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