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Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis

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Abstract

Accurate determination of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor-2 (HER2) status was very important in selecting breast cancer treatment. Discordance of ER, PR, and HER2 status between core needle biopsy (CNB) and open excision biopsy (OEB) varied among reported studies. We performed a meta-analysis to compare the accuracy of CNB with that of OEB for ER, PgR, and HER2 status detection in breast cancer. Medical subject heading (MeSH) terms (Breast Neoplasm) and key words (biopsy OR mammotome) AND (incision OR excision OR surgery) AND (estrogen OR progesterone OR HER2 OR hormone). Patients with HER2 immunohistochemical 3+ or fluorescence in situ hybridization positive were classified into HER2[b] group. A total of 27 studies were eligible in this study. Aggregate positive ER and PgR rate was 80.0 and 69.5% for CNB; and 77.7 and 66.2% for OEB, respectively. The HER2 positive rate difference between CNB and OEB was only 0.2%. The pooled sensitivity of evaluating ER, PgR, and HER2 status in CNB compared with OEB was 0.970, 0.911, and 0.799 (0.813 for HER2[b]), respectively. All of AUC values for these status determination were larger than 0.9. Heterogeneity between studies was introduced by various factors in PgR and HER2[b] analysis. Subgroup analysis showed that the specificity and OR of CNB in studies with ER positive rate >78% was lower than studies with ER positive rate ≤78% (P < 0.05). This meta-analysis indicated that CNB had high diagnostic accuracy in evaluating ER, PgR, and HER2 status compared with OBE in breast cancer patients. In terms of 2–3% positive rate difference, ER and PgR status should be detected both on CNB and OEB samples, especially to retest their expression on CNB in patients with hormonal receptor negative tumors in OEB.

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References

  1. Harris L, Fritsche H, Mennel R et al (2007) American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 25(33):5287–5312

    Article  PubMed  CAS  Google Scholar 

  2. Perou CM, Sorlie T, Eisen MB et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752

    Article  PubMed  CAS  Google Scholar 

  3. Sorlie T, Perou CM, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874

    Article  PubMed  CAS  Google Scholar 

  4. Sorlie T, Tibshirani R, Parker J et al (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100:8418–8423

    Article  PubMed  CAS  Google Scholar 

  5. Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22(8):1736–1747

    Article  PubMed  CAS  Google Scholar 

  6. Bruening W, Fontanarosa J, Tipton K et al (2010) Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med 152(4):238–246

    PubMed  Google Scholar 

  7. Mueller-Holzner E, Fink V, Frede T et al (2001) Immunohistochemical determination of HER2 expression in breast cancer from core biopsy specimens: a reliable predictor of HER2 status of the whole tumor. Breast Cancer Res Treat 69(1):13–19

    Article  PubMed  CAS  Google Scholar 

  8. Cahill RA, Walsh D, Landers RJ et al (2006) Preoperative profiling of symptomatic breast cancer by diagnostic core biopsy. Ann Surg Oncol 13(1):45–51

    Article  PubMed  Google Scholar 

  9. Lorgis V, Algros MP, Villanueva C et al (2011) Discordance in early breast cancer for tumour grade, estrogen receptor, progesteron receptors and human epidermal receptor-2 status between core needle biopsy and surgical excisional primary tumour. Breast 20(3):284–287

    Article  PubMed  Google Scholar 

  10. Zamora J, Abraira V, Muriel A et al (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31

    Article  PubMed  Google Scholar 

  11. Taucher S, Rudas M, Mader RM et al (2004) Prognostic markers in breast cancer: the reliability of HER2/neu status in core needle biopsy of 325 patients with primary breast cancer. Wien Klin Wochenschr 116(1–2):26–31

    Article  PubMed  Google Scholar 

  12. Shet T, Agrawal A, Chinoy R et al (2007) Changes in the tumor grade and biological markers in locally advanced breast cancer after chemotherapy—implications for a pathologist. Breast J 13(5):457–464

    Article  PubMed  Google Scholar 

  13. Taucher S, Rudas M, Gnant M et al (2003) Sequential steroid hormone receptor measurements in primary breast cancer with and without intervening primary chemotherapy. Endocr Relat Cancer 10(1):91–98

