Analysis of Clinicopathological and Immunohistochemical Profile in

Invasive Ductal Breast Cancer Patients

Fitriani Lumongga

, Esther R. D. Sitorus

, Juliandi Harahap

Departement of Anatomy, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.

Departement of Histology,Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.

Departement of Community Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Clinicopathological, Immunohistochemical, Breast Cancer

Abstract: Breast cancer is the most common malignant neoplasm among women worldwide. This cancer is the primary

cause of mortality and morbidity in Indonesian women. The aimed of this study was to analyze the pattern of

clinicopathologicalprofile and immunohistochemical of ER, PR, and Her2 ininvasive ductal breast cancer

patients. This study was a retrospective design. A Histopathological diagnosis and immunohistochemical ER,

PR, and Her2 from 105 patients with invasive ductal breast cancer were included during period January 2017

to June 2018. Information of clinical, pathologic and immunohistochemical examination was recorded and

analyzed. Average of age patients is range from25 to 80 years, 59% of cases are > 45 years. The majority of

tumor size of patients is 2 – 5 cm, 57 patients (54,3 %). Majority of a tumor is grade 3. The

Immunohistochemical overexpression of ER, PR, Her 2 and Triple negative was 59%, 59% ,46,7% and 10,5%

respectively.Incidence of invasive breast cencer is higest in premenopause women. Analyzeof tumor size,

grade histopathology, lymphvessel invasion and immunohistochemical profile is important to therapeutic

management in patients wit invasive ductal cancer.

1 INTRODUCTION

Breast cancer is the most common malignant breast

lesion in a woman with more than a milion new cases

per year in worldwide, representing 22% of all cancer

diagnosed in women. It is the leading cause of death

in the world with over 370.000 deaths per year, or

14% of cancer deaths in women (Isawi, 2016). From

data and information center of Indonesian Health

Ministry 2016, Incidence of breast cancer in

Indonesia is 40/100.000 people and mortality rate is

16,6/100.000 people. Invasive Ductal Breast Cancer

is the commonest type of epithelial breast cancer

(Kementrian Kesehatan RI, 2016) (Komite

Penanggulangan Kanker Nasional, 2016).

Treatment of breast cancer is multidisciplinary

and depends on the age of patients, the tumorsize,

lymphnode status and histologycal type, grade of the

tumor, estrogen receptor (ER)/ Progesteron Receptor

(PR) status and growth factor (Her-2). Prognosis and

survival life years of breast cancer is worse with

higher grade, subtype of tumor, lymph node

metastase, negativity for ER, PR and positivity for

Her-2. Analysis clinicopathology characteristic and

expression of Estrogen Receptor, Progesteron

Receptor and Her-2 immunostainingare very useful

tools to diagnose this cancer, important to

management protocol therapy and prognosis of the

patients (Kristina, 2010). The aimed of this study is

to analyze the profile of clinicopathological

parameters and immunohistochemical of ER, PR, and

Her2, in invasive ductal breast cancer .patients.

2 METHODS

The study was restrospective design and done as per

standard ethics. The study was performed on medical

record of eligible 100 patiens with breast cancer who

had undergone surgical treatment, pathologycal and

immunohistochemicalanalyze at MurniTeguh

Memorial Hospital in Medan Indonesia during period

in Januari 2017 to June 2018. Medical record with

missing data on clinicopathology and

immunostaining ER, PR and Her2/ neu were

Lumongga, F., Sitorus, E. and Harahap, J.

Analysis of Clinicopathological and Immunohistochemical Proﬁle in Invasive Ductal Breast Cancer Patients.

DOI: 10.5220/0010085207130717

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

713-717

ISBN: 978-989-758-449-7

713

excluded. The data of age, tumor size (< 2cm, 2 – 5

cm, > 5cm), histopatological type is specified

according to WHO classification of breast cancer,

histopatological tumor grade was performed using the

modified criteria of Bloom and Richardson as

described by Elston and Ellis, lymphnode metastase,

lymphvessel angioinvasion was collected as follows

(1). The hormone receptor status (ER,PR)

immunohistochemical stain was scored that positivity

cells ≥ 10.0% is positive and < 10% is negative. Her2

according to immunohistochemical staining of cells

can be divided into 0,1+. 2+ and 3+. Score 0 was

negative (no rectivity), 1+ was negative, (faint, weak

reactivity in > 10 % of tumor cells), but only a portion

of the membrane is positive), 2+ was equivocal

(circumferential) intense membran staining in < 30%

of cells . Score 0 and 1 were considered negative,

score 2 was considered weakly positive, and score 3

was considered strongly positive. Then only score 3

cases were considered as Her-2 overexpressing

cases.(Almumen, 2015) (Zineb, 2012).

