Breast cancer prognostic classification in the molecular era: the role of histological grade

• Type of Material: Article
• Authors: Emad A. Rakha, Nottingham University Hospital NHS Trust; Jorge S. Reis-Filho, Institute of Cancer Research; Frederick Baehner, University of California San Francisco; David J. Dabbs, University of Pittsburgh; Thomas Decker, University Hospital Munster; Vincenzo Eusebi, Università-ASL Ospedale Bellaria; Stephen B. Fox, Peter MacCallum Cancer Center; Shu Ichihara, Nagoya Medical Center; Jocelyne Jacquemier, Institut Paoli-Calmettes; Sunil R. Lakhani, University of Queensland; José Palacios, Hospital Universitario Virgen del Rocio; Andrea L. Richardson, Harvard University; Stuart J. Schnitt, Beth Israel Deaconess Medical Center; Fernando C. Schmitt, University of Porto; Puay-Hoon Tan, Singapore General Hospital; Gary M. Tse, Prince of Wales Hospital; Sunil Badve, Emory University; Ian O. Ellis, Nottingham University Hospital NHS Trust
• Language: English
• Date: 2010-01-01
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © 2010 BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.1186/bcr2607
• Title of Journal or Parent Work: BREAST CANCER RESEARCH
• Volume: 12
• Issue: 4
• Start Page: 207
• End Page: 207
• Grant/Funding Information: JSR-F is funded in part by Breakthrough Breast Cancer. The funding sources had no role in the literature search or in the drafting and approval of the manuscript.
• Keywords: BLOOM-RICHARDSON SBR; COOPERATIVE-ONCOLOGY-GROUP; OUTCOME PREDICTION; Life Sciences & Biomedicine; ADJUVANT THERAPY; GENE-EXPRESSION SIGNATURE; CLINICAL CHARACTERISTICS; Science & Technology; TERM-FOLLOW-UP; INVASIVE LOBULAR CARCINOMA; INTEROBSERVER AGREEMENT; Oncology; REPRODUCIBILITY
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Oncology

Abstract

Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. Current routine clinical management of breast cancer relies on the availability of robust clinical and pathological prognostic and predictive factors to support clinical and patient decision making in which potentially suitable treatment options are increasingly available. One of the best-established prognostic factors in breast cancer is histological grade, which represents the morphological assessment of tumor biological characteristics and has been shown to be able to generate important information related to the clinical behavior of breast cancers. Genome-wide microarray-based expression profiling studies have unraveled several characteristics of breast cancer biology and have provided further evidence that the biological features captured by histological grade are important in determining tumor behavior. Also, expression profiling studies have generated clinically useful data that have significantly improved our understanding of the biology of breast cancer, and these studies are undergoing evaluation as improved prognostic and predictive tools in clinical practice. Clinical acceptance of these molecular assays will require them to be more than expensive surrogates of established traditional factors such as histological grade. It is essential that they provide additional prognostic or predictive information above and beyond that offered by current parameters. Here, we present an analysis of the validity of histological grade as a prognostic factor and a consensus view on the significance of histological grade and its role in breast cancer classification and staging systems in this era of emerging clinical use of molecular classifiers.