Evaluation of Ki-67 Proliferation Index in Breast Cancer Subtypes and Its Correlation with Various Histopathological and Other Prognostic Parameters
DOI:
https://doi.org/10.21276/apalm.3402Keywords:
Breast Cancer, Ki67 antigen, HER2 Proto-Oncogene ProteinAbstract
Background: The current classification of breast cancer is based on molecular markers. However, due to the unavailability of these markers in all healthcare institutes in developing countries like India, certain IHC markers such as ER, PR, HER2Neu, and Ki67 act as surrogate markers and play a crucial role in determining prognosis and targeted therapy for each patient. This study aims to evaluate Ki67 expression in breast carcinomas and its correlation with IHC status and other prognostic parameters of the tumor.
Materials and Methods: The study was conducted on 200 specimens of breast carcinoma cases received in the Pathology Department over a period of 18 months at RNTMC and MB Hospital, Udaipur. These specimens were processed and examined under a microscope to describe them in terms of histologic subtype, lymph node status, and histologic grade. IHC status of ER, PR, HER2Neu, and Ki67 was evaluated.
Results: The mean age of presentation was 48.3 years. The most common histologic subtype was Invasive Breast Carcinoma (NOS) (81%), and the IHC-based subtype was Luminal-A (54%). The most common histologic grade was Grade II (55%). High Ki67 expression was observed in many cases of Luminal-B, HER2neu-enriched, and triple-negative types of breast carcinoma. Low Ki67 expression was seen in the Luminal-A subtype. There is a significant correlation between tumor size, lymph node positivity, histologic grade, ER, PR, and HER2Neu status with Ki67 expression.
Conclusion: Ki67 is a significant biomarker of breast cancer because higher Ki67 correlates with higher tumor grade. Therefore, its evaluation, along with other IHC markers, can aid in the targeted treatment of the patient.
References
1. Alkabban FM, Ferguson T. Breast Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan [updated 2022 Sep 26].
2. World Health Organization. WHO report on breast cancer. Geneva: World Health Organization; 2021.
3. Torsten ON, Leung CYS, Rimm DL, et al. Assessment of Ki67 in breast cancer: updated recommendations from the International Ki-67 in Breast Cancer Working Group. J Natl Cancer Inst. 2021 Jul;113(7):808-19.
4. Goldblum JR, Lamps LW, McKenny JK, et al. Rosai and Ackerman’s surgical pathology. 11th ed. St. Louis: Mosby Inc; 2018. p. 1492-5.
5. Ye J, Wang W, Xu L, Duan X, et al. A retrospective prognostic evaluation analysis using the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system for luminal A breast cancer. Chin J Cancer Res. 2017 Aug;29(4):351-60.
6. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ. Strategies for subtypes - dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the primary therapy of early breast cancer 2011. Ann Oncol. 2011;22:1736-47.
7. Madani SH, Payandeh M, Sadeghi M, et al. The correlation of Ki-67 with other prognostic factors in breast cancer: a study in Iranian patients. Indian J Med Paediatr Oncol. 2016;37(2):95-9.
8. Nishimura R, Osako T, Okumura Y, Hayashi M, Toyozumi Y, Arima N. Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer. Exp Ther Med. 2010;1:747-54.
9. Li FY, Wu SG, Zhou J, et al. Prognostic value of Ki-67 in breast cancer patients with positive axillary lymph nodes: a retrospective cohort study. PLoS One. 2014;9:e87264.
10. Spyratos F, Ferrero-Poüs M, Trassard M, et al. Correlation between MIB-1 and other proliferation markers: clinical implications of the MIB-1 cutoff value. Cancer. 2002;94:2151-9.
11. Kang YJ, Lee HB, Lim YG, et al. Ki-67 expression is a significant prognostic factor only when progesterone receptor expression is low in estrogen-positive and HER2-negative early breast cancer. J Oncol. 2019;2019:7386734.
12. Wang L, Lu N, Chen C, Lu X. Identifying the optimal cut-off point of Ki-67 in breast cancer: a single-center experience. J Int Med Res. 2023 Aug;51(8):03000605231195468.
13. Kontzoglou K, Palla V, Karaolanis G, Karaiskos I, Alexiou I, Pateras I, et al. Correlation between Ki67 and breast cancer prognosis. Oncology. 2013;84:219-25.
14. Inwald EC, Klinkhammer-Schalke M, Ortmann O. Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat. 2013;139(2):539-52.
15. Trihia H, Murray S, Price K, Gelber RD, et al. Ki-67 expression in breast carcinoma: its association with grading systems, clinical parameters, and other prognostic factors—a surrogate marker? Cancer. 2003;97:1321-31.
16. Tahir M, Shahid S, Khanum A, Saeed S, Akhtar N. Ki-67 expression and its correlation with tumor size, grade, and lymph node status in breast cancer. J Clin Diagn Res. 2015;9(11):XC01-4.
17. Shin HJ, Jim JH, Kim J, Lee H, Lee HE, Kim YJ, et al. Ki-67 expression and its prognostic significance in breast cancer. J Breast Cancer. 2016;19(2):153-61.
18. Hashmi A, Hashmi K, Irfan M, et al. Ki-67 index in intrinsic breast cancer subtypes and its association with prognostic parameters. BMC Res Notes. 2019 Sep 23;12(1):605.
19. Mohammadizadeh F, Saeedzadeh A, Mehdipour P, Yavari P, Ebrahimi M. Ki-67 expression in breast cancer: correlation with clinicopathological features. J Clin Diagn Res. 2018;12(10):XC01-4.
20. Gulati A, Singh V, Raju S, Agarwal A, Sen R. Ki-67 expression in breast cancer: a study of 100 cases. J Cancer Res Clin Oncol. 2019;145(5):1051-8.
21. Amini SM, Saeed A, Mohammad F, Ebrahim M, et al. Correlation between Ki-67 expression and clinicopathological features in breast cancer. Iran J Pathol. 2012;7(3):155-62.
22. Liu S, Zhou X, Wang Y, Li X. Clinicopathological significance of Ki-67 expression in breast cancer. J Huazhong Univ Sci Technolog Med Sci. 2013;33(4):539-44.
23. González-Sistal A, Sánchez AB, Del Rio MC, et al. Association between tumor size and immunohistochemical expression of Ki-67, p53 and BCL2 in a node-negative breast cancer population. Anticancer Res. 2014;34:269-72.
24. Yavari P, Saeedzadeh A, Mehdipour P, Ebrahimi M. Correlation between Ki-67 expression and clinicopathological features in breast cancer. J Res Med Sci. 2012;17(10):931-6.
25. Colozza M, Azambuja E, Cardoso F, et al. Proliferative markers as prognostic and predictive tools in early breast cancer: where are we now? Ann Oncol. 2005;16:1723-39.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Aakhyaa Pandey, Sonal Bhati, Gunjan Bhatia, Namita Goyal
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).