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Lymphocyte infiltration (LI) and immunohistochemistry (IHC) classification of metastatic breast cancer (MBC) correlation with medical survival.

1115 Background: IHC is a readily available pathologic technique that can be widely utilized to identify subsets of tumors with differing prognoses and treatment response. Small tissue cores used to construct microarray may not accurately represent characteristics of the whole tissue specimen. IHC staining with Estrogen Receptor (ER), Progesterone Receptor (PR), Her-2, and Ki-67 classifies breast tumors into molecular subtypes approximating gene array. Ki-67 index (>14%) distinguishes luminal A from luminal B. JNCI; 2009 101:736. LI has predicted response to neoadjuvant chemotherapy.


METHODS
An IRB-approved retrospective analysis of 110 patients presenting with MBC between 2001-2006 at Scott and White. Entry Criteria: 1) initial treatment at Scott and White Hospital 2) tissue blocks available. The tumor blocks were classified by IHC microarray from the center and leading edge of the tumor. LI was defined as lymphocytes invading the tumor epithelium by histological analysis on H&E stained slides. All cases were graded by the pathologists (CC, VS) as either present or absent.


RESULTS
Ki-67 proliferation indices were significantly higher at the leading edge and resulted in re-classification of 2 (12.5%) samples from luminal A to luminal B changing overall survival data. There were no significant differences in the hormonal markers (ER/PR/HER2Neu) when comparing leading edge versus central sampling. The median survival of patients treated with initial chemotherapy with LI was 64 months (n= 38) compared to 47 months (N=25) was not significant.


CONCLUSIONS
Microarray must be sampled from the leading edge to be a reliable method for Ki 67 classification of breast cancer subtypes. LI did not predict prolongation of survival in patients treated initially with chemotherapy. [Table: see text].