Abstract
Objectives: The aggressiveness of malignant tumors of breast can be correlated with the proliferation of neoplastic cells, and this detected by immunohistochemical study of proliferative index (Ki-67). American Society of Clinical Oncology (ASCO) does not recommend the use of Ki-67 routinely to predict the outcome of breast cancers, therefore the aim of current study is to detect the expression of Ki-67 in patients with primary breast cancer in Nineveh Province/North of Iraq and to correlate it with estrogen and progesterone receptors in addition to other prognostic factors. Methods: In this retrospective-case series study eighty cases of histologically proven primary breast carcinomas were included. The cases were collected from hospitals and private laboratories in Nineveh Province / North of Iraq and studied Immunohistochemicaly for Ki-67, estrogen receptor (ER) and progesterone receptor (PR) were done on tissue sections embedded in paraffin wax. An area with the maximum proliferation was chosen to evaluate Ki-67 and the cases with ≥20% positive nuclei were considered as high Ki-67 expression while those with <20% positive nuclei were considered as low Ki-67 expression.(10-14). The findings of Ki-67 were correlated with the age of the patients, histological type, grade of the tumors and with the estrogen and progesterone receptors. Results: The Ki-67 immunoreactivity was highly expressed in (45%) of the cases. Estrogen and progesterone receptors observed in (77.5%) and (67.5%) of the cases respectively. The Ki-67 was significantly associated with grade of tumor, estrogen receptor and progesterone receptor (P= 0.0057, 0.037 and 0.006 respectively). While the association with patientsˈage and histological types were not statistically significant. Conclusion: Ki-67 expression shows a significant direct correlation with grade of tumors and a significant inverse correlation has been shown with a well-known predictive factors, (estrogen and progesterone receptors).
Highlights
W orldwide, the most common malignant tumor in women is the breast cancer (BC)with an annually new diagnosed cases of more than 1.7 million patients and this number is increasing and may reach up to a 3.2 million per year by 2030.1
Regarding the histological types of the cases were included in the study; the majority of cases (69 out of 80) were of IDC-NOS, which form 86.25% of all the cases, the remaining cases were: 8 cases invasive lobular carcinoma (ILC) which form 10% and 3 cases were ductal carcinoma in situ (DCIS) which form 3.75% of all cases
The estrogen receptor (ER) was found to be positive in 62 cases (77.5%) while progesterone receptor (PR) was positive in 54 cases (67.5%), [Figure 1]
Summary
W orldwide, the most common malignant tumor in women is the breast cancer (BC)with an annually new diagnosed cases of more than 1.7 million patients and this number is increasing and may reach up to a 3.2 million per year by 2030.1. Since three decades in Iraq, BC is ranking the first among the Iraqi population.[2], in female BC account up to 29% of all newly diagnosed cancer and it is responsible for cancer related deaths in 14% of the cases.[3]. Better outcomes of breast cancer are associated with the expression of ER and PR receptors.[4 ], they act as predictors of a good response to hormonal (antiestrogen) therapy. Proliferation rates can give useful information on aggressiveness and prognosis of cancers, can be used as a guide for treatment regimen in clinical practice.[5] The Ki-. "Ki-67 is a non-histone nuclear cortex protein.[7,8], involved in the early steps of polymerase Idependent ribosomal RNA synthesis It was first identified in a Hodgkin lymphoma in 1983".8. "It is expressed in all continuously cycling cells of mid-
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