Expression Of Estrogen Receptor And Progesterone Receptor In Different Tumor Tissue Sites Of The Invasive Ductal Carcinoma

Background and objectiveBreast cancer is the most common carcinoma of women, which threats women's health seriously. For more than a century, people have made unremitting struggle with it. We can say that the achievement in treating breast cancer is a model for cancer therapeutics research. The development of modern medical science provides a new way for breast cancer treatment. Breast cancer is believed to be one of the highly heterogeneous tumors, and individual therapy has become a research hotspot in recent years. The prognosis differences of cancer patients who suffer from the same tumor are related to tumor's different molecular biology performance. Prediction of prognosis and guided therapy according to cancer patients'personal tumor molecular biology performance is a hot issue in medical research. But at present, the molecular biology index in clinical which has certain guiding significance is limited, among which estrogen receptor (ER) and progesterone receptor (PR) are affirmed. ER and PR are considered to be verified predictors in breast cancer to choose endocrine therapy for patients. However, the survey shows that estrogen and progesterone receptor immunohistochemical test results from worldwide lack of repeatability. The reasons can be attributed to pretreatment factors before immunohitochemical dyeing, antibodies of varying quality, differences in detecting systems, different scoring system and different criteria in selecting the threshold. Because of the importance of hormone receptor test results, in 2009, the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) organized experts to develop "American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer " to regulate the operating procedures of immunohistochemical experiments, and proposed new criteria to test positive results. The overall objectives are to improve the accuracy of hormone receptor testing and to help patients benefit from endocrine therapy and minimize the risks of the treatment.The purpose of this study is to regulate Immunohistochemistry operating procedures according to "the guideline " made by ASCO and CAP, and to test and understand the estrogen receptor (ER) and progesterone receptor (PR) performance in different parts of tumor tissue of the breast invasive ductal carcinoma (IDC).Materials and methodsIn this study, the 32 patients were all invasive ductal breast cancer patients who had received treatment in the Second Affiliated Hospital breast surgery of Zhengzhou University during 2009 to 2010. All of them were females, aged from 27 to 85 years old, median age of 48.3 years old. All patients were pathologically diagnosed as invasive ductal breast cancer, and any forms of radiotherapy, chemotherapy or endocrine therapy are not performed before surgery. What's more, the tumors removed by surgery all have a diameter≥2cm. Referring to " American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer ", standardized experiment procedures from the step of collecting specimens.32 tumor samples were taken from 4 different places, the mass center and three different places of the mass surrounding. They were conventionally fixed. Paraffin-embedded. Wax 1 were derived from tumor center (denoted as the center 1), other three wax samples were randomly derived from the surroundings (denoted as surrounding 1 to 3). Then immunohistochemical staining was done to observe and record results. Statistical data were counted by SAS9.2, and Kappa was used to analyze the consistency of immunohistochemical test results from 4 different parts in breast tumor tissues.Results1. Of the 32 cases of breast cancer patients, hormone receptors in the center of tumor tissue sites have a little lower positive expressions than in around. ER and PR Positive expressions of hormone receptors in the center of tumor tissue sites are both 50%. In the surrounding tumor tissue sites, the worst ER positive expression is 62.5% and the best is 71.9%; the worst PR positive expression is 53.2% and the best is 62.5%.2. The overall concordance was good for both ER and PR between different tumor tissue sites of 32 cases of breast cancer patients. The best Kappa values were 0.789 and 0.810, respectively. The worst Kappa values were 0.563 and 0.672, respectively (P<0.001).3. The concordance for PR is better than ER in different tumor tissue sites of the invasive ductal carcinoma. For PR, the best Kappa value is 0.813, the worst is 0.672. For ER, the best Kappa value is 0.789, the worst is 0.563.ConclusionEstrogen receptor (ER) and progesterone receptor (PR) in invasive ductal carcinoma expressions in different tumor tissue site by immunohistochemistry (IHC) has small differences in test results. Repeated testing in different parts of tumor tissue sites has little significance in clinical.In the aspect of guiding clinical treatment, after forecasting the prognosis of breast cancer patients, adding the reference to PR condition has much larger predictive value than just refer to ER condition.