COMPARATIVE PREDICTIVE VALUE OF THREE PROGNOSTIC MARKERS S-PHASE FRACTION, PCNA AND MITOTIC COUNT ON AXILLARY LYMPH NODE METASTASIS IN CARCINOMA BREAST

Shahid Pervez, Muhammad Nadeem Khan, Muhammad Israr Nasir

Abstract


Background: Axillary lymph node metastasis is the single most important prognostic factor in
carcinoma of the breast. Therefore , prognostic markers that may reliably predict probability of
lymph node (LN) metastases are of great value. This study was conducted to compare the
predictive value of two novel prognostic / proliferative markers i.e. S-phase fraction (SPF) and
proliferating cell nuclear antigen (PCNA) in parallel with mitotic index. Methods: Data of
consecutive cases of infiltrating ductal carcinoma (IDC) breast diagnosed from July 2003 to July
2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, were
reviewed. A total of 112 cases of infiltrating ductal carcinoma (IDC) of the breast with axillary LN
sampling were selected. SPF was calculated by flow cytometry while PCNA staining was done by
immunohistochemistry. Mitotic count was calculated according to modified Bloom and
Richardson’s grading guidelines. Result: It was observed that the number of axillary LN
metastases was increased with higher SPF (p value: 0.008). However no significant difference
was 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 predicting
axillary LN metastases. SPF was found to be a more reliable marker compared to PCNA reactivity
and conventional mitotic count in predicting axillary LN metastases.
Keyword: S-phase fraction, Proliferating cell nuclear antigen, Mitosis, Axillary Lymph node.

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