COMPARATIVE PREDICTIVE VALUE OF THREE PROGNOSTIC MARKERS S-PHASE FRACTION, PCNA AND MITOTIC COUNT ON AXILLARY LYMPH NODE METASTASIS IN CARCINOMA BREAST
Abstract
Background: Axillary lymph node metastasis is the single most important prognostic factor incarcinoma of the breast. Therefore , prognostic markers that may reliably predict probability oflymph node (LN) metastases are of great value. This study was conducted to compare thepredictive value of two novel prognostic / proliferative markers i.e. S-phase fraction (SPF) andproliferating cell nuclear antigen (PCNA) in parallel with mitotic index. Methods: Data ofconsecutive cases of infiltrating ductal carcinoma (IDC) breast diagnosed from July 2003 to July2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, werereviewed. A total of 112 cases of infiltrating ductal carcinoma (IDC) of the breast with axillary LNsampling were selected. SPF was calculated by flow cytometry while PCNA staining was done byimmunohistochemistry. Mitotic count was calculated according to modified Bloom andRichardson’s grading guidelines. Result: It was observed that the number of axillary LNmetastases was increased with higher SPF (p value: 0.008). However no significant differencewas found between the results of various categories of PCNA on axillary LN metastases(p value: 0.182) and mitotic count with axillary lymph node metastases (p value: 0.324).Conclusion: It was concluded that mitotic count and / PCNA alone cannot be used in predictingaxillary LN metastases. SPF was found to be a more reliable marker compared to PCNA reactivityand conventional mitotic count in predicting axillary LN metastases.Keyword: S-phase fraction, Proliferating cell nuclear antigen, Mitosis, Axillary Lymph node.References
Bhurgri Y, Hasan SH, Pervez S, Kayani N, Hussainy AS,
Muzaffar S et al. Large-scale pathology-based cancer data--a
reflection of population-based cancer data. Pathol Oncol Res.
;8(1):62-7
Clark GM: Prognostic & predictive factors. In: Harris JR
Lippman ME, Morrow M, et al (eds). Diseases of the Breast.
Philadelphia, PA,Lippincott Williams and Wilkins; 2000. p.
-514 .
Fitzgibbons PL, Page DL, Weaver D, Thor AD, Allred DC,
Clark GM et al. Prognostic factors in breast cancer. College of
American Pathologists Consensus Statement 1999. Arch Pathol
Lab Med. 2000;124(7):966-78.
van Diest PJ, Baak JP. The morphometric prognostic index is
the strongest prognosticator in premenopausal lymph nodenegative and lymph node-positive breast cancer patients. Hum
Pathol. 1991;22(4):326-30
Wong SW, Rangan AM, Bilous AM, Boyages J, Gebski V,
Benson EM. The value of S-phase and DNA ploidy analysis
as prognostic markers for node-negative breast cancer in the
Australian setting. Pathology. 1999;31(2):90-4.
Shiao YH, Chen VW, Lehmann HP, Wu XC, Correa P.
Patterns of DNA ploidy and S-phase fraction associated with
breast cancer survival in blacks and whites. Clin Cancer Res.
;3(4):587-92.
Horiguchi J, Iino Y, Takei H, Maemura M, Takeyoshi I, Yokoe
T et al. Long-term prognostic value of PCNA labeling index
in primary operable breast cancer. Oncol Rep. 1998 ;5(3):641-
Bakhtawar H, Ali NM, Khan S, Aziz SA, Sliddiqui T, Pervez
S. Evaluation and reinforcementof the correlation of S-phase
fraction with nodal metastases, tumor grade and tumor size in
breast carcinoma patients in Pakistan. Pathol Res Pract.
;197(8):531-6.
Kato T, Kimura T, Miyakawa R, Fujii A, Yamamoto K,
Kameoka S , et al. Clinicopathologic study associated with
long-term survival in Japanese patients with node-negative
breast cancer. Br J Cancer. 2000;82(2):404-11.
Sheen-Chen SM, Eng HL, Chou FF, Chen WJ. The prognostic
significance of proliferating cell nuclear antigen in patients
with lymph node-positive breast cancer. Arch Surg.
;132(3):264-7.
Simpson JF, Gray R, Dressler LG, Cobau CD, Falkson CI,
Gilchrist KW et al. Prognostic value of histologic grade and
proliferative activity in axillary node-positive breast cancer:
results from the Eastern Cooperative Oncology Group
Companion Study, EST 4189. J Clin Oncol. 2000;
(10):2059-69.
Clayton F. Pathologic correlates of survival in 378 lymph
node-negative infiltrating ductal breast carcinomas. Mitotic
count is the best single predictor. Cancer. 1991;68(6):1309-17.
Redkar AA, Balsara BR, Bhisey AN, Sampat MB, Mittra I.
DNA analysis of breast cancer by flow cytometry &
correlation with other prognostic parameters. Indian J Med
Res. 1992; 96:223-9.
Siitonen SM, Kallioniemi OP, Isola JJ. Proliferating cell
nuclear antigen immunohistochemistry using monoclonal
antibody 19A2 and a new antigen retrieval technique has
prognostic impact in archival paraffin-embedded nodenegative breast cancer. Am J Pathol. 1993; 142(4):1081-89.
Cook DL, Weaver DL. Comparison of DNA content, S-phase
fraction, and survival between medullary and ductal carcinoma
of the breast. Am J Clin Pathol. 1995; 104(1):17-22
Keshgegian AA, Cnaan A. Proliferation markers in breast
carcinoma. Mitotic figure count, S-phase fraction, proliferating
cell nuclear antigen, Ki-67 and MIB-1. Am J Clin Pathol.
; 104(1): 42-9.
Leivonen M, Krogerus L, Nordling S. DNA analysis in
advanced breast cancer. Cancer Detect Prev 1994;18(2):87-96.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
