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Comparison of tumor-infiltrating lymphocytes of breast cancer in core needle biopsies and resected specimens: a retrospective analysis

  • Preclinical study
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Abstract

Purpose

Neoadjuvant chemotherapy (NAC) is being increasingly used to treat locally advanced breast cancer and to conserve the breast. In triple-negative breast cancer and HER2-positive breast cancer, a high density of tumor-infiltrating lymphocytes (TILs) is an important predictor of NAC response. Thus far, it remains unclear whether the TIL scores in core needle biopsies (CNBs) are closely representative of those in the whole tumor section in resected specimens. This study aimed to evaluate the concordance between the TIL scores of CNBs and resected specimens of breast cancer.

Methods

A total of 220 matched pairs of CNBs and resected specimens of breast cancer were included. Stromal TILs were scored on slides stained with hematoxylin and eosin. Clinicopathologic parameters and the agreement of the TIL scores between CNBs and resected specimens were statistically analyzed.

Results

The average TIL score was approximately 4.4% higher for the resected specimens than for the CNBs. When the tumors were divided into two groups according to a 60% TIL score cut-off (low and intermediate TIL vs. high TIL), 8.2% showed discordance between the CNB and resected specimen. The overall intraclass correlation coefficient (ICC) value of the TIL score was 0.895 (95% confidence interval, 0.864–0.920, P < 0.001), and all molecular subtypes showed ICC values over 0.8 (P < 0.001). The ICC values were > 0.9 when ≥ 5 cores were included in the CNBs. Tumors with discordant TILs were characterized by histologic grade III, ER negativity, high proliferative index, and HER2 and triple-negative subtypes. A high proliferative index was an independent risk factor for TIL discordance.

Conclusions

The TIL score in CNB specimens is a reliable value that reflects the TIL status of the entire tumor in resected specimens of breast cancer. More than five CNB cores may accurately predict the TIL score of the entire tumor.

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Abbreviations

CI:

Confidence interval

CNB:

Core needle biopsies

ER:

Estrogen receptor

H&E:

Hematoxylin and eosin

HER2:

Human epidermal growth factor receptor-2

ICC:

Intraclass correlation coefficient

LI:

Labeling index

NAC:

Neoadjuvant chemotherapy

PR:

Progesterone receptor

TNBC:

Triple-negative breast cancer

TIL:

Tumor-infiltrating lymphocytes

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Acknowledgements

The authors are deeply indebted to Hye Sun Lee, PhD, Biostatistics Collaboration Unit, Yonsei University College of Medicine, for her insightful comments that greatly improved the manuscript.

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Author notes

  1. Yoon Jin Cha and Sung Gwe Ahn have contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea

    Yoon Jin Cha, Jayeong Seo & Woo Hee Jung

  2. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea

    Sung Gwe Ahn, Soong June Bae, Chang Ik Yoon & Joon Jeong

  3. Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea

    Eun Ju Son

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  1. Yoon Jin Cha
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Correspondence to Joon Jeong.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Supplementary material 1 (TIF 26832 KB)

Supplementary Figure 1. Comparison of the subclassifications of tumor-infiltrating lymphocyte scores between resected specimens and core needle biopsies. (A) Three-tiered subclassification. (B) Two-tiered subclassification.

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Cha, Y.J., Ahn, S.G., Bae, S.J. et al. Comparison of tumor-infiltrating lymphocytes of breast cancer in core needle biopsies and resected specimens: a retrospective analysis. Breast Cancer Res Treat 171, 295–302 (2018). https://doi.org/10.1007/s10549-018-4842-7

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  • DOI: https://doi.org/10.1007/s10549-018-4842-7

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