    Article  PubMed  CAS  Google Scholar 

  14. Burge CN, Chang HR, Apple SK (2006) Do the histologic features and results of breast cancer biomarker studies differ between core biopsy and surgical excision specimens? Breast 15(2):167–172

    Article  PubMed  Google Scholar 

  15. Di Loreto C, Puglisi F, Rimondi G et al (1996) Large core biopsy for diagnostic and prognostic evaluation of invasive breast carcinomas. Eur J Cancer 32A(10):1693–1700

    Article  PubMed  Google Scholar 

  16. Railo M, Nordling S, Krogerus L et al (1996) Preoperative assessment of proliferative activity and hormonal receptor status in carcinoma of the breast: a comparison of needle aspiration and needle-core biopsies to the surgical specimen. Diagn Cytopathol 15(3):205–210

    Article  PubMed  CAS  Google Scholar 

  17. Zidan A, Christie Brown JS et al (1997) Oestrogen and progesterone receptor assessment in core biopsy specimens of breast carcinoma. J Clin Pathol 50(1):27–29

    Article  PubMed  CAS  Google Scholar 

  18. Al Sarakbi W, Salhab M, Thomas V et al (2005) Is preoperative core biopsy accurate in determining the hormone receptor status in women with invasive breast cancer? Int Semin Surg Oncol 22(2):15

    Article  Google Scholar 

  19. Mann GB, Fahey VD, Feleppa F et al (2005) Reliance on hormone receptor assays of surgical specimens may compromise outcome in patients with breast cancer. J Clin Oncol 23(22):5148–5154

    Article  PubMed  Google Scholar 

  20. Badoual C, Maruani A, Ghorra C et al (2005) Pathological prognostic factors of invasive breast carcinoma in ultrasound-guided large core biopsies-correlation with subsequent surgical excisions. Breast 14(1):22–27

    Article  PubMed  CAS  Google Scholar 

  21. Usami S, Moriya T, Amari M et al (2007) Reliability of prognostic factors in breast carcinoma determined by core needle biopsy. Jpn J Clin Oncol 37(4):250–255

    Article  PubMed  Google Scholar 

  22. Wood B, Junckerstorff R, Sterrett G et al (2007) A comparison of immunohistochemical staining for oestrogen receptor, progesterone receptor and HER-2 in breast core biopsies and subsequent excisions. Pathology 39(4):391–395

    Article  PubMed  CAS  Google Scholar 

  23. Hodi Z, Chakrabarti J, Lee AH, Ronan JE et al (2007) The reliability of assessment of oestrogen receptor expression on needle core biopsy specimens of invasive carcinomas of the breast. J Clin Pathol 60(3):299–302

    Article  PubMed  Google Scholar 

  24. Sutela A, Vanninen R, Sudah M et al (2008) Surgical specimen can be replaced by core samples in assessment of ER, PR and HER-2 for invasive breast cancer. Acta Oncol 47(1):38–46

    Article  PubMed  CAS  Google Scholar 

  25. Abdsaleh S, Wärnberg F, Azavedo E et al (2008) Comparison of core needle biopsy and surgical specimens in malignant breast lesions regarding histological features and hormone receptor expression. Histopathology 52(6):773–775

    Article  PubMed  CAS  Google Scholar 

  26. Hanley KZ, Birdsong GG, Cohen C et al (2009) Immunohistochemical detection of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression in breast carcinomas: comparison on cell block, needle-core, and tissue block preparations. Cancer 117(4):279–288

    PubMed  Google Scholar 

  27. Park SY, Kim KS, Lee TG, Park SS, Kim SM, Han W, Noh DY, Kim SW et al (2009) The accuracy of preoperative core biopsy in determining histologic grade, hormone receptors, and human epidermal growth factor receptor 2 status in invasive breast cancer. Am J Surg 197(2):266–269

    Article  PubMed  CAS  Google Scholar 

  28. Arnedos M, Nerurkar A, Osin P et al (2009) Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). Ann Oncol 20(12):1948–1952

