Abstract
Tumour-infiltrating lymphocytes (TILs) are an important component of the immune response to cancer and have a prognostic value in breast cancer. Although several studies have investigated the role of T lymphocytes in breast cancer, the role of B lymphocytes (TIL-Bs) in ductal carcinoma in situ (DCIS) remains uncertain. This study aimed to assess the role of TIL-Bs in DCIS. Eighty DCIS cases (36 pure DCIS and 44 mixed with invasive cancer) were stained immunohistochemically for B lineage markers CD19, CD20 and the plasma cell marker CD138. TIL-Bs density and localization were assessed, including relation to the in-situ and invasive components. An association with clinicopathological data and patient outcome was performed. Pure DCIS showed a higher number of TIL-Bs and lymphoid aggregates than DCIS associated with invasion. In pure DCIS, a higher number of peri- and paratumoral TIL-Bs was associated significantly with large tumour size (P = 0.016), hormone receptor (ER/PR) negative (P = 0.008) and HER2+ status (P = 0.010). In tumours with mixed DCIS and invasive components, cases with high-density B lymphocytes, irrespective of their location or topographic distribution, were associated significantly with variables of poor prognosis, including larger size, high grade, lymphovascular invasion, lymph node metastases, ER/PR-negative and HER2+ status. Outcome analysis showed that pure DCIS associated with higher numbers of B lymphocytes had shorter recurrence-free interval (P = 0.04); however, the association was not significant with the CD138+ plasma cell count (P = 0.07). Assessment of TIL-B cells based on location and topographic distribution can provide prognostic information. Validation in a larger cohort is warranted.
Highlights
Breast cancer is a heterogeneous disease, there is a great similarity between ductal carcinoma in situ (DCIS) and associated invasive carcinoma at the histological and molecular levels [1]
36 cases were of Ductal carcinoma in situ (DCIS) alone, while in 44 cases, DCIS was associated with an invasive
During the follow-up period, Ipsilateral local recurrence in pure DCIS occurred in 7/36 (19.4%) patients, of which 2 (5.5%) cases recurred as invasive disease
Summary
Breast cancer is a heterogeneous disease, there is a great similarity between ductal carcinoma in situ (DCIS) and associated invasive carcinoma at the histological and molecular levels [1]. The association with patient outcome in majority of the studies have focussed on the role of tumour infiltrating T lymphocytes (TILs) [5,6,7,8,9]. In tumours with mixed DCIS and invasive components, cases with high density B-lymphocytes, irrespective of their location or topographic distribution, were significantly associated with variables of poor prognosis including larger size, high grade, lymphovascular invasion, lymph node metastases, ER/PR negative and HER2+ status. Outcome analysis showed that pure DCIS associated with higher numbers of B-lymphocytes had shorter recurrence free interval (p=0.04), the association was not significant with CD138+ plasma cell count (p=0.07).
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