Japanese Journal of Clinical Oncology, Vol 28, Issue 8 486-491, Copyright © 1998 by Foundation for Promotion of Cancer Research
H Tsuda, F Akiyama, M Kurosumi, G Sakamoto and T Watanabe
BACKGROUND: A multi-institutional randomized clinical trial of adjuvant
therapy for patients with high-risk node-negative (n0) breast cancer has
been undertaken in Japan. The pathology panel was organized in order to
establish histological criteria to identify patient groups with higher
rates of recurrence. METHODS: Initially, three pathologists independently
judged the nuclear grade, composed of nuclear atypia and mitotic counts, of
100 n0 invasive ductal carcinomas, focusing on interobserver variation of
the nuclear grade and its correlation with patient prognosis. These
pathologists then gave consensus histological types and nuclear grades for
130 other n0 breast carcinomas and examined the prognostic significance of
the grade. RESULTS: In the first study, nuclear grade 2-3 significantly
identified a patient group with a rate of recurrence of 17-20% by any
pathologists and the degree of agreement for the grade was fair. In the
second study, the consensus type and nuclear grade identified a group (n =
66) with a 22% recurrence rate and another group (n = 64) with a 3.6%
recurrence rate at 10 years. In 12 tumors, the resection-fixation interval
of the tumor did not generate any significant difference in mitotic counts.
CONCLUSIONS: The histological type and the nuclear grade clearly identified
a higher-risk patient group with n0 breast carcinoma, and may be applied to
the multi-institutional protocol study when the criteria have been well
standardized by the pathologists.
CASE REPORTS
Establishment of histological criteria for high-risk node-negative breast carcinoma for a multi-institutional randomized clinical trial of adjuvant therapy. Japan National Surgical Adjuvant Study of Breast Cancer (NSAS-BC) Pathology Section
Pathology Division, National Cancer Center Research Institute and Hospital, Tokyo, Japan.
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