Heterogeneity between Core Needle Biopsy and Synchronous Axillary Lymph Node Metastases in Early Breast Cancer Patients-A Comparison of HER2, Estrogen and Progesterone Receptor Expression Profiles during Primary Treatment Regime

Laura Weydandt; Ivonne Nel; Anne Kreklau; Lars-Christian Horn; Bahriye Aktas

doi:10.3390/cancers14081863

Heterogeneity between Core Needle Biopsy and Synchronous Axillary Lymph Node Metastases in Early Breast Cancer Patients-A Comparison of HER2, Estrogen and Progesterone Receptor Expression Profiles during Primary Treatment Regime

Cancers (Basel). 2022 Apr 7;14(8):1863. doi: 10.3390/cancers14081863.

Authors

Laura Weydandt¹, Ivonne Nel¹, Anne Kreklau¹, Lars-Christian Horn², Bahriye Aktas¹

Affiliations

¹ Department of Gynecology, Medical Center, University of Leipzig, 04103 Leipzig, Germany.
² Department of Pathology, Medical Center, University of Leipzig, 04103 Leipzig, Germany.

Abstract

In breast cancer therapeutic decisions are based on the expression of estrogen (ER), progesterone (PR), the human epidermal growth factor 2 (HER2) receptors and the proliferation marker Ki67. However, only little is known concerning heterogeneity between the primary tumor and axillary lymph node metastases (LNM) in the primary site. We retrospectively analyzed receptor profiles of 215 early breast cancer patients with axillary synchronous LNM. Of our cohort, 69% were therapy naive and did not receive neoadjuvant treatment. Using immunohistochemistry, receptor status and Ki67 were compared between core needle biopsy of the tumor (t-CNB) and axillary LNM obtained during surgery. The discordance rates between t-CNB and axillary LNM were 12% for HER2, 6% for ER and 20% for PR. Receptor discordance appears to already occur at the primary site. Receptor losses might play a role concerning overtreatment concomitant with adverse drug effects, while receptor gains might be an option for additional targeted or endocrine therapy. Hence, not only receptor profiles of the tumor tissue but also of the synchronous axillary LNM should be considered in the choice of treatment.

Keywords: Ki67; axillary lymph node metastases; breast cancer; core needle biopsy; estrogen; human epidermal growth factor receptor-2; progesterone; receptor change; receptor expression profiles; tumor heterogeneity.