title: Identifying a highly-aggressive DCIS subgroup by studying intra-individual DCIS heterogeneity among invasive breast cancer patients.
abstract: The heterogeneity among multiple ductal carcinoma in situ (DCIS) lesions within the same patient also diagnosed with invasive ductal carcinoma (IDC) has not been well evaluated, leaving research implications of intra-individual DCIS heterogeneity yet to be explored. In this study formalin-fixed paraffin embedded sections from 36 patients concurrently diagnosed with DCIS and IDC were evaluated by immunohistochemistry. Ten DCIS lesions from each patient were then randomly selected and scored. Our results showed that expression of PR, HER2, Ki-67, and p16 varied significantly within DCIS lesions from a single patient (P<0.05 for PR; P<1×10(-8) for HER2, Ki-67 and p16). In addition, seventy-two percent of the individuals had heterogeneous expression of at least 2/6 markers. Importantly, by evaluating the expression of promising DCIS risk biomarkers (Ki-67, p53 and p16) among different DCIS subgroups classified by comparing DCIS molecular subtypes with those of adjacent normal terminal duct lobular units (TDLU) and IDC, our results suggest the existence of a highly-aggressive DCIS subgroup, which had the same molecular subtype as the adjacent IDC but not the same subtype as the adjacent normal TDLU. By using a systematic approach, our results clearly demonstrate that intra-individual heterogeneity in DCIS is very common in patients concurrently diagnosed with IDC. Our novel findings of a DCIS subpopulation with aggressive characteristics will provide a new paradigm for mechanistic studies of breast tumor progression and also have broad implications for prevention research as heterogeneous pre-invasive lesions are present in many other cancer types.
authors: Cancer Epigenetics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Dana
authors: D
authors: Pape-Zambito
authors: Cancer Epigenetics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Zhengyu
authors: Z
authors: Jiang
authors: Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Hong
authors: H
authors: Wu
authors: Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Karthik
authors: K
authors: Devarajan
authors: Cancer Epigenetics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Carolyn M
authors: CM
authors: Slater
authors: Cancer Epigenetics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Kathy Q
authors: KQ
authors: Cai
authors: Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Arthur
authors: A
authors: Patchefsky
authors: Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Mary B
authors: MB
authors: Daly
authors: Cancer Epigenetics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America.
authors: Xiaowei
authors: X
authors: Chen
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000235:genetics; D005260:Female; D005557:Formaldehyde; D015870:Gene Expression; D018740:Genetic Heterogeneity; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000235:genetics; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics; D011960:Receptors, Estrogen / Q000235:genetics; D011980:Receptors, Progesterone / Q000235:genetics; D016610:Tissue Embedding; D016707:Tissue Fixation; D016159:Tumor Suppressor Protein p53 / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; D019941:Cyclin-Dependent Kinase Inhibitor p16; D005557:Formaldehyde; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D016159:Tumor Suppressor Protein p53; C508053:ERBB2 protein, human