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

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

  • 1. PT1a/b breast cancer Prognostic and predictive factors. Frdrique 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)
  • 2. Outlines 1. Definition 2. Specific specimens handling 3. Tumor characteristics
  • 3. 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 ..)
  • 4. 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
  • 5. 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
  • 6. 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%
  • 7. 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
  • 8. 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
  • 9. 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%
  • 10. 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-, Ki6720%) as compared to HER2- More frequently HR - With extended or multifocal DCIS Young age HER2
  • 13. 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