Ki-67 immunostaining in human breast tumors and its relationship to prognosis

Article Abstract:

As it would be highly desirable to predict which breast cancer patients are at greatest risk for recurrence, and thus would be likely to benefit from more intensive therapy, considerable attention is being paid to possible prognostic factors. To date, the most reliable prognostic factors are tumor size, lymph node status, the concentration of hormone receptors on the tumor cells, and the histologic grade of the tumor. While the mitotic index, or the proportion of cells seen to be undergoing cell division under the microscope, constitutes one of the factors that determines tumor grade, the mitotic index is also a prognostic factor in its own right. However, the mitotic index varies greatly between observers and is sensitive to technical artifacts. The advent of monoclonal antibody techniques may provide a more practical method of quickly estimating the cell proliferation in a pathological specimen of breast tissue. Normal differentiated cells are sometimes said to be in G0, meaning they have given up replicating, left the cell cycle, and are going about their business as adult cells. Such cells do not express the Ki-67 antigen. In contrast, cells still cycling through the replicative process, whether in the G1, S, G2, or M phase, do express Ki-67. Therefore, monoclonal antibodies against Ki-67 can be used to label cells in tissue sections that are still traversing the cell cycle. To determine if such staining actually provides useful prognostic information for patients with breast cancer, sections of 63 breast cancers were stained and compared with sections of 37 nonmalignant breast specimens. The results showed that there was great overlap between the cancerous and the noncancerous tissues in the number of cells staining with Ki-67, although the cancerous tissues did have significantly greater staining with Ki-67. However, the Ki-67 staining was highly correlated with tumor stage, node status, and tumor grade. When the average Ki-67 staining was used as a cutoff point in the analysis, no additional information was added to conventional prognostic factors. However, if a higher cutoff was chosen, Ki-67 staining did provide independent prognostic information. The results suggest that for a minority of individuals with very high Ki-67 staining, the outcome of the disease is more likely to be poor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Tumor antigens, Tumor markers

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The clinical and histologic criteria that predict metastases from cystosarcoma phyllodes

Article Abstract:

Cystosarcoma phyllodes is a form of breast tumor. While cystosarcoma is generally benign, this tumor may also be cancerous and seed the metastatic dissemination of disease. Cystosarcoma phyllodes is similar in appearance to another breast tumor, fibroadenoma. Both tumors are composed of both ductal and stromal components. Ductal components resemble the structural components of breast tissue responsible for the tissue's function. In any normal or pathological tissue, the stromal components are those which contribute to the general structure and support of the tissue but do not contribute to its specialized function. The distinction between fibroadenoma and cystosarcoma phyllodes depends upon differences in the structure of the stromal component of the tumor. Tissue specimens from 33 cases of cystosarcoma phyllodes were examined to determine which microscopic features might distinguish between tumors that remained benign and those that developed metastases. The cystosarcoma phyllodes tumor had become malignant in eight of the 33 cases. Features which correlated with malignancy included mitotic index and nuclear pleomorphism. Mitotic index indicates the fraction of cells which are dividing at any moment; nuclear pleomorphism is the appearance of several different shapes and structures of nuclei within the cell. Infiltrating cells along the tumor margin were also suggestive of malignant potential. However, the strongest indicator of malignancy was found to be the overgrowth of the stromal component. Indeed, malignancy was not observed in any case which did not have stromal overgrowth. In the present series of patients, one woman with benign cystosarcoma phyllodes died of unrelated causes, while the remainder are alive without evidence of disease. Among the eight patients with malignant cystosarcoma only one has survived without evidence of disease, the remainder died of their malignancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

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