Simplified scoring system predicting HER-2 status in patients with breast carcinoma.

PURPOSE: The existing scoring systems HERSI (Kajo 2007) and DIVER (Taucher 2003) are based on the assumption that tumor grade, estrogen (ER) and progesterone receptors (PR) equally affect HER-2 status. Our idea was to propose a simplified scoring system (SIMPLY) which employs tumor characteristics according to their significance. METHODS: A total of 621 cases of invasive breast carcinoma with determined tumor grade, size, histological type, ER, PR, lymph node metastasis, lymphovascular invasion, age and HER-2 status were included in the study. The main features of the proposed system were simplicity in the scoring of ER and PR and emphasizing the role of tumor grade as the most important predictor of HER-2. RESULTS: The percentage of cases for which HER-2 assessment could be postponed was 33.98% for HERSI, 42.51% for DIVER, 53.62% for SIMPLY (score 5), and 66.34% for SIMPLY with a subgroup (score 3.5-5), when all scoring systems were applied to the same data set. CONCLUSION: In the SIMPLY group with the highest score, HER-2 assessment could be delayed, since the results from HER-2 assessment were not expected to affect patient management. SIMPLY could be helpful in improving patient care in countries lacking financial resources.

Correlation of steroid hormone receptor status with histological and nuclear grading in breast carcinoma.

PURPOSE: The present study was performed to evaluate the immunohistochemical analysis of estrogen receptor (ER) and progesterone receptor (PR) in invasive breast carcinomas of various histological subtypes and grades. In this paper an attempt was made to establish a correlation between hormone receptor status and histological and nuclear grading of breast carcinoma. MATERIALS AND METHODS: Immunohistochemistry was performed on paraffin sections of 80 invasive breast carcinomas (38 ductal, 18 lobular, 18 ducto-lobular, 2 medullary, 2 mucinous, 1 tubular and 1 papillary). The same scoring system was used for immunohistochemically stained ER and PR. The results were compared with the histological and nuclear grade and analyzed by the chisquare test. RESULTS: Positive immunoreactivity for ER and PR were seen in 71.25% and 60.00% cases, respectively. Both ER and PR positive immunostaining was observed in all (100%) well-differentiated (grade I) breast carcinomas, while in grade II tumors ER and PR-positive cancer cells were 76.36% and 61.62%, respectively. The corresponding figures for grade III carcinomas were 41.18% and 35.29%. A significant association (p <0.05) between different histological grades of breast carcinomas and ER and PR immunoreactivity was found. No significant association was found between nuclear grade of breast carcinoma and ER and PR immunoreactivity. CONCLUSION: The results presented herein suggest that histological grade of invasive breast carcinoma was significantly associated with ER and PR immunoreactivity, while nuclear grade alone showed no correlation. Moreover, our findings showed that ER and PR positivity declined with increasing tumor grade.