Carcinome du sein Biologie moléculaire Thomas McKee Service de Pathologie Clinique Genève
Pathology Diagnostic Prognostic information Predictive information The information provided depends on the available technology
Histology alone Breast cancer types
Breast Cancer One disease or many WHO classification
Ductal Lobular Medullary Mucinous
Histology alone Breast cancer types Tumor grade
Breast Cancer one disease or many Grading Bloom-Richardson Bloom-Richardson (BR) Score Frequency of cell mitosis Tubule formation Nuclear pleomorphism Bloom-Richardson Grade Low grade = BR score 3 5 = grade 1 Intermediate grade = BR score 6, 7 = grade 2 High grade = BR score 8, 9 = grade 3
ARCHITECTURE Score 1 Score 3 Score 2
Histology alone Breast cancer types Tumor grade Tumor stage
TNM Criteria T = Primary Tumor Tis = carcinoma in situ T1 = less than 2 cm in diameter T2 = between 2 and 5 cm in diameter T3 = more than 5 cm in diameter T4 = any size, but extends to the skin or chest wall N = Regional Lymph nodes N0 = no regional node involvement N1 = metastasis to movable same side axillary nodes N2 = metastasis to fixed same side axillary nodes N3 = metastasis to same side internal mammary nodes M = Distant Metastasis M0 = no distant metastasis M1 = distant metastasis
Breast Cancer Staging/Prognosis Stage TNM category 5 yr survival Recurrence free at 10 yrs 0 TisN0M0 99% 98% I T1N0M0 (all stage I) 92% 80% T<1 cm 90% T>1-2 cm 80-90% IIA T0N1M0;T2N0M0 82% 60-80% T1N1M0 50-60% IIB T3N0M0 65% 30-50% IIB T2N1M0 5-10% IIIA T0-2N2M0;T3N1-2M0 47% 10-40% IIIB T4N1-2M0; 44% 5-30% IIIC TanyN3M0 15-20% IV TanyNanyM1 14% <5%
Histology alone Breast cancer types Tumor grade Tumor stage Immunohistochemistry Hormone receptors
HE Presque 70% de carcinomes expriment les récepteurs hormonaux Estrogen receptor Progesterone receptor
Allred Immunohistochemistry Score Proportion score (0 1 1/100) (2 1/10) (3 1/3) (4 2/3) (5 1) Intensity score 0 = negative 1 = weak 2 = intermediate 3 = strong Total score = proportion score + intensity score (range 0, 2 8) Reprinted from Allred D, et al. Mod Pathol. 1998;11:155-168, with permission from Nature Publishing Group.
Histology alone Breast cancer types Tumor grade Tumor stage Immunohistochemistry Hormone receptors FISH/CISH HER-2
HER-2 The gene HER2/neu (ERBB2) is found on chromosome 17 (17p21) It is amplified in 10-20% of breast cancers. Breast cancers with ERBB2 amplification are more aggressive and have a worse prognosis than the average Targeted treatments are available trastuzumab
HER2 Testing Result Category IHC Score HER2 Protein Expression Testing Method FISH Score HER2 Gene Amplification Positive 3+ HER2/CEP17 ratio >2.2 Or Average gene copy number > 6 Equivocal 2+ HER2/CEP17 ratio 1.8-2.2 Or Average gene copy number 4-6 Negative 0-1+ HER2/CEP17 ratio < 1.8 Or Average gene copy number < 4 Defined as uniform intense membrane staining of >30% of invasive tumor cells
HER2 Testing HER2 analysis must be performed on the invasive component of breast cancer since HER2 overexpression and/or amplification is frequently increased in situ Equivocal results require additional action Equivocal Samples IHC FISH Confirm by FISH analysis of original sample Counting additional cells Or Repeating FISH
Immunohistochemistry: 1+
Immunohistochemistry: positive (3+)
FISH normal
FISH amplified
FISH amplified
HER-2 Problems 1. Heterogeneity
HER-2 Problems 1. Heterogeneity Solution selon ASCO Take an average report >2< And add to the report with tumor microheterogeneity
HER-2 Problems 1. Heterogeneity Solution selon ASCO Take an average report >2< with tumour microheterogeneity 2. Aneuploidy Additional or missing chromosomes