3 RESULT

In our study, 105 of histopathoplogical of a tumorand

immunohistochemical profile in patients with

invasive ductal breast cancer were taken. Average of

age patients was ranges from 25 – 80 years. The

majority ages group was 45 – 54 (42,8%) patients.

Majority of patients belonged to histologic grade III

WHO (73,4%). Majority of tumor size is 2 – 5 cm

(54,3%).Lymph vessel invasion was present in 54

patients (51,4%). Location of tumor commonly in

right breast site. Over expression of

Immunohistochemical profile ER, PR and Her2 was

62 (59%), 62 (59%) and 49 (46,7%) respeectively.

Immunoexpression Triple negative was found in 11

(10,5%) patients (Table 1).

Table 1. Clinicopathological and immunohistochemical profile

Profile Number Percentage

Age (years)

25 – 34 6 5,7

35 – 44 32 30,5

45 - 54 45 42,8

55 - 64 15 14.3

≥ 65 7 6,7

Tumor size (cm)

< 2 10 9,5

2 - 5 57 54,3

> 5 38 36,2

Histological Grade

1 1 0,9

II 27 25,7

III 77 73,4

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

714

Lymph-vessel invasion Present 54 51,4

Absent 51 48,6

Location Right 67 63.8

Left 33 31,4

Bilateral 5 4,8

Estrogen Receptor (ER) Positive 62 59,0

Negative 43 41,0

Progesteron Receptor (PR) Positive 62 59,0

Negative 43 41,0

Her2/neu Positive 49 46,7

Negative 56 53,3

Triple Negative 11 10,5

Table 2.Comparison Clinic opathological profile and Immunohistochemicalexpression ER, PR, Her2 and Triple negative.

Clinicopathological ER PR Her2 Triple Negative

Profile N % N % N % N %

Age (years) ≤ 45

> 45

25 40,3 24 38,7 27 55,1 7 63,7

37 59,7 38 61,3 22 44,9 4 36,3

< 2 6 9,7 3 4,8 3 6,1 1 9,1

Tumor size 2 - 5 34 54,8 36 58,1 20 40,8 6 54,5

(cm) > 5 22 35,5 23 37,1 26 53,1 4 36,4

I 1 1,6 1 1,6 - - - -

Analysis of Clinicopathological and Immunohistochemical Proﬁle in Invasive Ductal Breast Cancer Patients

715

Grade II 15 24,2 15 24,2 3 22,4 3 27,3

III 46 74,2 46 74,2 8 77,6 8 72,7

Lymph vessel Invasion

Present

Negative

35 56,5 30 48,4 30 61,2 5 45,5

27 43,5 32 51,6 19 38,7 6 54,5

Comparison positivity immunohistochemical

expression ER, PR and Her2 with age, tumor size ,

histopathological grade and lymp vessel invasion has

been shown in table 2. Her2 positivity showed in age

≤ 45 (55,1%), tumor size > 5 cm (53,1%),

histopathology tumor grade III (77,6%) and lymph

vessel present (61,2%).

4 DISCUSSION

Our study comprised of 105 patients with invasive

ductal breast cancer , Range of age of patients from

25 to 80 years old and majority patients are

premenopausal women (45 – 54 years old. This is

consistent with the study condusted by Sahu N and

Almumen M, size of tumor , histopathologic grade

and lymph vessel invasion are the traditional

prognostic factor in invasive ductal breast

cancerpatients (Colditz, 2012). In our study,

majority tumor size , the histological grade is 2 – 5

cm(54,3cm) and grade III (73,4%) respectively. The

many studies have demonstrated a strongly

association between grade of histologicaland

survival of invasive ductal breast cancer patients

(Heng, 2017) (Kouame, 2012). The grade is dominant

prognostic factor and should be included as a

component of the minimum dataset for histological

reporting of breast cancer (Colditz, 2012). This was

compatible to the result observer in Indian women,

Mir MA et al showed that 72,3% patients were in

histological grade III and tumor size range from 2 – 5

cm. E Gottfried studied showed 51,2% patients had

been 2 – 5 cm size of a tumor. Five-years survival

in breast cancer less than 1 cm is 93% while as it is

63% for more massive than 5 cm in size (Colditz,

2012) (Gottifried, 2004) (Schoppmann, 2010).