    Article  PubMed  CAS  Google Scholar 

  29. Richter-Ehrenstein C, Müller S, Noske A et al (2009) Diagnostic accuracy and prognostic value of core biopsy in the management of breast cancer: a series of 542 patients. Int J Surg Pathol 4:323–326

    Article  Google Scholar 

  30. Apple SK, Lowe AC, Rao PN et al (2009) Comparison of fluorescent in situ hybridization HER-2/neu results on core needle biopsy and excisional biopsy in primary breast cancer. Mod Pathol 22(9):1151–1159

    Article  PubMed  CAS  Google Scholar 

  31. Tsuda H, Kurosumi M, Umemura S et al (2010) HER2 testing on core needle biopsy specimens from primary breast cancers: interobserver reproducibility and concordance with surgically resected specimens. BMC Cancer 10:534

    Article  PubMed  Google Scholar 

  32. Lebeau A, Turzynski A, Braun S et al (2010) Reliability of human epidermal growth factor receptor 2 immunohistochemistry in breast core needle biopsies. J Clin Oncol 28(20):3264–3270

    Article  PubMed  Google Scholar 

  33. Zagouri F, Sergentanis TN, Nonni A et al (2010) Comparison of molecular markers expression in vacuum-assisted biopsies and surgical specimens of human breast carcinomas. Pathol Res Pract 206(1):30–33

    Article  PubMed  Google Scholar 

  34. D’Alfonso T, Liu YF, Monni S et al (2010) Accurately assessing her-2/neu status in needle core biopsies of breast cancer patients in the era of neoadjuvant therapy: emerging questions and considerations addressed. Am J Surg Pathol 34(4):575–581

    Article  PubMed  Google Scholar 

  35. Uy GB, Laudico AV, Carnate JM Jr et al (2010) Breast cancer hormone receptor assay results of core needle biopsy and modified radical mastectomy specimens from the same patients. Clin Breast Cancer 10(2):154–159

    Article  PubMed  Google Scholar 

  36. Khoury T, Zakharia Y, Tan W et al (2011) Breast hormonal receptors test should be repeated on excisional biopsy after negative core needle biopsy. Breast J 17(2):180–186

    Article  PubMed  Google Scholar 

  37. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378(9793):771–784

    Google Scholar 

  38. Early Breast Cancer Trialists’ Collaborative Group (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100000 women in 123 randomised trials. Lancet 379(9814):432–444

    Google Scholar 

  39. Slamon D, Eiermann W, Robert N et al (2011) Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 365(14):1273–1283

    Article  PubMed  CAS  Google Scholar 

  40. Baselga J, Campone M, Piccart M et al (2012) Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med 366:520–529

    Article  PubMed  CAS  Google Scholar 

  41. Baselga J, Cortés J, Kim SB et al (2012) Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 366:109–119

    Article  PubMed  CAS  Google Scholar 

  42. Hammond ME, Hayes DF, Dowsett M et al (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28(16):2784–2795

    Article  PubMed  Google Scholar 

  43. Douglas-Jones AG, Collett N, Morgan JM et al (2001) Comparison of core oestrogen receptor (ER) assay with excised tumour: intratumoral distribution of ER in breast carcinoma. J Clin Pathol 54(12):951–955

    Article  PubMed  CAS  Google Scholar 

  44. Wolff AC, Hammond ME, Schwartz JN et al (2007) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol 25(1):118–145

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research was supported in part by the grants from Leading Academic Discipline Project of Shanghai Municipal Education Commission (Grant Number: J50208); Cancer Foundation of China (Grant Number: 0901) and Science and Technology Commission of Shanghai Municipality (Grant Number: 09411961400).

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Correspondence to Kunwei Shen.

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Xiaosong Chen and Ying Yuan contributed equally to this work.

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Chen, X., Yuan, Y., Gu, Z. et al. Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis. Breast Cancer Res Treat 134, 957–967 (2012). https://doi.org/10.1007/s10549-012-1990-z

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  • DOI: https://doi.org/10.1007/s10549-012-1990-z

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