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Comparative Analysis of the Histopathological

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Comparative Analysis of the Histopathological ORIGINAL ARTICLE J Bras Patol Med Lab. 2019; 55(1): 69-86. Comparative analysis of the histopathological and epidemiological profile of ductal and lobular breast carcinomas diagnosed at the Hospital de Clínicas da Universidade Federal do Paraná during 10.5935/1676-2444.20190009 the period 2008-2013 Análise comparativa do perfil histopatológico e epidemiológico dos carcinomas ductal e lobular da mama diagnosticados no Hospital de Clínicas da Universidade Federal do Paraná entre 2008 e 2013 Heloisa Z. Rocha; Graciele C. M. Manica; Lucia de Noronha; Edneia A. S. Ramos; Giseli Klassen Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil. ABSTRACT Introduction: Breast cancer is the second leading cause of cancer death among women worldwide, and epidemiological studies may help understanding its mechanisms. Objective: To carry out a survey of the number of breast cancer cases diagnosed in a period of six years. Methods: The profile of breast cancers diagnosed in a tertiary hospital in Curitiba was compared with the literature, using a retrospective analysis of ductal/special types and lobular breast carcinoma reports issued between 2008 and 2013. Results: Three hundred twenty-seven (91.6%) cases of ductal/special types carcinoma and 30 (8.4%) cases of lobular carcinoma were diagnosed, totaling 357 samples. From these cases, 27 (7.5%) were carcinoma in situ (20 ductal and seven lobular) and 330 (92.4%) were invasive carcinoma (307 invasive ductal/special types and 23 lobular). The prevalence of breast cancer among women was 99.1% and the majority of patients were older than 50 years of age (67.2%). Regarding the União Internacional de Controle do Câncer/American Joint Committee on Cancer (UICC/AJCC) staging, 49.2% of the ductal/special types tumors were diagnosed in Stages I or II, while 56.6% of lobular carcinomas were diagnosed in Stages II or III/IV. Regarding the Nottingham score, most cases were intermediate grade (43.9%). A total of 61% of the tumors were estrogen receptor positive (ER+) and 54% were progesterone receptor positive (PR+). Moreover, 36.1% presented positive human epidermal growth factor receptor 2 (HER2+), a rate higher than that indicated by the literature. Conclusion: The breast carcinomas evaluated in this study presented a profile similar to that reported in the literature, with some peculiarities inherent to the local pathology service. Nevertheless, the low frequency of in situ cases indicates failure in early diagnosis. Key words: ductal carcinoma of the breast; lobular carcinoma; pathology; epidemiology; oncology. RESUMO Introdução: O câncer da mama é a segunda causa de morte por câncer entre as mulheres em todo o mundo, e estudos epidemiológicos podem auxiliar no entendimento dos seus mecanismos. Objetivos: Realizar um levantamento do número de casos dos carcinomas da mama diagnosticados em um período de seis anos. Método: Foi comparado com a literatura o perfil dos carcinomas da mama diagnosticados em um hospital terciário de Curitiba, por meio da análise retrospectiva dos laudos de carcinomas da mama ductal/ tipos especiais e lobular de pacientes atendidos entre os anos de 2008 e 2013. Resultados: Foram diagnosticados 327 (91,6%) casos de carcinoma ductal/tipos especiais e 30 (8,4%) de carcinoma lobular, totalizando 357 amostras. Desses casos, 27 (7,5%) eram de First submission on 06/09/17; last submission on 01/04/18; accepted for publication on 11/30/18; published on 02/20/19 69 Heloisa Z. Rocha; Graciele C. M. Manica; Lucia de Noronha; Edneia A. S. Ramos; Giseli Klassen carcinoma in situ (20 ductal e sete lobular) e 330 (92,4%), invasores (307 ductal invasor + tipos especiais e 23 lobular). A prevalência de tumores da mama nas mulheres foi de 99,1%, tendo os pacientes, na sua maioria, mais de 50 anos (67,2%). Em relação ao estadiamento da União Internacional de Controle do Câncer/American Joint Committee on Cancer (UICC/AJCC), 49,2% dos tumores ductal + tipos especiais foram diagnosticados em estadio I ou II, enquanto 56,6% dos tumores lobular concentraram-se nos estadios II ou III/IV. Quanto à escala de Nottingham, grande parte dos casos era de grau intermediário (43,9%). Um total de 61% dos tumores eram receptor de estrogênio positivo (RE+) e 54%, receptor de progesterona positivo (RP+). Por outro lado, 36,1% apresentaram receptor 2 de fator de crescimento epidermal humano positivo (HER2+), taxa superior à indicada pela literatura. Conclusão: Os carcinomas da mama avaliados neste estudo apresentaram perfil semelhante ao exposto na literatura, com algumas peculiaridades inerentes ao serviço local. Entretanto, a baixa frequência de casos in situ indica falha no diagnóstico precoce. Unitermos: carcinoma ductal