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Confronto Interistituzionale Confronto Interistituzionale in Patologia Mammaria: in Patologia Mammaria: determinazione determinazione immunofenotipica di ER/PR immunofenotipica di ER/PR Licia Laurino and Angelo P. Licia Laurino and Angelo P. Dei Tos Dei Tos Dipartimenti di Patologia ed Dipartimenti di Patologia ed Oncologia Oncologia Treviso Treviso

Confronto Interistituzionale in Patologia Mammaria: determinazione immunofenotipica di ER/PR Licia Laurino and Angelo P. Dei Tos Dipartimenti di Patologia

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  • Confronto Interistituzionale in Patologia Mammaria: determinazione immunofenotipica di ER/PR Licia Laurino and Angelo P. Dei Tos Dipartimenti di Patologia ed Oncologia Treviso
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  • Breast Cancer Diagnosis NecessaryNecessary DifficultDifficult Insufficient for planning the adjuvant treatmentInsufficient for planning the adjuvant treatment
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  • St. Gallen Conference Absolute importance of timely, accurate and reliable histopathologic assessmentAbsolute importance of timely, accurate and reliable histopathologic assessment Target identification and quantitationTarget identification and quantitation Enhanced partnership between clinician and pathologists substantially improved outcomes.Enhanced partnership between clinician and pathologists substantially improved outcomes.
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  • Treatment Options Endocrine therapyEndocrine therapy Any detectable ER Anti HER2 therapyAnti HER2 therapy HER2 + (ASCO/CAP) ChemotherapyChemotherapy
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  • Gene Epression Signatures after a long debate, the Panel supported the use of a validated multigene-profiling assay, as an adjunct to high quality phenotyping of breast cancer in cases in which the indication for adj chemo remained uncertain
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  • Currently accepted prognostic/predictive parameters Patient AgePatient Age characteristics(Race) DiseaseTumor sizeDiseaseTumor size characteristicsTumor type Axillary status Tumor grade Peritum. vascular invasion BiomarkersReceptor statusBiomarkersReceptor status HER2/neu expression Ki-67 labeling index
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  • The histopathologic report Invasive ductal ca, NOS, G2, negative margins, with 2 lymph node mets in post-meno patient.Invasive ductal ca, NOS, G2, negative margins, with 2 lymph node mets in post-meno patient. ER: 90%; PgR 90%, HER2 negative, Ki67: 12%ER: 90%; PgR 90%, HER2 negative, Ki67: 12% Endocrine-responsive tumor with an intermediate risk. Adjuvant Tamoxifen for 2 yrs, followed by AI for additional 3 yrs. Then wait for the results of current trials of extended endocrine treatmentEndocrine-responsive tumor with an intermediate risk. Adjuvant Tamoxifen for 2 yrs, followed by AI for additional 3 yrs. Then wait for the results of current trials of extended endocrine treatment
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  • The histopathologic report Invasive ductal ca, NOS, G2, negative margins, with 2 lymph node mets in post-meno patient.Invasive ductal ca, NOS, G2, negative margins, with 2 lymph node mets in post-meno patient. ER: 90%; PgR 90%, HER2 negative, Ki67: 12%ER: 90%; PgR 90%, HER2 negative, Ki67: 12% Endocrine-responsive tumor with an intermediate risk. Adjuvant Tamoxifen for 2 yrs, followed by AI for additional 3 yrs. Then wait for the results of current trials of extended endocrine treatmentEndocrine-responsive tumor with an intermediate risk. Adjuvant Tamoxifen for 2 yrs, followed by AI for additional 3 yrs. Then wait for the results of current trials of extended endocrine treatment
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  • Taxane most effective on endocrine Non or INCOMPLETELY responsive tumorsTaxane most effective on endocrine Non or INCOMPLETELY responsive tumors Optimal ER/PgR/HER2 assessment Microtubule binding protein TAU predicts response to PaclitaxelMicrotubule binding protein TAU predicts response to Paclitaxel Topoisomerase II alpha amplification and protein overxpression predict response to anthracyclins (?)Topoisomerase II alpha amplification and protein overxpression predict response to anthracyclins (?) Basal like tumors (often associated with BRCA1) more responsive to DNA damaging agents (platinum)Basal like tumors (often associated with BRCA1) more responsive to DNA damaging agents (platinum) Increasing Roles for Pathologist
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  • External quality controls for ER UK-NEQAS (round #53) (#54)UK-NEQAS (round #53) (#54) Score >12/20 49%69% Score 10-12 27%16% Score
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  • J Nat Cancer Inst 2008, 100:836.
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  • CQ Veneto 09 Inviate sezioni di mammella normale, carcinoma papillare, (+vo) carcinoma adenoidocistico (-vo), carcinoma lobulare pleomorfo (debolmente +vo) 14 centri
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  • Nor ER Nor PR Pos ER Pos PR Neg ER Neg PR Deb ER Deb PR Metodica TVOK 100% 002% SP1 / 636 Polimero DAKO AOK-100% disomog 100% ++ 0Deb pos ? 2% deb 100% deb ? SP1/Ab8 ultravision COK 100% disomog 100%0030- 40% ? 0?0? Vector Polimero DAKO DDeb 50% disomog 100%0 Contr. Ins. 00 Contr. Ins. 0 Contr. Ins. SP1/Ab8 Bond-max EDeb-90% disomog 100%00