title: High Ki67 expression is a risk marker of invasive relapse for classical lobular carcinoma in situ patients.
abstract: BACKGROUND
  The clinical management of lobular carcinoma in situ lesions remains challenging. Our aim was to evaluate the risk of relapse for lobular carcinoma in situ (LCIS) patients, diagnosed on mammography performed for microcalcifications and according to proliferation assessed by Ki67 staining.
  
  
  METHODS
  A series of 47 patient's files with LCIS and followed in our institution were retrospectively selected. All patients underwent lumpectomy without radiation therapy. The expression of E-cadherin, estrogen receptor (ER), progesterone receptor (PR), EGFR and Ki67 were determined. Four different classes were then defined with the following criteria: ER+ and Ki67 ≤ 10%; ER+, Ki67 >10%; ER-; ER-PR- and EGFR+.
  
  
  RESULTS
  Patient's mean age was 51.3 yrs. The majority of the lesions were classical LCIS (97%). All cases were E-cadherin either negative (71%) or weak and incomplete (29%). Among the 44 evaluable cases, 34 cases were ER or PR positive with KI67 ≤ 10% (79%), 9 cases ER positive with KI67 > 10% (21%), 1 case was ER and PR negative and expressed EGFR. At five years, all patients were alive, 1/34 ER positive and Ki67 low experienced a relapse contrasting with 3 out of 9 ER positive and Ki67 high (3 invasive carcinomas including 2 ductal and 1 lobular) (p = 0.0054).
  
  
  CONCLUSIONS
  In this retrospective study, we observed a higher risk of relapse associated with a high proliferative activity of classical LCIS. If confirmed in larger series, this observation suggests that radiation therapy or hormonotherapy could be discussed for patients with Ki67 high classical LCIS in order to decrease their risk of relapse.
authors.affiliation: Department of Tumor Biology, Institut Curie, 26 rue d'ULM, 75248 Paris Cedex 05, France. anne.salomon@curie.net
authors.forename: Anne
authors.initials: A
authors.lastname: Vincent-Salomon
authors.forename: David
authors.initials: D
authors.lastname: Hajage
authors.forename: Alexandre
authors.initials: A
authors.lastname: Rouquette
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cédenot
authors.forename: Nadège
authors.initials: N
authors.lastname: Gruel
authors.forename: Séverine
authors.initials: S
authors.lastname: Alran
authors.forename: Xavier
authors.initials: X
authors.lastname: Sastre-Garau
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sigal-Zafrani
authors.forename: Alain
authors.initials: A
authors.lastname: Fourquet
authors.forename: Youlia
authors.initials: Y
authors.lastname: Kirova
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology*; D002278:Carcinoma in Situ / Q000378:metabolism / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D017404:In Situ Hybridization, Fluorescence; D019394:Ki-67 Antigen / Q000378:metabolism*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen