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Mammakarzinomgraduierung an Gewebestanzen

Objektivierung mit dem Proliferationsmarker Ki-67

Improvement of breast cancer grading in punch biopsies

  • Schwerpunkt: Mammapathologie
  • Published:
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Zusammenfassung

Das Graduieren invasiver Mammakarzinome nach Bloom und Richardson (Nottingham-Modifikation, N-BRG) gehört zu den wichtigsten Prognosefaktoren neben Ausbreitung und Lymphknotenstatus. Die Reproduzierbarkeit im diagnostischen Alltag stellt bislang ein Problem dar. Häufig sind die geforderten Kriterien zu Auswahl und Umfang der zu graduierenden Fläche in Stanzbiopsien nicht einzuhalten.

Retrospektiv wurde an 346 Fällen ein Vergleich der Routinegraduierung am Operationspräparat mit einer der Stanzbiopsie äquivalenten kleinen Gewebemenge durchgeführt. Daneben wurde eine modifizierte Graduierung dieser kleinen Gewebemengen entwickelt mit Ki-67-Immunhistochemie und Kerngrößenmessung.

Beim modifizierten Grading wurden je 1–3 Punkte für Ki-67 und den durchschnittlichen maximalen Kerndurchmesser vergeben. Die Tubulusbildung wurde mit 1 oder 2 Punkten bewertet. Ein Vergleich mit rezidivfreiem Überleben und Gesamtüberleben zeigte signifikante Prognoseunterschiede zwischen Fällen mit 3–5 Punkten (niedriges Risiko) und 6–8 Punkten (hohes Risiko) in der univariaten und multivariaten Analyse.

An kleinen Gewebeproben wie einer Stanze sind die Auswertekriterien des N-BRG nicht zu erfüllen. In unserer Serie war nur für nodal-negative Fälle ein prognostischer Wert nachweisbar. Nach Modifikation durch objektivierbare Parameter wie Kerngrößenmessung und Ki-67-Proliferationsindex kann aber auch an kleinen Gewebeproben eine signifikante Prognoseabschätzung sowohl für nodal-negative als auch nodal-positive Fälle erfolgen.

Abstract

The grading of invasive breast cancers according to Bloom and Richardson (Nottingham modification) provides one of the most important prognostic factors in addition to size and the status of the lymph nodes. Diagnostic reproducibility has been problematic in daily practice as the required criteria for selection and extent of the grading area are frequently not present in the punch biopsies.

A total of 346 cases were retrospectively used to compare routine grading from surgical preparations with an equivalently small sample from punch biopsies. In addition, a modified grading of these small samples was developed with Ki-67 immunochemistry and the measurement of core size.

In the case of modified grading, 1–3 points were given for Ki-67 and average maximum core diameter. Tubule development was evaluated with 1 or 2 points. A comparison for recurrence free survival and total survival showed significant prognostic differences between 3–5 points (low risk) and 6–8 points (high risk) in uni- and multivariate analyses.

The evaluation criteria for Nottingham-Bloom-Richardson grading in a small tissue sample, such as that from a punch biopsy, can hardly be fulfilled. In our series, prognostic value was only found for nodal negative cases. After modification using objective parameters such as nuclear size measurement and Ki-67 proliferation index, a small tissue sample can prove to be of significant prognostic value for nodal negative as well as nodal positive cases.

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Dr. R. von Wasielewski besitzt ein Patent auf die verwandte Technik zur Multiblock Herstellung und ist geschäftsführender Gesellschafter der multiblock GmbH, Hannover.

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Authors and Affiliations

  1. Institut für Pathologie, Medizinische Hochschule, Carl-Neuberg Straße 1, 30625, Hannover

    R. von Wasielewski, K. Klöpper &  H. Kreipe

  2. Brustzentrum, Medizinische Hochschule Hannover

    H. J. Lück

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  1. R. von Wasielewski
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  2. K. Klöpper
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  3. H. J. Lück
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  4. H. Kreipe
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Correspondence to H. Kreipe.

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von Wasielewski, R., Klöpper, K., Lück, H.J. et al. Mammakarzinomgraduierung an Gewebestanzen. Pathologe 27, 337–345 (2006). https://doi.org/10.1007/s00292-006-0855-9

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  • DOI: https://doi.org/10.1007/s00292-006-0855-9

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