13
PT1a/b breast cancer Prognostic and predictive factors. Frédérique PENAULT LLORCA, France, on behalf of the ODISEE group (Nina RADOSEVIC-ROBIN, Magali LACROIX-TRIKI, Bernard LOUIS, Isabelle ROCHE- COMET, Marie-Sophie SOYBERAND, Florence DALENC, Yazid BELKACEMI)

Frederique Penault Llorca : PT1a/b breast cancer : Prognostic and predictive factors

Embed Size (px)

DESCRIPTION

 

Citation preview

Page 1: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

PT1a/b breast cancer

Prognostic and predictive factors.

Frédérique PENAULT LLORCA, France, on behalf of the ODISEE group (Nina RADOSEVIC-ROBIN, Magali LACROIX-TRIKI, Bernard LOUIS, Isabelle ROCHE-COMET, Marie-Sophie SOYBERAND, Florence DALENC, Yazid BELKACEMI)

Page 2: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Outlines

1. Definition

2. Specific specimens handling

3. Tumor characteristics

Page 3: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

PT1a/b breast cancer

• TNM UICC 2010, OMS 2012 classifications

─ T1mi: micro-invasion ≤1mm

• Associated to extended and:or high grade DCIS, distinct

entity?

─ T1a: >1mm & ≤5mm

─ T1b: >5mm & ≤10mm

• Clinical (T) vs pathological (pT)

─ Gross measurement (before fixation) vs microscopic

─ If multiple: size of the biggest

─ pT evaluation can be hampered by previous biopsies

(fragmentation, hematomas …..)

Page 4: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Mandatory items in the path report

National (INCa, 2011) et international guidelines1

• Tumor size

• Histologic type (OMS 2012)

• Elston et Ellis histologic grade

• In situ component (%, type, grade)

• Multicentricity or multifocality

• Surgical margins(mm)

• Embolies

• Hormonal receptors2: ER et PR

• HER2, whatever the size3,4

• Node status

• pT/pN stage (TNM UICC 2010)

1 Lester SC et al. Arch Pathol Lab Med 2009 2 Hammond ME et al. JCO 2010 3 Wolff AC et al. JCO 2007 4 Penault-Llorca et al. Ann Pathol 2010

HER2

Page 5: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Tissue handling

The inital biopsy might be the only tumor material => the pathologist

must spare tissue when possible

• Inclusion of biopsies in different

cassettes

• Whole inclusion of the tumor in

surgical specimen

• Do not exhaust the blocks

• Provide tumor phenotype on the

biopsies (ER, PR, HER2, +/- Ki67

Page 6: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Histopathological Characteristics

Hanrahan (2007)

Kennedy (2007)

Gonzalez-Angulo (2009)

Cancello (2011)

Theriault (2011)

Lacroix-Triki (2012)

Population T1a,b N0 T1a,b N0 T1a,b N0 T1mi,a,bN0 T1a,b N0 T1a,b N0

N 51246 123212 965 1691 1012 375

Histopath ductal lobular

77% 6%

74-76% 6%

77%

75% 9%

78%

72% 9%

Grade I II III

33% 46% 21%

78-82%

17-21%

42% 46% 12%

51% 40% 9%

Embolies 5% 4%

HR+ 83% 80-86% 83% 89% 76% 93%

HER2+ 10% 10% 9% 4%

Low Ki67 52% 95%

Page 7: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

0 10 20 30 40 50 60 70 80 90 100

CANALAIRE (CCI)

LOBULAIRE (CLI)

CCI / CLI

TUBULEUX

MEDULLAIRE

MICROPAPILLAIRE

MUCINEUX

METAPLASIQUE

PAPILLAIRE MIXTE

CRIBRIFORME

APOCRINE

pT1a pT1b

86%

14%

Median Tumor size= 8 mm

(1 – 10 mm)

CCI

CLI

other 72 %

11 %

17 %

*

* 53 % of tubular carc

Tumor size and histotype in Odissee

N = 323 N = 52

Page 8: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Histograde, proliferation, DCIS and invasion

CIS - CIS +

50.4 %

40.1 %

9.4 %

82.5 %

11.3

%

6.7 %

36 %

64 %

Elston & Ellis grade Mitotic count 10 HPF

Associated DCIS

LOW GRADE, LOW PROLIF, ~ 1/3 WITH DCIS

BAS

INTERMED

HAUT

Embolies

6 %

94 %

Absent Present

1

2

3

Page 9: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Hanrahan (2007)

Kennedy (2007)

Lacroix-Triki (2012)

Park (2012)

Population T1a,b N0 T1a,b N0 T1a,b N0 T1b,c N0

N 51246 123212 375 1043

Lobular Mixed

6% 6% 3-6%

9% 1%

3-5% 0.6-1%

Tubular

4-5% 9% 2-3%

Mucinous

3% 2-3% 1% 13-15%

Papillary

0.5% 1%

Micropapillary

2% 1%

Cribriform 0.5% 0.4%

Page 10: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Molecular subtypes

Molecular classification using IHC (ER, PR, HER2, Ki67, EGFR, CK5/6,

AR) 1, 2, 3

Cancello (2011)

Lacroix-Triki (2012)

Population T1mi,a,b N0 T1a,b N0

N 1691 375

Luminal A 52% 85%

Luminal B 37% 12%

HER2+ (RH-) 5% 1%

Triple negative / Basal-like

6%

1%

Apocrine 1%

• Luminal A = HR+, HER2-,

Ki67<14%)

• Luminal B = HR+ &

Ki67≥14% or HER2+

• HER2+ = HR - & HER2+

• Triple negative = HR - HER2-

• Basal-like = HR - HER2-

CK5/6+ and/or EGFR+

• Apocrine = HR- HER2 AR+

1 Cheang MC et al. JNCI 2009 2 Nielsen T et al. CCR 2004 3 Farmer P et al. Oncogene 2005

Page 11: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Molecular subtypes in OdisseeMOLECULAIRE

LUMINAL A

LUMINAL B

HER2

TRIPLE-NEG

BASAL-LIKE

TRIPLE-NEG

NON-BASAL-LIKE

APOCRINE

84.7 %

19.7 %

0.9 %

1.2 %

0.3 %

1.2 %

N = 324

N = 51 : missing data

Page 12: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

HER2+ sub group

Cancello et al. BCRT 2011, Gonzalez-Angulo et al.

JCO 2009, Sanchez-Munoz et al. Breast J 2010,

Theriault et al. Clin Breast Cancer 2011, Banerjee et

al. Lancet Oncol 2010, Chia et al. JCO 2008,

Curigliano JCO 2009, Joensuu et al. CCR 2003

• HER2 overexpression unfrequent: mean 6% of the cases

(range 4-14%)

• More frequent inT1mi/T1a

• High grade

• High proliferation (Ki67>20%) as compared to HER2-

• More frequently HR -

• With extended or multifocal DCIS

• Young age

HER2

Page 13: Frederique Penault Llorca  : PT1a/b breast cancer : Prognostic and predictive factors

Take-home messages

1. Same handling as other invasive breast cancer but a

specific strategy of tissue sparing should be

organized (importance +++ to specify the clinical size

in the request form)

2. Know the technical limitations due to the size of the

tumor

3. T1a,b N0 Profile: usually : invasive ductal – NOS, low

grade, low proliferation, HR+ (intense and diffuse),

HER2-, wihout embolies…