Immunohistochemistry for diagnosis and prognosis of breast cancer: a review

[pic 1][pic 2]Biotechnic & Histochemistry

ISSN: 1052-0295 (Print) 1473-7760 (Online) Journal homepage: https://www.tandfonline.com/loi/ibih20

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Immunohistochemistry for diagnosis and prognosis of breast cancer: a review

T. Bonacho, F. Rodrigues & J. Liberal

To cite this article: T. Bonacho, F. Rodrigues & J. Liberal (2019): Immunohistochemistry

for diagnosis and prognosis of breast cancer: a review, Biotechnic & Histochemistry, DOI:

10.1080/10520295.2019.1651901

To link to this article: https://doi.org/10.1080/10520295.2019.1651901

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Published online: 10 Sep 2019.

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[pic 15]BIOTECHNIC & HISTOCHEMISTRY

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https://doi.org/10.1080/10520295.2019.1651901

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Immunohistochemistry for diagnosis and prognosis of breast cancer: a review

T. Bonachoa,  F. Rodrigues [pic 19]a,b,c, and J. Liberal [pic 20]a,b

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aEscola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco, Castelo Branco, Portugal; bQualidade de Vida no Mundo Rural (QRural), Instituto Politécnico de Castelo Branco, Castelo Branco, Portugal; cSport, Health & Exercise Unit (SHERU), Instituto Politécnico de Castelo Branco, Castelo Branco, Portugal

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ABSTRACT

Breast cancer is the most prevalent malignant tumor and main oncologic cause of mortality in women. Although most diagnosis of breast pathology is accomplished using hematoxylin and eosin stained sections, some cases require immunohistochemistry for proper evaluation. We investigated the latter cases including distinctions between ductal and lobular carcinoma, in situ and invasive carcinoma, typical ductal hyperplasia and atypical ductal hyperplasia/ductal carcinoma in situ, papillary and spindle cell lesion assessment, metastasis evaluation, and assessment of prognostic and therapy markers. E-cadherin is used to differentiate ductal and lobular carcinoma; 34βE12, CK8, p120 catenin and β-catenin also produce consistent results. Myoepithelial cell (MEC) stains are used to evaluate in situ and invasive carcinoma; calponin, smooth muscle myosin heavy chain and p63 are sensitive/ specific markers. 34βE12 and CK5/6 are positive in ductal hyperplasia, which enables its differentiation from atypical ductal hyperplasia and ductal carcinoma in situ. CK 5/6, ER and MEC markers are consistent options for evaluating papillary lesions. Spindle cell lesions can be assessed using β-catenin, SMA, CD34, p63, CKs and hormone receptors. It is important to differentiate primary carcinomas from metastases; the most commonly used markers to identify breast origin include mammaglobin, GCDFP-15, GATA3 and ER, although none of these is completely sensitive or specific. Immunohistochemistry can be used to evaluate central prognostic and predictive factors including molecular subtypes, HER2, hormone receptors, proliferation markers (Ki-67) and lymph-vascular invasion markers including ERG, CD31, CD34, factor VIII and podoplanin. Owing to the complexity of mammary lesions, diagnosis also depends on each particular situation, evaluation of cytological characteristics revealed by immunochemistry and correlation with histological findings.

KEYWORDS

Breast; cancer; diagnosis; immunohistochemistry; prognosis; review

Breast cancer is the most prevalent malignant tumor and the main oncologic cause of mortality in women in both developed and developing countries (Jemal et al. 2011). Risk factors that contribute to high incidence include unhealthy lifestyle, long time fertility, use of hormone based contraceptives, hormone replacement therapy, alcohol consumption, obesity after menopause and physical inactivity (Ghoncheh et al. 2016). Early diagnosis is vital for identifying high risk cases and providing the most appropriate treatment (Anothaisintawee et al. 2013).

Glandular and ductal breast tissue comprise three cell types: myoepithelial cells (MEC), basal cells and luminal cells. Each type expresses different protein subtypes, which are described in Table 1 (Lerwill 2004; Yeh I-T 2008; Liu 2014; Zaha 2014).

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Immunohistochemistry (IHC) for diagnosis

Ductal carcinoma vs. lobular carcinoma

Most invasive and in situ ductal and lobular carcinomas are identified easily using hematoxylin and eosin (H & E) stained sections. Some cases exhibit ambiguous morphological features, however, and IHC can be helpful for classifying the cancer. Accurate pathological classification is vital from a therapeutic standpoint, because ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) are treated differently (Khazai and Rosa 2015; Peng et al. 2017).