Evaluation Of Breast Biopsy To HR And HER-2and Ki-67and Neoadjuvant Chemotherapy’s Effect On Them

ObjectiveCurrently there are disputes among scholars on whether neoadjuvantchemotherapy has effect on the expression status of HR, HER2and Ki-67whichdirectly affects the selection of the follow-up treatment programs in breast cancer. Itmostly relies on core needle biopsy to test the expression in a clinical context.However, consensus hasn’t reached on whether there is consistency between coreneedle biopsy specimens and surgical specimens in determining the status of HR,HER-2and Ki-67. Meanwhile, it hasn’t drawn the same consistent conclusion of thepredictive effect the expression status has on neoadjuvant chemotherapy. Thisresearch, through analyzing changes of HR, HER-2and Ki-67of core needle biopsyspecimens with neoadjuvant chemotherapy, core needle biopsy specimens withoutneoadjuvant chemotherapy and surgical specimens, investigate the consistency of thestatus between core needle biopsy specimens and surgical specimens, research theeffect neoadjuvant chemotherapy has on HR, HER-2and Ki-67of breast cancer.Observing the consistency between preoperative expression status of HR, HER-2andKi-67and the curative effect of neoadjuvant chemotherapy while looking for the indicator that can predict the curative effect of neoadjuvant chemotherapy, it aims toprovide basis of individualized treatment for breast cancer patients.MethodsOur study selected177patients with breast cancer in our Breast Surgery fromMarch2012to January2013. The expression of HR、HER-2and Ki-67wereexamined by immunohistochemical between the core needle biopsies and surgicalexcision specimens in95patients with NAC. As a control group, we analyzed samplepairs from82patients without NAC. The response of NAC was also evaluated by thestandard of RECIST (response evaluation criteria in solid tumors). Qualitative dateuse chi-square test. Spearman rho values determined by correlation analysis indicatedthe agreement of HR、HER-2and Ki-67between the core biopsy and excisionalspecimens in patients with/without NAC. Rho values greater than0.8weredetermined as highly correlated. The chi-square test was used to compare the twogroups regarding the change of HR、HER-2and Ki-67status in core biopsy andexcised tissue specimens. The statistical Package for Social Sciences (SPSS)19.0wasused, and p-Value less than0.05was assumed as significant.Results1. The expression of ER97.6%(80/82), PR95.1%（78/82），HER-297.6%（80/82）and Ki-6792.7%(76/82) have good coincidence between the core needlebiopsy and surgical excision specimens (Spearman Rho all＞0.8, P all＜0.05).2. The change rate of ER、PR、HER-2and Ki-67with NAC was separately12.4%、24%、5%and38.0%, while3.9%、2.4%、2.4%and7.3%without NAC. Thedifference of the change rate of ER、PR and Ki-67was statistically significant（P＜0.05）and HER-2was no statistically significant (P＞0.05）. Ten(12.4%）of79patientswith NAC showed the ER status modulation in the surgically removed specimen ascompared with only2(3.9%) of82patients without NAC,P=0.014. Nineteen(24.0%）of79patients undergoing NAC appeared in the PR status alteration in the final surgicalspecimen, whereas only4(2.4%) of82patients without NAC did, P=0.001. The shift of HER-2status was found in4(5%) of79patients with NAC and in2(2.4%) of82patients without NAC, respectively, P=0.379.Thirty(38.0%)of79patients with NACshowed the Ki-67status changed in the surgically removed specimen and6(7.3%)of82patients without NAC,P＜0.001.The positive rates of ER before and after NAC were64.6%and53.2%,P=0.146.The positive rates of PR before and after NAC were63.3%and45.6%,P=0.025. The high expression rates of Ki-67before and after NAC were45.6%and15.2%,P=0.017。3. The status of ER、PR has no obvious relation with the efficiency of NAC(P＞0.05).The efficiency of NAC between the patients with HER-2positive and thepatients with HER-2negative was81.8%and50.7%,P=0.010.The efficiency of NACbetween the patients with high expression of Ki-67and the patients with lowexpression of Ki-67was70.2%and45.5%,P=0.029.Conclusion1. The core needle biopsies had good coincidence with surgical excision specimenwhen determining the status of ER、 PR、 HER-2and Ki-67.2. NAC can chan ge the status of ER、PR and Ki-67. The expression of Ki-67andthe positive rate of PR decreased after NAC, while the decrease of ER positive rateshowed no statistically significant. NAC had no effect on the status of HER-2.3. HER-2positive and high expression of Ki-67are correlated with better responsewith of neoadjuvant chemotherapy.