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Frederique Penault Llorca : PT1a/b breast cancer : Prognostic and predictive factors.
1. PT1a/b breast cancer
Prognostic and predictive factors.
FrĂŠdĂŠrique 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)
3. PT1a/b breast cancer
⢠TNM UICC 2010, OMS 2012 classifications
â T1mi: micro-invasion â¤1mm
⢠Associated to extended and:or high grade DCIS, distinct
entity?
â T1a: >1mm & â¤5mm
â T1b: >5mm & â¤10mm
⢠Clinical (T) vs pathological (pT)
â Gross measurement (before fixation) vs microscopic
â If multiple: size of the biggest
â pT evaluation can be hampered by previous biopsies
(fragmentation, hematomas âŚ..)
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
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-,
Ki67<14%)
⢠Luminal B = HR+ &
Ki67âĽ14% or HER2+
⢠HER2+ = HR - & HER2+
⢠Triple negative = HR - HER2-
⢠Basal-like = HR - HER2-
CK5/6+ and/or EGFR+
⢠Apocrine = HR- HER2ďą AR+
1 Cheang MC et al. JNCI 2009
2 Nielsen T et al. CCR 2004
3 Farmer P et al. Oncogene 2005
11. Molecular subtypes in OdisseeMOLECULAI
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
12. 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
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 â NOS, low
grade, low proliferation, HR+ (intense and diffuse),
HER2-, wihout emboliesâŚ