Breast cancer prognostic classification in the molecular era: the role of histological grade.
Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. Current routine clinical management of breast cancer relies on the availability of robust clinical and pathological prognostic and predictive factors to support clinical and patient decision making in which potentially suitable treatment options are increasingly available. One of the best-established prognostic factors in breast cancer is histological grade, which represents the morphological assessment of tumor biological characteristics and has been shown to be able to generate important information related to the clinical behavior of breast cancers. Genome-wide microarray-based expression profiling studies have unraveled several characteristics of breast cancer biology and have provided further evidence that the biological features captured by histological grade are important in determining tumor behavior. Also, expression profiling studies have generated clinically useful data that have significantly improved our understanding of the biology of breast cancer, and these studies are undergoing evaluation as improved prognostic and predictive tools in clinical practice. Clinical acceptance of these molecular assays will require them to be more than expensive surrogates of established traditional factors such as histological grade. It is essential that they provide additional prognostic or predictive information above and beyond that offered by current parameters. Here, we present an analysis of the validity of histological grade as a prognostic factor and a consensus view on the significance of histological grade and its role in breast cancer classification and staging systems in this era of emerging clinical use of molecular classifiers.
Rakha
Emad A
EA
Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK.
Reis-Filho
Jorge S
JS
Baehner
Frederick
F
Dabbs
David J
DJ
Decker
Thomas
T
Eusebi
Vincenzo
V
Fox
Stephen B
SB
Ichihara
Shu
S
Jacquemier
Jocelyne
J
Lakhani
Sunil R
SR
Palacios
José
J
Richardson
Andrea L
AL
Schnitt
Stuart J
SJ
Schmitt
Fernando C
FC
Tan
Puay-Hoon
PH
Tse
Gary M
GM
Badve
Sunil
S
Ellis
Ian O
IO
D001943:Breast Neoplasms / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D005260:Female; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D011379:Prognosis; D012720:Severity of Illness Index; D047368:Tumor Burden
Breast Cancer Res Treat. 1994;32(3):281-90
7865856
Cancer. 1991 Nov 15;68(10):2142-9
1913453
Health Technol Assess. 2006 Sep;10(34):iii-iv, ix-xi, 1-204
16959170
Breast Cancer Res Treat. 1999 Jan;53(1):1-8
10206067
J Am Coll Surg. 2000 Jul;191(1):1-6; discussion 6-8
10898177
Am J Manag Care. 2005 May;11(5):313-24
15898220
J Natl Cancer Inst. 2007 Nov 21;99(22):1715-23
18000217
Arch Pathol Lab Med. 2000 Jul;124(7):966-78
10888772
Ann Pathol. 1998 Nov;18(5):385-90
9864574
N Engl J Med. 2004 Dec 30;351(27):2817-26
15591335
Indian J Cancer. 1999 Jun-Dec;36(2-4):149-53
10921219
J Natl Cancer Inst. 2006 Feb 15;98(4):262-72
16478745
N Engl J Med. 2006 Aug 10;355(6):560-9
16899776
J Clin Pathol. 2007 Dec;60(12):1300-6
17630399
Eur J Cancer. 2007 Jul;43(10):1545-7
17320376
Proc Natl Acad Sci U S A. 2003 Sep 2;100(18):10393-8
12917485
Eur J Cancer. 2009 May;45(7):1162-1167
19121932
Cancer. 1989 Nov 1;64(9):1914-21
2551477
Clin Cancer Res. 2008 Aug 15;14(16):5158-65
18698033
Proc Natl Acad Sci U S A. 2005 Mar 8;102(10):3738-43
15701700
Genes Chromosomes Cancer. 2009 Apr;48(4):351-65
19156836
Proc Natl Acad Sci U S A. 2003 Jul 8;100(14):8418-23
12829800
Int J Cancer. 2005 Sep 1;116(3):340-50
15818618
J Clin Oncol. 2007 Oct 20;25(30):4772-8
17876012
Eur J Surg Oncol. 1989 Feb;15(1):21-3
2645174
Pathol Res Pract. 1990 Dec;186(6):732-6
1964730
J Clin Pathol. 2002 Feb;55(2):88-92
11865000
J Clin Oncol. 2000 May;18(10):2059-69
10811671
J Natl Cancer Inst. 2008 Oct 1;100(19):1380-8
18812550
Anal Quant Cytol Histol. 2006 Aug;28(4):213-8
16927641
Hum Pathol. 1995 Aug;26(8):873-9
7635449
J Clin Oncol. 2006 Aug 10;24(23):3726-34
16720680
Histopathology. 1995 Sep;27(3):219-26
8522285
Histopathology. 2009 Dec;55(6):724-31
19845790
Lancet Oncol. 2009 Nov;10(11):1070-6
19801202
Aust N Z J Surg. 1984 Feb;54(1):11-5
6586161
Am J Clin Oncol. 2001 Feb;24(1):10-8
11232942
Breast Cancer Res. 2008;10(4):R65
18662380
Cancer. 2004 Apr 1;100(7):1331-6
15042664
Mod Pathol. 2006 Feb;19(2):195-207
16341153
Ann Surg. 2002 Jan;235(1):10-26
11753038
Eur J Cancer. 2007 Mar;43(4):745-51
17257824
Breast Cancer Res Treat. 2008 Mar;108(2):191-201
18297396
Cancer. 1986 Dec 15;58(12):2662-70
3536070
J Clin Pathol. 2006 Feb;59(2):138-45
16443727
Cancer Res. 2004 May 1;64(9):2962-8
15126326
Acta Oncol. 2000;39(1):41-5
10752652
Breast Cancer Res Treat. 2008 Sep;111(1):121-7
17929165
J Clin Pathol. 2001 Jan;54(1):20-4
11271783
Int J Oncol. 2002 Apr;20(4):791-6
11894126
Eur J Cancer. 2010 Jan;46(1):56-71
19811907
Eur J Cancer. 1999 Jun;35(6):908-12
10533470
Am J Clin Pathol. 1995 Feb;103(2):195-8
7856562
Breast Cancer Res Treat. 1992;22(3):207-19
1391987
Eur J Cancer. 2004 Aug;40(12):1837-41
15288284
J Surg Oncol. 1999 Jun;71(2):101-5
10389866
J Clin Oncol. 2001 Jan 1;19(1):28-36
11134192
Histopathology. 1991 Nov;19(5):403-10
1757079
Cancer. 2000 Feb 15;88(4):804-13
10679650
Eur J Cancer. 1995 Dec;31A(13-14):2289-95
8652258
Eur J Cancer. 2008 Jan;44(1):73-83
18035533
Cancer Cell. 2006 Dec;10(6):529-41
17157792
J Pathol. 2010 Jan;220(2):263-80
19927298
J Clin Oncol. 2006 May 1;24(13):2113-22
16648513
Ann Oncol. 2011 Sep;22(9):2021-2030
19955335
Ann Oncol. 2009 Aug;20(8):1319-29
19535820
N Engl J Med. 2002 Dec 19;347(25):1999-2009
12490681
Cancer Invest. 2008 Feb;26(1):1-10
18181038
Br J Cancer. 2000 Aug;83(4):487-92
10945496
Int J Surg Pathol. 2009 Aug;17(4):285-302
19103611
J Clin Oncol. 2002 Sep 1;20(17):3628-36
12202663
J Clin Oncol. 2010 Jan 1;28(1):99-104
19917872
J Clin Oncol. 2008 Jul 1;26(19):3153-8
18490649