HER-2 Problems 1. Heterogeneity Solution selon ASCO Take an average report >2< with tumour microheterogeneity 2. Aneuploidy Solution Count the total HER2 signals, if more than 6 per cell, report as amplified
Does chromosome 17 centromere copy number predict polysomy in breast cancer? A fluorescence in situ hybridization and microarray based CGH analysis The Journal of Pathology Volume 219, Issue 1, pages 16-24, 8 MAY 2009 DOI: 10.1002/path.2574 http://onlinelibrary.wiley.com/doi/10.1002/path.2574/full#fig1
Histology alone Breast cancer types Tumor grade Tumor stage Immunohistochemistry Hormone receptors FISH/CISH HER-2 Expression profiling Diagnosis tumor typing
Breast cancer subtypes
Reproducibility of microarrays 295 breast cancers Agilent 24K microarrays 3 single sample predictors described by Perou and/ or Sorlie
Histology alone Breast cancer types Tumor grade Tumor stage Immunohistochemistry Hormone receptors FISH/CISH HER-2 Expression profiling Diagnosis tumor typing Prognosis
Commercially available prognostic multigene signatures for breast cancer
Oncotype DX (21-gene signature) ER+/ LN -/ Tamoxifen treated paients Proliferation Ki67 STK15 Survivin CCNB1 MYBL2 Invasion MMP11 CTSL2 CD68 BAG1 GSTM1 BAG1 CD68 Recurrence score Low risk RS 18 Intermediate risk 18>RS<31 High risk RS 31 HER2 GRB7 HER2 GSTM1 Oestrogen ER PGR BCL2 SCUBE2 Reference ACTB GAPDH RPLPO GUS TFRC
Importance of proliferation genes in prognostic signatures
Gene expression profiling: Does it add predictive accuracy to clinical characteristics in cancer prognosis? Daniela Dunkler a, d, Stefan Michiels b, c, d, Michael Schemper Explained variation in % Model without predictors 0 Standard error Model with clinical characteristics 16 ±5 Model with gene classifier 12 ±4 19 ±5 Model with clinical characteristics and gene classifier Gain by adding gene classifier to clinical characteristics 3 Clinical characteristics ER status, number of ln metastatic, histological grade
Histology alone Breast cancer types Tumor grade Tumor stage Immunohistochemistry Hormone receptors FISH/CISH HER-2 Expression profiling Diagnosis tumor typing Prognosis High throughput sequencing Personnalized medecine???
High Througput Sequencing Standard Sanger sequencing 600-1000 bp/run High throughput Roche Illumina Ion Torrent 6 600 X 10 bp per run
And Sequencing approaches. Cosmic database
Cancer genome landscapes. L D Wood et al. Science 2007;318:1108-1113 Published by AAAS
Somatic rearrangements observed in six of the twenty-four breast cancer samples screened. PJ Stephens et al. Nature 462, 1005-1010 (2009) doi:10.1038/nature08645
Tumour evolution inferred by single-cell sequencing Nicholas Navin1,2, Jude Kendall1, Jennifer Troge1, Peter Andrews1, Linda Rodgers1, Jeanne McIndoo1, Kerry Cook1, Asya Stepansky1, Dan Levy1, Diane Esposito1, Lakshmi Muthuswamy3, Alex Krasnitz1, W. Richard McCombie1, James Hicks1 & Michael Wigler1 Comparison of SK-BR-3 single cells to millions. N Navin et al. Nature 000, 1-5 (2011) doi:10.1038/nature09807
Sequencing of 50 breast cancer genomes all ER pos Ellis, Straton et al Genes PI3Kinase 40% TP53 20% MAP3K1 10% ATR 10% MyST3 10% Others <5% % of cancers harbouring mutations Suggests that there is much more heterogeneity that suggested by the expression profiling data
Does chromosome 17 centromere copy number predict polysomy in breast cancer? A fluorescence in situ hybridization and microarray based CGH analysis The Journal of Pathology Volume 219, Issue 1, pages 16-24, 8 MAY 2009 DOI: 10.1002/path.2574 http://onlinelibrary.wiley.com/doi/10.1002/path.2574/full#fig2
Breast Cancer Epidemiology: Breast cancer is the most common lethal neoplasm in women. The incidence varies among different populations 1 out of 8 women will have BC in her life-time. ~ 25 percent of women with cancer have BC. 0,5-1 % of all breast cancer cases occur in men.