IJPPP Copyright © 2009-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Physiol Pathophysiol Pharmacol 2009;1(1):57-63.

Original Article
Predictive Markers in Primary Breast Cancer Compared With Lymph Node and
Bloodspread Metastases

Mohammad F. El-Sibai, Cynthia Cohen, Aziza Nassar, Sandra C. Bryant, Momin T. Siddiqui

Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA; Department of Pathology and
Laboratory Medicine, Mayo Clinic, Rochester, MN, USA; Division of Biomedical Statistics and Informatics, Department of Health
Sciences Research, Mayo Clinic, Rochester, MN, USA.

Received November 23, 2008; accepted February 9, 2009; available online February 15, 2009

Abstract: High levels of HER2 expression identify those patients who might benefit from treatments that target HER2. Among women
with metastatic breast cancer, the predictive markers may be different from the primary tumor. We compared predictive markers:
Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2 of primary breast carcinomas with those of lymph node (LN) and
blood spread metastases (BM). ER, PR and HER2 status were compared between the primary breast tumor and the LN metastasis
and blood spread metastasis. ER, PR and HER2 were performed on primary tumor core biopsies and available FNA cell blocks and on
metastatic lesions using FDA approved antibodies and HercepTest (Dako). ER and PR were positive when >/=10%. Her2 was positive
(amplified/expressed) when 3+ >30% by immunostain or >2.2 by FISH. Sixty four metastatic breast cancer patients were included in
this analysis. Forty-eight patients had LN metastases (35 [73 %] diagnosed by FNA) and twenty seven patients had BM (16 [60 %]
diagnosed by FNA). P value was determined comparing primary breast with BM and LN for ER, PR and HER2. ER p values when
compared for primary breast with BM and LN were 0.45 and 0.57 respectively, and for PR were 0.31 and 0.06 and for HER2 were 0.45
and 0.07. All three predictive markers are similar in the primary and two metastatic sites (lymph node, bloodspread). Only in primary
versus lymph node metastases is there a tendency for PR and HER2 (P values 0.06, 0.07) to be different. For HER2, the majority of
lymph node metastases are in cell blocks (FNA), fixed in ethanol rather than formalin, which may have caused false positive HER2
expression. (IJPPP902003).

Key words: Breast carcinoma, prognostic markers, metastatic breast cancer, hormone receptors

Full Text  PDF

Address all correspondence to:
Momin T. Siddiqui, MD
Department of Pathology and Laboratory Medicine
Emory University Hospital
1364 Clifton Road NE
Atlanta, GA. 30322
Tel No: 404-712-4188, Fax No: 404-712-0714