Review

Lymph node status as a guide to selection of available prognostic markers in breast cancer: the clinical practice of the future?

A Elzagheid^1,2 , T Kuopio³ , S Pyrhönen¹ and Y Collan²

¹  Department of Oncology and Radiotherapy, Turku University Hospital, Savitehtaankatu 1 PB 52, FIN-20521, Turku, Finland

²  Department of Pathology, University of Turku, and Turku University Hospital, Kiinamyllynkatu 10, FIN-20520, Turku, Finland

³  Department of Pathology, Jyväskylä Central Hospital, FIN-40620, Jyväskylä, Finland

author email corresponding author email

Diagnostic Pathology 2006, 1:41doi:10.1186/1746-1596-1-41

Published:	8 November 2006

Abstract

Prognosticators evaluating survival in breast cancer vary in significance in respect to lymph node status. Studies have shown e.g. that HER2/neu immunohistochemistry or HER2/neu gene amplification analysis do perform well as prognosticators in lymph node positive (LN +) patients but are less valuable in lymph node negative (LN -) patients. We collected data from different studies and tried to evaluate the relative significance of different prognosticators in LN+/LN- patient groups. In LN+ patients HER2/neu and E-cadherin immunohistochemistry were the statistically most significant prognosticators followed by proliferation associated features (mitotic counts by SMI (standardised mitotic index) or MAI (mitotic activity index), or S-phase fraction). Bcl-2 immunohistochemistry was also significant but p53 and cystatin A had no significance as prognosticators. In LN- patients proliferation associated prognosticators (SMI, MAI, Ki-67 index, PCNA immunohistochemistry, S-phase fraction) are especially valuable and also Cathepsin D, cystatin A, and p53 are significant, but HER2/neu or bcl-2, or E-cadherin less significant or without significance. We find that in studies evaluating single prognosticators one should distinguish between prognosticators suitable for LN+ and LN- patients. This will allow the choice of best prognosticators in evaluating the prospects of the patient. The distinction between LN+ and LN- patients in this respect may also be of special value in therapeutic decisions.