title: Grading system for blood vessel tumor emboli of invasive ductal carcinoma of the breast.
abstract: We previously reported that the number of mitotic and apoptotic figures in tumor cells in blood vessel tumor emboli had the greatest significant power for the accurate prediction of the outcome of patients with invasive ductal carcinoma of the breast. The purpose of the present study was to devise a grading system for blood vessel tumor emboli based on the mitotic and apoptotic figures of tumor cells in blood vessel tumor emboli, enabling accurate prediction of the outcome of patients with invasive ductal carcinoma of the breast. We classified 263 invasive ductal carcinomas into the following 3 grades according to the numbers of mitotic and apoptotic figures in tumor cells located in blood vessels within 1 high-power field: grade 0, no blood vessel invasion; grade 1, absence of mitotic figures and presence of any number of apoptotic figures, or 1 mitotic figure and 0 to 2 apoptotic figures; and grade 2, 1 mitotic figure and 3 or more apoptotic figures, or 2 or more mitotic figures and 1 or more apoptotic figures. Multivariate analyses with well-known prognostic factors demonstrated that grade 2 blood vessel tumor emboli significantly increased the hazard ratios for tumor recurrence independent of the nodal status, pathological TNM stage, hormone receptor status, or HER2 status. The presently reported grading system for blood vessel tumor emboli is the strongest histologic factor for accurate prediction of the outcome of patients with invasive ductal carcinoma of the breast.
authors.affiliation: Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan; Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan. Electronic address: michikos612@gmail.com.
authors.forename: Michiko
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan. Electronic address: thasebe@saitama-med.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hasebe
authors.affiliation: Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan; Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Shimada
authors.affiliation: Department of Breast Oncology, Saitama Medical University Hospital, Iruma County, Saitama 350-0495, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Takeuchi
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yasuda
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ueda
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shigekawa
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Osaki
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan. Electronic address: tsaeki@saitama-med.ac.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saeki
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009383:Neoplasms, Vascular Tissue / Q000473:pathology* / Q000556:secondary; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011379:Prognosis
keywords: Apoptosis; Blood vessel; Breast; Caspase 3; MIB-1; Mitosis