| ObjectiveThe treatment of breast cancer has entered into the age of molecular typing.The expression of hormone receptor,human epidermal growth factor receptor 2 and Ki-67 in patients with breast cancer has a direct impact on the formulation of treatment protocols.Core needle biopsy and surgical specimen of breast cancer,pre-and post-neoadjuvant chemotherapy,the primary tumor and axillary lymph node metastasis and distant metastasis between HR,HER-2 and Ki-67 expression is consistent is still controversial.Comparison of core needle biopsy specimens and surgical specimens of pre-and post-neoadjuvant chemotherapy,the primary tumor and axillary lymph node of HR,HER-2 and Ki-67 expression between metastasis and distant metastasis status through this study,to investigate the consistency of breast cancer HR,HER-2 and Ki-67 expression in the above case,in order to guide the formulation of breast cancer patients with comprehensive treatment programs,treatment options for more reasonable and more diversified for patients,more benefit from treatment.Methods323 patients with breast cancer admitted to the Department of surgery of Shandong Provincial Cancer Hospital Affiliated to from 2013 to December,2016 were collected from03 patients with breast cancer in the First Affiliated Hospital of Shandong University.The age of the patients was 24 years(-79 years),with a median age of 49 years.There were 298 cases of infiltrating ductal carcinoma,and invasive lobular carcinoma in 25 cases.Of which 143 patients received neoadjuvant chemotherapy(chemotherapy after pathological complete remission in 19 cases);initial treatment of core needle biopsy after neoadjuvant chemotherapy in patients with direct surgery in 110 cases,which received preoperative core needle biopsy directly after surgery and axillary lymph node metastasis in 77 cases;distant metastasis organ metastases received puncture 75 patients(43 cases of liver metastasis;lung metastasis in 32cases),including 2 patients with recurrence and metastasis after neoadjuvant therapy,3 cases of newly diagnosed patients with metastasis.The expression of HR,HER-2 and Ki-67 weredetected by immunohistochemistry,comparing the results of core needle biopsy and resected specimens,the specimens of pre-and post-neoadjuvant chemotherapy,the primary tumor and axillary lymph node metastasis and distant metastasis specimen.Comparison between the count data using the chi square test-X;the consistency of ER,PR,HER-2 and Ki-67 status was analyzed by Spearman correlation coefficient,Rho values greater than 0.8were found to be highly correlated.Inspection level a=0.05.ResultsComparison of the expression of ER,PR,Her-2 and Ki-67 in the specimens of primary foci and direct surgical specimens: 110 cases of direct operation after initial treatment of core needle biopsy,the concordance rate of ER expression between the primary foci and the specimens was 97.3%(107/110),PR was 95.5%(105/110),HER-2 was(107/110),Ki-67 was(103/110),Spearman rank correlation coefficient was >0.8,P value was <0.05.Comparison of the expression of ER,PR,Her-2 and Ki-67 in specimens of patients receiving neoadjuvant chemotherapy(group NAC)after core needle biopsy and direct operation after core needle biopsy(control group).The ER change rate of NAC group and control group were 13.7%(17/124)and 3.6%(4/110),the difference was statistically significant,P= 0.014;the rate of change for PR was 24.2%(30/124)and 2.7%(3/110),a statistically significant difference,P<0.001;the rate of change for HER2 was 4.8%(6/124)and 3.6%(4/110),there was no significant difference in the expression of Ki-67,P=0.664;the rate of change of 35.5%(44/124)and 6.4%(7/110),there was statistical significant difference,P<0.001.Comparison of the expression of ER,PR,Her-2 and Ki-67 in primary and metastatic axillary lymph nodes,110 cases of newly diagnosed breast cancer patients with direct surgery and axillary lymph node metastasis in 77 cases: the expression of ER in primary and metastatic axillary lymph nodes was 3.89%(3/77)from the primary positive to the axillary metastatic lymph node negative,the difference was not statistically significant(P=1.00>0.05).The total change rate of PR was 7.79%(6/77),and the difference was not statistically significant(P=0.687>0.05).The total change rate of HER2 was 11.68%(9/77),and the difference was not statistically significant(P=0.508>0.05).The total change rate of Ki-67 was 20.8%(16/77),and the difference was not statistically significant(P= 0.454>0.05).Comparison of ER,PR,HER-2and Ki-67 expression in 75 cases of distant metastases in primary and distant metastases:The total change rate of ER was 21.3%(16/75),and the difference was not statistically significant(P=0.804>0.05).The total change rate of PR was 29.3%(22/75),and the difference was statistically significant(P=0.017 < 0.05).The total change rate of HER-2 was 18.7%(14/75),and the difference was not statistically significant(P=0.791>0.05).The total change rate of Ki-67 was 29.3%(22/75),and the difference was statistically significant(P=0.017 < 0.05).Conclusion1.The expression of HR,HER-2 and Ki-67 in the core needle biopsy specimens was consistent with that of the resected specimens,core needle biopsy can accurately evaluate the molecular biological information of breast cancer patients.2.The expression of HR and Ki-67 before and after neoadjuvant chemotherapy in breast cancer patients were significantly different,but NAC had no significant effect on the expression of HER-2.It is necessary to detect the expression of HR and Ki-67 in breast cancer patients before and after neoadjuvant therapy.3.The expression of ER,PR,Her-2 and Ki-67 were significantly higher in direct operation and metastatic axillary lymph nodes,but there are still some patients have changes.It is suggested that the expression of HR,Ki-67 and HER-2 were detected in the primary tumor and metastatic lymph node metastasis.4.The expressions of PR and Ki-67 were significantly different between primary and distant metastases,but,there was no significant difference in the expression of ER and HER-2,which may be influenced by many factors.It is suggested that the patients with distant metastases can simultaneously detect the biological information of the primary and metastatic lesions,so as to seek more treatment opportunities for the patients. |
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