Virchows Archiv

, Volume 450, Issue 6, pp 627–636 | Cite as

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

  • Ossama Tawfik
  • Bruce F. Kimler
  • Marilyn Davis
  • Christopher Stasik
  • Sue-Min Lai
  • Matthew S. Mayo
  • Fang Fan
  • John K. Donahue
  • Ivan Damjanov
  • Patricia Thomas
  • Carol Connor
  • William R. Jewell
  • Holly Smith
  • Carol J. Fabian
Original Article

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 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Ossama Tawfik
    • 1
  • Bruce F. Kimler
    • 2
  • Marilyn Davis
    • 1
  • Christopher Stasik
    • 1
  • Sue-Min Lai
    • 3
  • Matthew S. Mayo
    • 3
    • 5
  • Fang Fan
    • 1
  • John K. Donahue
    • 1
  • Ivan Damjanov
    • 1
  • Patricia Thomas
    • 1
  • Carol Connor
    • 4
  • William R. Jewell
    • 4
  • Holly Smith
    • 5
  • Carol J. Fabian
    • 6
  1. 1.Department of Pathology and Laboratory MedicineKansas University Medical CenterKansas CityUSA
  2. 2.Department of Radiation OncologyKansas University Medical CenterKansas CityUSA
  3. 3.Department of Preventive Medicine and Public HealthKansas University Medical CenterKansas CityUSA
  4. 4.Department of SurgeryKansas University Medical CenterKansas CityUSA
  5. 5.Center for Biostatistics and Advanced InformaticsKansas University Medical CenterKansas CityUSA
  6. 6.Department of Medicine, Oncology DivisionKansas University Medical CenterKansas CityUSA

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