title: Impact of molecular subtypes classification concordance between preoperative core needle biopsy and surgical specimen on early breast cancer management: Single-institution experience and review of published literature.
abstract: BACKGROUND
  Core needle biopsy (CNB) plays a crucial role as diagnostic tool for breast cancer (BC). The characterization of biomarkers status before surgical treatment is crucial when primary systemic therapy is a therapeutic option. The aim of this analysis was to report concordance between preoperative CNB and surgical specimen (SS) in evaluating biomarkers and molecular subtypes.
  
  
  METHODS
  Data have been collected from a cohort of 101 patients affected by early BC treated at Careggi Florence University Hospital, between January 2014 and March 2015. The conformity between molecular subtype classification was tested using kappa (κ) test.
  
  
  RESULTS
  Mean age was 57.5 years (range 29-86). There was concordance between the estrogen receptor (ER) assessment on CNB and SS in 95 cases (94.1%). Concordance of the progesterone receptor (PgR) assessment was observed in 89 cases (88.1%). Concordance for detecting immunohistochemistry-assessed BC molecular subtypes was 87.1% (κ = 0.78). Concerning Ki-67 evaluation, we report a concordance rate of 88.1% (κ = 0.68). The evaluation of luminal A plus luminal B/HER negative subgroup showed a κ-value of 0.65.
  
  
  CONCLUSIONS
  CNB showed good accuracy in evaluating hormonal receptors status, HER2, and BC molecular subtypes. Evaluation of Ki67 status was less accurate than other biomarkers; therefore, we recommend that it should be detected both on CNB and SS samples, especially in hormonal positive HER2 negative tumors, in order to avoid a misclassification of tumor subtypes that could lead to an omission of potential effective systemic therapy.
authors.affiliation: Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy. Electronic address: icro.meattini@unifi.it.
authors.forename: I
authors.initials: I
authors.lastname: Meattini
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bicchierai
authors.affiliation: Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Saieva
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: De Benedetto
authors.affiliation: Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Desideri
authors.affiliation: Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Becherini
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Abdulcadir
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Vanzi
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Boeri
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gabbrielli
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lucci
authors.affiliation: Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Sanchez
authors.affiliation: Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Casella
authors.affiliation: Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bernini
authors.affiliation: Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Orzalesi
authors.affiliation: Division of Pathological Anatomy, University of Florence, Florence, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Vezzosi
authors.affiliation: Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Greto
authors.affiliation: Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mangoni
authors.affiliation: Division of Pathological Anatomy, University of Florence, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bianchi
authors.affiliation: Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Firenze, University of Florence, Florence, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Livi
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Nori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008875:Middle Aged; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D064726:Triple Negative Breast Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D016217:Ultrasonography, Mammary
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Breast cancer; Core needle biopsy; Estrogen receptor; Ki-67 proliferative index; Molecular subtypes; Surgical specimen