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Visual assessment of Ki67 at a glance is an easy method to exclude many luminal-type breast cancers from counting 1000 cells

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Abstract

Background

The Ki67 labeling index (LI) reflects the proliferative activity of breast cancers and defines luminal A and B tumors; however, no detailed method to measure Ki67 has been standardized. Here, we propose a fast and easy way to evaluate Ki67.

Methods

Immunohistochemical staining of estrogen receptor (ER), progesterone receptor (PgR), HER2 and Ki67 (MIB-1) was performed on 235 primary invasive ductal carcinomas. For each sample, a hot spot with many Ki67+ cells was identified using a low-power field (40×, 4× objective). Three independent areas in high-power field (400×) were selected at the hot spot, and all cancer cells in the 3 areas were manually counted to calculate LI (% Ki67+ cells). Alternatively, micrographs taken at 100× and 200× fields including the hot spot were shown to 2 pathologists, who visually assessed percentages of Ki67+ cells in 10 % intervals at a glance (Eye-10).

Results

Eye-10 and LI were strongly correlated (r = 0.9412, P < 0.0001). All cases of Eye-10 ≥ 30 % had LI > 14 %; most of those <10 % had LI < 14 %. Of 170 ER+/HER2− tumors, Eye-10-based subtypes matched 87 % of LI-driven subtypes, and interobserver agreement was good (κ = 0.705).

Conclusion

Eye-10 is far easier than counting many cancer cells and useful for classifying breast cancers. Eye-10 can exclude obviously high and low Ki67 cases, leaving a “gray zone” around a cutoff point. Combining Eye-10 and manual counting is a good candidate for a standard method to evaluate Ki67.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Matsuyama Red Cross Hospital, 1 Bunkyo, Matsuyama, Ehime, 790-8524, Japan

    Akira I. Hida & Yumi Oshiro

  2. Department of Breast Surgery, Matsuyama Red Cross Hospital, Ehime, Japan

    Hiromichi Inoue & Hidetoshi Kawaguchi

  3. Division of Clinical Biostatistics, Center for Clinical Research, National Hospital Organization Shikoku Cancer Center, Ehime, Japan

    Natsumi Yamashita

  4. Department of Pathology 2, Kawasaki Medical School, Kurashiki, Japan

    Takuya Moriya

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  1. Akira I. Hida
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  2. Yumi Oshiro
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  3. Hiromichi Inoue
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  4. Hidetoshi Kawaguchi
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  5. Natsumi Yamashita
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  6. Takuya Moriya
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Correspondence to Akira I. Hida.

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Hida, A.I., Oshiro, Y., Inoue, H. et al. Visual assessment of Ki67 at a glance is an easy method to exclude many luminal-type breast cancers from counting 1000 cells. Breast Cancer 22, 129–134 (2015). https://doi.org/10.1007/s12282-013-0460-8

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  • DOI: https://doi.org/10.1007/s12282-013-0460-8

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