Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma 英文参考文献.docVIP

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Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma 英文参考文献.doc

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Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma 英文参考文献

Yenidunyaetal.DiagnosticPathology2011,6:18 /content/6/1/18 RESEARCH OpenAccess Predictivevalueofpathologicaland immunohistochemicalparametersforaxillary lymphnodemetastasisinbreastcarcinoma SibelYenidunya*,ReyhanBayrak,HacerHaltas Abstract Background/Objective:Whileseveralprognosticfactorshavebeenidentifiedinbreastcarcinoma,theclinical outcomeremainshardtopredictforindividualpatients.Betterpredictivemarkersareneededtohelpguide difficulttreatmentdecisions.Axillarylymphnodemetastasis(ALNM)isoneofthemostimportantprognostic determinantsinbreastcarcinoma;however,thereasonswhytumorsvaryintheircapabilitytoresultinaxillary metastasisremainunclear.IdentifyingbreastcarcinomapatientsatriskforALNMwouldimprovetreatment planning.ThisstudyaimedtoidentifythefactorsassociatedwithALNMinbreastcarcinoma,withparticular emphasisonbasal-likephenotype. Methods:Breastcarcinomapatients(n=210)whounderwentbreastconservingsurgeryandaxillarylymphnode dissection(ALND)(levelIandII)ormodifiedradicalmastectomywereincludedinthisstudy.Pathologicaland immunohistochemicaldataincludingindividualreceptor/genestatuswascollectedforanalysis.Thebasal phenotypestatuswasascertainedusingthebasalcytokeratinmarkersCK5,CK14,CK17andEGFR. Results:ALNMwasfoundin55%(n=116)ofthepatients.Onunivariateanalysis,multicentricdisease,largetumor size(2cm),vascularandlymphaticinvasion,epithelialhyperplasia,necrosis,insitucarcinomaandperineural invasionwereassociatedwithhigherriskforALNM,whereasCK5,CK14,EGFRpositivityandbasal-liketumortype wereassociatedwithlowerrisk.Onmultivariateanalysis,CK5positivity(OR0.003,95%CI0.000-0.23,p=0.009)and lymphatic/vascularinvasion(OR17.94,95%CI4.78-67.30,p0.001)werefoundtobeindependentpredictors. Conclusions:AlthoughthevalueofcompleteALNDhasbeenquestionedininvasivebreastcancerpatients, treatmentdecisionsforbreastcarcinomahavebeeninfluencedbymanyparameters,includinglymphnodestatus. Sincehistopathologiccharacteristicsandexpressionofbiologicalmarkersvariesamongthesamehistologic subtypesofbreastca