianjin Medical University Cancer Institute and Hospital between August 2015 and November 2016.Among them,324 patients were in non-chemotherapy and we evaluated samples from 109 patients with NAC.The aim of this analysis was to report concordance between CNB and surgical specimens in evaluating biomarkers and molecular subtypes.And we compared the expression of these biomarkers before and after neoadjuvant chemotherapy.Results:1、There was concordance between estrogen receptor(ER)assessment on CNB and RS in 94.1%(305/324)of the patients(κ=0.84).Concordance of the progesterone receptor(PR)and the human epidermal growth factor receptor 2(HER2)assessments were observed in 90.7%(294/324,(κ=0.76)and98.4%(125/127,κ=0.96)patients,respectively.Evaluation of Ki67 revealed an accordance rate of 86.7%(281/324,κ=0.34).2.The concordance for immunohistochemistry detection for assessing breast cancer(BC)molecular subtypes was 73.4%(91/124,κ=0.64).3.Logistic analysis:The inconsistency of ER expression between CNB and resection specimens detected by immunohistochemistry was positively correlated with the diameter of the tumor.The inconsistency of PR expression between CNB and resection specimens was negatively correlated with the pathological grade.4.One case of CNB was Luminal B(HER2 positive),whereas the resection specimens were Luminal A subtype.Another case of TNBC type in CNB,postoperative specimens was HER2 overexpression subtype.5.There was concordance between estrogen receptor(ER)assessment pre-andpost-neoadjuvant in 91.8%(89/97)of the patients(κ=0.72).Concordance of the progestrone receptor(PR)and the human epidermal growth factor receptor 2(HER2)assessments were observed in 82.5%(80/97,κ=0.57)and94.4%(84/89,κ=0.84)patients,respectively.Evaluation of Ki67 revealed an accordance rate of66.0%(33/97)of the patients(κ=0.37).6.There was no significant difference in the expression of ER,PR and HER2 preand post-neoadjuvant chemotherapy(P>0.05),but the expression of Ki67 changed after neoadjuvant chemotherapy(P=0.02).7.In the pre-NAC ER-negative group,the overall pCR rate was 15.8%.The pre-NAC ER-/ post-NAC ER-group was more effective than the pre-NAC ER-/post-NAC ER+ group.In the pre-NAC ER-positive group,the overall pCR rate was10.0%.The pre-NAC ER+/ post-NAC ER+ group was less effective than the pre-NAC ER+/post-NAC ER-group.8.In the pre-NAC PR-negative group,the overall pCR rate was 12.9%.The pre-NAC PR-/post-NAC PR-group was more effective than the pre-NAC PR-/post-NAC PR+ group.In the pre-PR-positive group,the overall pCR rate was10.2%.The pre-NAC PR+/ post-NAC PR+ group was less effective than the pre-NAC PR+/ NAC PR-group.9.In the NAC pre-HER2 negative group,the overall pCR rate was 11.8%,and the clinical response rate of pre-NAC HER2-/ post-NAC HER2-group was 58.2%.In the pre-NAC HER2 positive group,the overall pCR rate was 12.0%,and the pre-NAC HER2+/ post-NAC HER2+ group was less effective than the pre-NAC HER2+/post-NAC HER2-group.10.In the pre-NAC low expression of Ki67 group,the overall pCR rate was 0%,and the pre-NAC low expression of Ki67 /post-NAC low expression of Ki67 was less effective than the pre-NAC low expression of Ki67/post-NAC high expression of Ki67 group.In the high expression group of pre-NAC Ki67,the overall pCR rate was 8%.The high expression of Ki67 before NAC/high expression of Ki67 after NAC was 61.4% lower than the high expression of Ki67 before NAC/low expression of Ki67 after NAC.Conclusion:1.The inconsistency of immunohistochemical index ER between CNB and RS was positive correlation with tumor diameter.For tumor diameter equal to or larger than2 cm can be multi-point puncture to improve the diagnostic accuracy of ER.2.The inconsistency of immunohistochemical index PR between CNB and RS was negative correlation with histopathological grade.3.The concordance for assessing Ki67 was lower than ER,PR,HER2 between CNB and RS.4.There fore,we should combine immunohistochemical results with both CNB and RS samples,in order to improve accuracy when diagnosing molecular subtypes.Moreover,improved diagnoses can provide the basis for more effective systemic therapies.5.Estrogen or progestrone receptor negative,HER2 overexpression and high expression of Ki67 may be more sensitive indexes to chemotherapy.6.The expression of Ki67 was down-regulated by NAC,suggesting that patients with high expression of Ki67 may be more sensitive to NAC,but there is no significant difference in the expression of ER,PR,HER2 before and after NAC.7.The concordance for assessing Ki67 was lower than ER,PR,HER2 before and after NAC.8.The changes of immunohistochemical indexes before and after neoadjuvant chemotherapy have associations with the efficacy of neoadjuvant chemotherapy.Whether the efficacy of neoadjuvant chemotherapy can be predicted by performing secondary percutaneous during neoadjuvant chemotherapy needs further study. |
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