Abstract
BackgroundEstrogen receptor (ER) expression is important for treatment selection and prognostication of breast cancer patients. Although the metastases are the main targets of endocrine therapy, ER status is often based on the primary tumor. However, ER expression in breast cancer primary lesion may not match with its synchronous metastatic lesions in some cases. In this study, we analyzed ER expression concordance between breast cancer primary tumor and metastatic lesions.MethodsParaffin blocks of 100 primary breast invasive ductal carcinoma cases with axillary lymph node metastases were collected. Five tissue cores were punched out from individual primary breast cancer, and one tissue core from each lymph node metastases to assemble tissue microarrays for ER staining. Samples were then scored as 0, 1+, 2+, and 3+ according to the number and intensity of ER stained tumor cells.ResultsFor cases with ER 3+ (strong expression) in all cores of primary lesions (n = 38), ER expression in metastatic lymph node was found in 94.7% of the patients. 91.0% of the metastatic lymph nodes were ER positive, and 84.3% of them to be 3+. Among the 46 cases of ER negative expression in all cores of primary lesions, 39 of them had all the metastatic nodes being ER negative, and ER negative nodes were seen in 95.7% of the metastases. As for 16 cases of ER inconsistent expression in primary lesions, 4 cases showed negative ER expression in all metastatic nodes, 2 cases displayed diffuse consistent ER 3+ expression, and 10 cases displayed variant ER expression.ConclusionsThe findings suggest that ER expression concordance between breast cancer primary lesion and its matched metastatic lesions could be estimated by primary tumor ER expression pattern.
Highlights
Estrogen receptor (ER) expression is important for treatment selection and prognostication of breast cancer patients
The findings suggest that ER expression concordance between breast cancer primary lesion and its matched metastatic lesions could be estimated by primary tumor ER expression pattern
The metastases are the main targets of endocrine therapy, ER status is often based on the primary tumor
Summary
Estrogen receptor (ER) expression is important for treatment selection and prognostication of breast cancer patients. We analyzed ER expression concordance between breast cancer primary tumor and metastatic lesions. There are several studies reported the changes of ER expression in the metastatic tumors when compared to the primaries [1,2,3,4,5]. Change of ER status was regarded to be rare for metastasis [2, 4], whereas others found that metastatic tumors are different from the primary ones in ER expression [1, 3, 5]. Biological explanations for discrepant ER expression in metastases have been mentioned, including heterogeneity of the primary lesion, cancer cells early distant seeding, clonal selection, and therapy induced clonal evolution [6, 7].
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