Abstract
Introduction
Breast cancer is a highly heterogenous tumor with different subtypes showing varying
prognosis. Tumor budding is an unfavorable histological feature of many epithelial
cancers. The purpose of this study is to analyze the association between tumor bud
density with various histological and immunohistochemical characteristics and to explore
its prognostic role in breast carcinoma.
Materials and Methods
A retrospective analysis was performed on 100 patients of breast cancer diagnosed
in our institute from January to December 2017. Hematoxylin and eosin (H&E) stained
slides from tumors and immunohistochemical slides were reviewed independently by two
pathologists, and clinical data were acquired from computerized records. Patients
on neoadjuvant chemotherapy were excluded from the study.
Results
The study comprised 100 patients of invasive breast carcinoma. The median age was
52 years, and 96% were invasive ductal carcinoma. The median follow-up was 34 months.
High tumor bud density was substantially correlated with primary tumor staging (T3,
T4; 73% [11/15] cases) and lymph node staging (N2, N3; 68% [13/19] cases) with p-values of 0.017 and 0.023, respectively. Systemic metastasis (85% [6/7] cases) was
significantly associated with high tumor bud density (p =0.025) but lymphovascular invasion (LVI) and perineural invasion (PNI) were not
significantly associated with tumor bud density (p = 0.762 and 0.862, respectively). Patients with N2 nodal stage had low event-free
survival rate than N0/N1 nodal stage irrespective of tumor bud status. Grade 3 tumors
with high tumor bud density had worse event-free survival than any other grades. There
was no association of tumor bud density with tumor staging, necrosis, PNI, LVI, estrogen
receptor (ER), progesterone receptor (PR) and Her2/neu, and event-free survival.
Conclusion
Strong relationships have been found between tumor bud density and poor prognostic
variables such as primary tumor staging and lymph node staging. These results provide
credence to the idea that tumor bud density can be an assessable prognostic feature
that should be taken into account while reporting breast cancer cases. Tumor bud density
evaluation has to be standardized nevertheless if it is to be widely adopted.
Keywords
breast carcinoma - event-free survival -
Her2/neu
- hormone receptors - tumor bud
