title: Reliability of the Ki67-Labelling Index in Core Needle Biopsies of Luminal Breast Cancers is Unaffected by Biopsy Volume.
abstract: BACKGROUND
  Assessing prognostic and predictive factors like the Ki67 labelling index (Ki67-LI) in breast cancer core needle biopsies (CNB) may be hampered by undersampling. Our aim was to arrive at a representative assessment of Ki67-LI in CNB of luminal breast cancers by defining optimal cutoffs and establishing the minimum CNB volume needed for highest concordance of Ki67-LI between CNB and subsequent surgical excision biopsy (SEB).
  
  
  METHODS
  We assessed the Ki67-LI in CNB and subsequent SEB of 170 luminal breast cancers according to two counting methods recommended by the International Ki67 in Breast Cancer Working Group and applied the cutoffs to distinguish low and high proliferation given by the St Gallen 2013 and 2015 consensus, respectively. We then compared CNB volume characteristics for cases with concordant and discordant Ki67-LI between CNB versus SEB.
  
  
  RESULTS
  Highest concordance (75%, κ = 0.44) between CNB and SEB was achieved using the method that assesses the average tumor Ki67-LI and a cutoff of 20%. No significant differences were found between cases with concordant and discordant Ki67-LI in CNB versus SEB for number of biopsy cores, total core length, tumor tissue length, or total CNB or tumor tissue area size in the CNB for two various cutoffs.
  
  
  CONCLUSIONS
  A concordance of 75% between CNB and SEB can be achieved for the Ki67-LI using a method assessing average Ki67-LI at the threshold of 20%. Increasing CNB volume did not result in improved agreement rates, indicating that reliability of Ki67 levels in CNB of luminal breast cancers is unaffected by CNB volume.
authors.affiliation: Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany. Cornelia.Focke@web.de.|Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands. Cornelia.Focke@web.de.
authors.forename: C M
authors.initials: CM
authors.lastname: Focke
authors.affiliation: Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Decker
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: van Diest
mesh_terms: D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism*; D008207:Lymphatic Metastasis; D015588:Observer Variation; D015203:Reproducibility of Results
chemical_list: D019394:Ki-67 Antigen