de mama; carcinoma lobular; patologia; epidemiologia; oncologia. RESUMEN Introducción: El cáncer de mama es la segunda causa de muerte por cáncer entre mujeres alrededor del mundo, y estudios epidemiológicos pueden contribuir al entendimiento de sus mecanismos. Objetivos: Determinar el número de casos de carcinoma de mama diagnosticados en un período de seis años. Método: El perfil de los carcinomas de mama diagnosticados en un hospital terciario de Curitiba ha sido comparado con aquel de la literatura, a través de análisis retrospectivo de historias de carcinoma de mama ductal/tipos especiales y lobulillar de pacientes atendidos entre los años de 2008 y 2013. Resultados: Se han diagnosticado 327 (91,6%) casos de carcinoma ductal/tipos especiales y 30 (8,4%) de carcinoma lobulillar, totalizando 357 muestras. De estos casos, 27 (7,5%) eran de carcinoma in situ (20 ductal y siete lobulillar) y 330 (92,4%), invasores (307 ductal invasor + tipos especiales y 23 lobulillar). La incidencia de tumores de mama en mujeres fue de 99,1%, siendo los pacientes, en su generalidad, mayores de 50 años (67,2%). Con respecto a la estadificación de Unión Internacional Contra el Cáncer/American Joint Committee on Cancer (UICC/AJCC), 49,2% de los tumores ductales + tipos especiales fueron diagnosticados en los estadios I o II, mientras 56,6% de los tumores lobulillares se concentraron en los estadios II o III/IV. En cuanto al sistema de Nottingham, gran parte de los casos era de grado intermediario (43,9%). Un total de 61% de los tumores era receptor de estrógeno positivo (RE+) y 54%, receptor de progesterona positivo (RP+). Por otro lado, 36,1% presentaron el receptor 2 del factor de crecimiento epidérmico humano positivo (HER2+), tasa superior a la indicada en la literatura. Conclusión: Los carcinomas de mama evaluados en este estudio presentaron perfil semejante al expuesto en la literatura, con algunas peculiaridades inherentes al servicio local. Sin embargo, la baja frecuencia de casos in situ indica fracaso en el diagnóstico precoz. Palabras clave: carcinoma ductal de mama; carcinoma lobulillar; patología; epidemiología; oncología. INTRODUCTION carcinoma), forming in situ or invasive lesions. It is also known that invasive mammary carcinoma are the most frequent, and 75% of them are subclassified in invasive ductal carcinoma/not Breast cancer is the most common and the second leading otherwise specified (IDC/NOS), 15% as lobular and 10% called cause of cancer death among women worldwide(1, 2). Although special subtypes(3-7). In addition, invasive breast carcinoma are the statistics account for it as a single disease, it is known that also categorized according to the immunophenotypic profile, it has several anatomopathological classifications and distinct through the immunohistochemical study for estrogen receptor carcinogenesis models, as well as specific epidemiological (ER), progesterone receptor (PR) and human epidermal trends(3-6). growth factor receptor 2 (HER2), important prognostic and In this context, studies indicate that approximately 95% predictive markers, that will define the treatment and clinical of mammary malignancies have epithelial origin (called management(3-5, 7). Anatomopathological evaluation is essential 70 Comparative analysis of the histopathological and epidemiological profile of ductal and lobular breast carcinomas diagnosed at the Hospital de Clínicas da Universidade Federal do Paraná during the period 2008-2013 for the definition of therapeutic approach and prognosis. The presence of estrogen receptor (ER), progesterone receptor (PR) same applies to epidemiological study, which defines the at-risk and human epidermal growth factor receptor 2 (HER2) molecular populations and disease screening protocol(5, 7). markers. Results regarding the hormone receptor expression were obtained. For the identification of these receptors the IHC method Therefore, the objective of this study was to carry out a was used, considering HER2 positive the cases scoring greater than survey of the cases of ductal, special types and lobular breast or equal to 2+ and using the Allred score for the classification of ER carcinomas diagnosed at the Clinical Hospital of the Federal and PR. This evaluation was performed during the period between University of Paraná [Hospital de Clínicas da Universidade 2008 and 2011 using the Advance TM method + DAB chromogen Federal do Paraná (HC-UFPR)] in the 2008-2013 period and to system with positive and negative internal controls. During the compare them with the literature. period between 2011 and 2013 the Envision method + Dual link system HRP + DAB was implemented in the IHC analysis. METHOD Statistical analysis Sampling The clinicopathological variables were sex, age, tumor staging A retrospective and analytical evaluation of 357 (UICC/AJCC), histological
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