Original Article

Virchows Archiv

, Volume 450, Issue 6, pp 627-636

First online:

Grading invasive ductal carcinoma of the breast: advantages of using automated proliferation index instead of mitotic count

  • Ossama TawfikAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center Email author 
  • , Bruce F. KimlerAffiliated withDepartment of Radiation Oncology, Kansas University Medical Center
  • , Marilyn DavisAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center
  • , Christopher StasikAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center
  • , Sue-Min LaiAffiliated withDepartment of Preventive Medicine and Public Health, Kansas University Medical Center
  • , Matthew S. MayoAffiliated withDepartment of Preventive Medicine and Public Health, Kansas University Medical CenterCenter for Biostatistics and Advanced Informatics, Kansas University Medical Center
  • , Fang FanAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center
  • , John K. DonahueAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center
  • , Ivan DamjanovAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center
    • , Patricia ThomasAffiliated withDepartment of Pathology and Laboratory Medicine, Kansas University Medical Center
    • , Carol ConnorAffiliated withDepartment of Surgery, Kansas University Medical Center
    • , William R. JewellAffiliated withDepartment of Surgery, Kansas University Medical Center
    • , Holly SmithAffiliated withCenter for Biostatistics and Advanced Informatics, Kansas University Medical Center
    • , Carol J. FabianAffiliated withDepartment of Medicine, Oncology Division, Kansas University Medical Center

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Abstract

Breast carcinomas are graded according to the “Nottingham modification of the Bloom–Richardson system” (SBR). The system is hindered, however, by lack of precision in assessing all three parameters including nuclear grade, mitosis, and tubular formation, leading to an element of subjectivity. Our objective was to evaluate a new grading system [the nuclear grade plus proliferation (N+P) system] for subjectivity, ease, and better representation of tumor biology. Its components are nuclear grade and automated proliferation index. Invasive ductal carcinomas, consisting of 137 SBR grade I, 247 grade II, and 266 grade III, were re-evaluated by the N+P system. The two systems were compared with each other and correlated with patients’ overall survival, tumor size, angiolymphatic invasion, lymph node status, and biomarker status including estrogen receptor, progesterone receptor, p53, epidermal growth factor receptor, BCL-2, and Her-2. Although there was an agreement between the two systems with histologic and prognostic parameters studied, there was 37% disagreement when grading individual tumors. Fifty-three percent of SBR grade II tumors were “down-graded” to N+P grade I, and 7% were “up-graded” to N+P grade III. Distinction among the different histologic grades for overall survival curves was better indicated by the N+P than the SBR system.

Keywords

Invasive breast carcinoma grading MIB-1 (Ki-67) Immunohistochemistry Automation Image analysis Survival