Lymph vessel present are found in 54 (51,4%) in

patients with invasive ductal breast cancer. This is

different result from studied of Schoppmann SF,

where as lymph vessel invasion was present in 36,6%

of case. Three molecular biomarker , Estrogen

receptot(ER), Progesteron Receptor and Her2 are

used in routine clinical management of patients with

invasive ductal breast cancer. Our study shown ER,

PR, Her2 positivity in 59%, 59% and 49 %

respectively. Many studies have demonstrated that

ER is strong predictive factor for response to

hormonal therapies such as tamoxifen (Colditz, 2012)

(Kristina, 2010). The over expression of the Her2 in

a patients of breast cancer is a prognostic and

predictive biomarker. Her2 expression is associated

with diminished prognosis (higher risk of

recurrence)(Heng, 2017).

Our study showed Triple negative positivity was

found in 10,5% patients with invasive ductal breast

cancer, and was seen in 63,7% women under 45 years

old , 54,5% in 2 – 5 cm size of tumor and 72,7% in

hitipathological grade III tumor.Biswal P et al studied

show that 35% cases are triple negative

(Priyadharshini, 2015).

5 CONCLUSION

Analysis of clinicopathological and immuno-

histochemical profile is important in patients with

invasive ductal breast cancer. They are provide

valuable for prognostic, predictive and therapeutic

management in patients. The accurate assessment of

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

716

the clinicopathological aspect and biomarker testing

(ER,PR and HER2) is associated with a patient’s

overal clinical outcome.

ACNOWLEDGEMENTS

This study was suported by TALENTA Program of

Universitas Sumatera Utara.

REFERENCES

Al Isawi, AO., 2016. Breast Caancer in Western Iraq :

Clinicopathological Single Institution Study

Advances in Breast Cancer Research 583-9

Almumen M., 2015. Immunohistochemical Expression of

VEGF in Relationship to Other Pathological

Parameters of Breast Carcinoma Journal Of Cancer

Therapy6 811-20

Colditz G, Chia KS., Invasive Breast Carcinoma:

Introduction and General Features 2012 WHO

classification of Tumours of the BreastEd:Sunil L, Ian

OE, Stuart JS Lyon France International Agency for

Research on Cancer (IARC) 14 - 21

Gottfried E,Konecny,Gloria M,et al 2004 Association

between HER-2/neu and Vascular Endothelial

Growth Factor Expression PredictsClinical Outcome

in Primary Breast Cancer PatientsClinical Cancer

Research10 1704-16.

Heng C, Jinjun L, Wei T 2017 Clinicopathological And

Immunohistochemical Features of Triple Negative

Breast Cancer Advances in Breast Cancer Research6

93-9

Kementrian Kesehatan RI 2016 Bulan Peduli Kanker

Payudara Infodatin Pusat Data dan Informasi

Kementrian Kesehatan RI 2-3

Komite Penanggulangan Kanker Nasional 2016 Panduan

Penatalaksanaan Kanker Payudara Kementrian

Kesehatan Republik Indonesia 1, 7-10

Kouame JN 2012 Epidemiology and Histology aspect of

Breast Cancer of Women in Ivory Coast Journal of

Cancer Therapy 3 782-6.

Kristina S, Jin FL, Laurie B, et al 2010 The Expression

Pattern of ER,PR, HER2, CK5/6. EGFR, Ki-67 and

AR by Immuunohistochemical Analysis in Breast

Cancer Cell Lines Breast Cancer: Basic and Clinical

Research 4 35-41

Mujahid AM,Farzana M, Balvinder S,et al 2017

Clinicopathological Profile of Breast Cancer Patients

at a Tertiary Care Hospital in Kashmir ValleySurgical

Science 8162-8

Priyadharshini B, Susmita B, Arasanti K,et al 2015

Correlation of Hormonal Receptors Estrogen

Receptor,Progesteron Receptor and Her-2/Neuwith

Tumor Characteristics in Breast Carcinoma:Study of

100 Consecutive Case International Journal of

Clinical Medicine 6 961-6.

Schoppmann SF, Tamandi D, Roberts L, et al 2010

HER2/neu Expression Correlates with Vascular

Endothelial Growth Factor-C and

Lymphangiogenesis in Lymph node Positive Breast

Cancer Annals of Oncology 21 955-960

Yueling J, Xiu Y, Yanfei L,et al 2017 Clinical Pathological

Analysis in 104 Ductal Breast Cancer Cases Journal

of Biosciences and Medicines 5 37-43

Zineb B, Nadia B, Amina T, et al 2012 Association

between Overexpression of Her2 and other

Clinicopathologic Prognostic Factors in Breast

Cancer in Morocco Journal of Cancer Therapy 3 789

– 792

Analysis of Clinicopathological and Immunohistochemical Proﬁle in Invasive Ductal Breast Cancer Patients

717