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Jenseits von Staging, Typing und Grading

Herausforderungen und Perspektiven für die Tumorpathologie der Mamma

Beyond staging, typing and grading

New challenges in breast cancer pathology

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Zusammenfassung

Tumorbiologische Parameter zur Prädiktion und Prognose gewinnen beim invasiven Mammakarzinom gegenüber den traditionellen pathologischen Kategorien eine immer größere Bedeutung. Die immunhistochemisch bestimmten Steroidhormonrezeptoren entscheiden nicht nur über eine endokrine Therapie, die mittlerweile bei auch geringster Expression empfohlen wird, sondern auch über eine mögliche Chemotherapie. Von annähernd gleicher Bedeutung ist der Her2-Status, der bei jedem invasiven Karzinom zu erheben ist, wobei die Reproduzierbarkeit sicherzustellen ist, was größere Anstrengungen verlangt als bei den Hormonrezeptoren. Nur eine kleinere Untergruppe der Mammakarzinome profitiert wahrscheinlich von einer Chemotherapie, jedoch genügen die traditionellen pathologischen Kategorien nicht zu ihrer zuverlässigen Identifikation. Aus diesem Grund wird nach alternativen prognostischen Parametern gesucht, von denen die Genexpressionsprofile am meisten versprechen. Trotz geringer Übereinstimmung in den einzelnen Genen konvergieren die verschiedenen Profile in der Identifikation der proliferationsaktiven Signatur als dem entscheidenden negativen Prognosefaktor. Ob das traditionelle Grading und eine immunhistochemische Proliferationsbestimmung des Ki-67-Antigens oder Genprofile zuverlässiger den aggressiven Subtyp identifizieren können, kann nur durch klinische Studien mit eingeschlossener standardisierter Pathologie entschieden werden.

Abstract

Tumor biological parameters for the prediction and prognosis of invasive breast cancer are gaining in importance compared to traditional pathological categories. The immunohistochemically determined steroid hormone receptor status is not only the decisive factor influencing whether endocrine therapy (which is indicated in cases of even slight expression) is given or not, but also whether chemotherapy is considered. The Her2 status is of similar importance and needs to be analysed in every case of invasive carcinoma, whereby reproducibility, which requires greater efforts than with steroid hormone receptors, has to be assured. Probably only a small portion of breast cancers will benefit from chemotherapy. Since traditional pathological categories are not sufficient for the identification of this subgroup, there has been an intense search for alternative prognostic parameters, whereby gene expression profiling has emerged as the most promising tool. Despite minimal concordance with regard to single genes, the various profiles available converge in the identification of the proliferative signature as the prognostically most relevant. Whether histopathological grading and immunohistochemical determination of the growth fraction with Ki-67 or genetic profiling will be more reliable in the identification of the aggressive subtype has yet to be clarified in clinical studies which encompass central pathological review.

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  1. Institut für Pathologie, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Deutschland

    H.H. Kreipe, P. Ahrens, M. Christgen, U. Lehmann & F. Länger

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  1. H.H. Kreipe
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  2. P. Ahrens
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  3. M. Christgen
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  4. U. Lehmann
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  5. F. Länger
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Correspondence to H.H. Kreipe.

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Kreipe, H., Ahrens, P., Christgen, M. et al. Jenseits von Staging, Typing und Grading. Pathologe 31, 54–59 (2010). https://doi.org/10.1007/s00292-009-1244-y

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