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To the Editor,
I wish to congratulate Gallardo and colleagues for their article [1], in which they evaluated the prognostic significance of Ki67 and aimed to determine the most accurate prognostic cut-off. They found that the prognosis of luminal breast carcinoma can be predicted using Ki67 as a continuous variable and a standard cut-off value of 14%. It was reported that interlaboratory reproducibility of Ki67 was moderate. Although central staining demonstrated a better intraclass correlation coefficient of 0.7, in the setting of local staining, the intraclass correlation coefficient was low, i.e., 0.59 [2]. Furthermore, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology do not recommend testing Ki67 routinely [3]. Therefore, Ki67 staining is not routinely carried out as a standard practice due to its inefficient reproducibility and insufficient recommendation other than for the purpose of clinical study.
References
Gallardo A, Garcia-Valdecasas B, Murata P, Teran R, Lopez L, Barnadas A, Lerma E (2017) Inverse relationship between Ki67 and survival in early luminal breast cancer: confirmation in a multivariate analysis. Breast Cancer Res Treat. doi:10.1007/s10549-017-4486-z [Epub ahead of print]
Polley M-YC, Leung SCY, Mcshane LM, Gao D, Hugh JC, Mastropasqua MG, Viale G, Zabaglo LA, Penault-Llorca F, Bartlett JMS, Gown AM, Symmans WF, Piper T, Mehl E, Enos RA, Hayes DF, Dowsett M, Nielsen TO (2013) An International Ki67 reproducibility study. J Natl Cancer Inst 105:1897–1906
https://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 04 Sep 2017
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Kadri Altundag has no conflicts of interest to declare.
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Altundag, K. Questions about Ki67 staining in luminal breast cancer. Breast Cancer Res Treat 167, 599 (2018). https://doi.org/10.1007/s10549-017-4515-y
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DOI: https://doi.org/10.1007/s10549-017-4515-y