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MCQS
Year : 2020  |  Volume : 57  |  Issue : 2  |  Page : 198-200
 

MCQs on “Study of ER, PR, HER2/neu, p53, and Ki67 expression in primary breast carcinomas and synchronous metastatic axillary lymph nodes”


1 Department of Medical Oncology and Hemato-Oncology, Narayana Superspeciality Hospital, Gurugram, Karnataka, India
2 Department of Radiation Oncology, Artemis Hospital, Gurugram, Karnataka, India
3 Department of Surgical Oncology, Command Hospital, Bangalore, Karnataka, India

Date of Submission08-Apr-2020
Date of Decision09-Apr-2020
Date of Acceptance09-Apr-2020
Date of Web Publication17-May-2020

Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-Oncology, Narayana Superspeciality Hospital, Gurugram, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_306_20

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How to cite this article:
Darling H S, Jayalakshmi S, Jaiswal P. MCQs on “Study of ER, PR, HER2/neu, p53, and Ki67 expression in primary breast carcinomas and synchronous metastatic axillary lymph nodes”. Indian J Cancer 2020;57:198-200

How to cite this URL:
Darling H S, Jayalakshmi S, Jaiswal P. MCQs on “Study of ER, PR, HER2/neu, p53, and Ki67 expression in primary breast carcinomas and synchronous metastatic axillary lymph nodes”. Indian J Cancer [serial online] 2020 [cited 2020 May 31];57:198-200. Available from: http://www.indianjcancer.com/text.asp?2020/57/2/198/284470




Questions:

  1. Allred score is used for evaluating immunoreactivity of which of the following markers in carcinoma breast


    1. ER/PR
    2. HER2/neu
    3. Ki 67
    4. P53


  2. As per this study, which of the following molecular markers have maximum discordance rates between primary breast cancer and axillary lymph nodes


    1. ER
    2. PR
    3. Her 2Neu
    4. Ki 67


  3. Which of the following statements about hormonal receptor status change (ER/PR) with respect to primary breast cancer and asynchronous metastatic sites is not true


    1. ER/PR conversion is associated with change in survival rates
    2. Salvage hormonal therapy is of no value in case of positive to negative receptor change
    3. With progression of disease, there may be change of receptor status
    4. Rates of receptor conversion in various studies are i n the range of 18-54%


  4. As per the current literature, which of the following markers has the least predictive and prognostic value


    1. PR
    2. HER2/neu
    3. p53
    4. Ki 67


  5. The possible mechanisms of molecular discordance in synchronous primary and axillary lymph node metastases are all except


    1. tumor heterogeneity
    2. receptor downregulation
    3. assay variability
    4. second synchronous primary


  6. A group of HER2/neu negative metastatic breast cancer patients with comparable disease load were biopsied at onset and then at disease progression. Which subgroup is likely to have the worst survival


    1. ER positive at both biopsies
    2. ER negative at both biopsies
    3. Initially ER positive, later ER negative
    4. Initially ER negative, later ER positive


  7. Choose the false option about Ki 67


    1. It is also called labelling index
    2. It is indicative of good chemotherapeutic sensitivity
    3. It is indicative of high aggressiveness
    4. It is a neither a predictive nor a prognostic marker


  8. Further action for a HER2/neu positive ipsilateral axillary lymph node with synchronous discordant HER2/neu negative primary breast invasive ductal carcinoma is


    1. to treat as HER2/neu positive cancer
    2. repeat biopsy of the primary
    3. repeat biopsy of primary as well as axillary lymph node
    4. treat as HER2/neu negative breast cancer


  9. In this study, of discordant cases, which marker had increased expression in axillary lymph nodes than breast primary


    1. ER
    2. PR
    3. HER2/neu
    4. Ki 67


  10. Which primary invasive breast cancer subtype will benefit the most from a discordant finding in axillary lymph node


    1. ER positive
    2. HER2/neu positive
    3. ER negative
    4. All of the above


Answers with Explanations and References:

1 (a) ER/PR

Allred score was used to evaluate the ER and PR, and a score of 3–8 was considered positive

2 (d) Ki 67



3 (b) Salvage hormonal therapy is of no value in case of positive to negative receptor change.

”ER and PR status may change several times during metastatic tumor progression. A change of HR from positive to negative was associated with worse survival compared with consistent positivity. Repeated evaluations of HR status are necessary in metastatic breast cancer. Salvage hormonal therapy is still worth trying for patients whose HR status changes from positive to negative. ”

Meng X, Song S, Jiang ZF, Sun B, Wang T, Zhang Sh, et al. Receptor conversion in metastatic breast cancer: A prognosticator of survival. Oncotarget 2016;7:71887-903.

4 (c) p53

”The results of the present study did not reveal a prognostic significance for p53 ”, “Further studies on p53 as a predictive factor for late recurrence and adjuvant chemotherapy are required ”

Ohara M, Matsuura K, Akimoto E, Noma M, Doi M, Nishizaka T, et al. Prognostic value of Ki67 and p53 in patients with estrogen receptor-positive and human epidermal growth factor receptor 2-negative breast cancer: Validation of the cut-off value of the Ki67 labeling index as a predictive factor. Mol Clin Oncol 2016;4:648-54.

Purdie CA, Quinlan P, Jordan LB, Ashfield A, Ogston S, Dewar JA, et al. Progesterone receptor expression is an independent prognostic variable in early breast cancer: A population-based study. Br J Cancer 2014;110:565-72.

5 (b) receptor downregulation

”There are several possible mechanisms for the conversion in ER, PR, and HER-2 expression. Firstly, technical artifacts and the variability in the accuracy of IHC tests may contribute to the difference of biomarker status between primary and recurrent tumors. Another possible etiology of receptor status changes is the clonal genome evolution and biological heterogeneity of the tumor.

Nguyen TH, Nguyen VH, Nguyen TL, Qiuyin C, Phung TH. Evaluations of biomarker status changes between primary and recurrent tumor tissue samples in breast cancer patients. Biomed Res Int 2019;2019:7391237.

6 (b) ER negative at both biopsies

”Worse survival was witnessed for patients with all three tumors negative for biomarkers ”

Lower EE, Khan S, Kennedy D, Baughman RP. Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press) 2017;9:515-20.

7 (d) is neither a predictive nor a prognostic marker

”Ki-67 expression is associated with common histopathological parameters, but is an additional independent prognostic parameter for DFS and OS in breast cancer patients. ”

Inwald EC, Klinkhammer-Schalke M, Hofstädter F, Zeman F, Koller M, Gerstenhauer M, et al. 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;139:539-52.

8 (a) to treat as HER2/neu positive cancer

”In the discordant cases, it is more frequent to have HER2-positive metastases with negative primary tumors than the opposite. ”

Rossi S, Basso M, Strippoli A, Dadduzio V, Cerchiaro E, Barile R, et al. Hormone receptor status and HER2 expression in primary breast cancer compared with synchronous axillary metastases or recurrent metastatic disease. Clin Breast Cancer 2015;15:307-12.

9 (d) Ki 67

KiLI was ≥10% in 63.3% cases in the PBC, which increased to 66.7% cases in the MALN (P = 0.848).

10 (c) ER negative

”Worse survival was witnessed for patients with all three tumors negative for biomarkers, and intermediate survival for those with discordant tumors. ”

Lower EE, Khan S, Kennedy D, Baughman RP.

Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press) 2017;9:515-20.






 

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