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What Is Ki-67 Breast Cancer

What Is A High Ki

Ki-67 shows proven clinical utility as a predictive clincal biomarkers for breast cancer

The fraction of proliferating cells was based on a count of at least 500 tumor cells. The Ki-67 values were expressed as the percentage of positive cells in each case. Cases with > 15% positive nuclei were classified as high Ki-67 expression, and those with < 15% were classified as low Ki-67 expression24,25.

Is Ki 67 A Prognostic Biomarker

Clinicians have made wide use of Ki-67 staining with immunohistochemistry as a prognostic biomarker in breast cancer for years. 1 The International Ki-67 in Breast Cancer Working Group is a panel of breast cancer experts that has confirmed the evidence for Ki-67s clinical value as a prognostic biomarker and clinical studies support Ki-67 measurement to help guide treatment decisions. 2-5

What Is Vascular Lymphovascular Or Angiolymphatic Invasion What If My Report Mentions D2

If cancer cells are seen in small blood vessels or lymph vessels under the microscope, it is called vascular, angiolymphatic, or lymphovascular invasion. When cancer is growing in these vessels, there is an increased risk that it has spread outside the breast. If your report does not mention this type of invasion, it means it is not there. Even if it is there, it does not always mean that your cancer has spread. How this finding affects your treatment is best discussed with your doctor.

D2-40 and CD34 are special tests that the pathologist may use to help identify these types of vascular invasion. These tests are not needed in every case.

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Why Is Ki67 Used

More recently, KI67 is utilised by two molecular tests developed to help predict the risk of recurrence in breast cancer. It must be noted that instead of IHC, both these tests are based on reverse transcriptase-polymerase chain reaction . Therefore, they determine gene expressionrather than protein staining.

Ethics And Consent Statement

Cell Proliferation (KI

The authors declare that this is a retrospective study and it does not require approval by the Ethics Committee, but rather, only required approval by the Breast Unit Core Team Institutional Review Board . Professor Amanti, as an author of the paper, recused himself from the review and approval process undertaken by the institutional review board.

Patient consent to review their medical records was not required by the board because all patients included in the study signed, at admission, a standard form about privacy and processing of personal data.

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How Do Doctors Use Ki67

  • Clinicians have made wide use of Ki-67 staining with immunohistochemistry as a prognostic biomarker in breast cancer for years.1 The International Ki-67 in Breast Cancer Working Group is a panel of breast cancer experts that has confirmed the evidence for Ki-67s clinical value as a prognostic biomarker and clinical studies support Ki-67 measurement to help guide treatment d

Use As A Marker Of Proliferating Cells

The Ki-67 protein is a cellular marker for proliferation, and can be used in immunohistochemistry. It is strictly associated with cell proliferation. During interphase, the Ki-67 antigen can be exclusively detected within the cell nucleus, whereas in mitosis most of the protein is relocated to the surface of the chromosomes. Ki-67 protein is present during all active phases of the cell cycle , but is absent in resting cells . Cellular content of Ki-67 protein markedly increases during cell progression through S phase of the cell cycle. In breast cancer Ki67 identifies a high proliferative subset of patients with ER-positive breast cancer who derive greater benefit from adjuvant chemotherapy

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Univariable And Multivariable Analysis Of Ki

We studied the association of Ki-67 expression levels and histological grade with RFS . In the univariable analysis, both the Ki-67 expression level and histological grade had significant associations with RFS in luminal-like patients but not in HER2-positive or TNBC patients. The multivariable analysis by Cox proportional hazard models adjusting for tumour stage, lymph stage, LVI and IHC-based subtypes confirmed the findings of the univariate analysis. Meanwhile, we divided HER2-positive patients into a luminal HER2-positive subgroup and non-luminal HER2-positive subgroup , and conducted survival analyses in the two subgroups. We found that both the univariable and multivariable analyses showed that the Ki-67 expression level and histological grade had no significant associations with RFS in the two subgroups .

Table 2 Univariable and multivariable analyses of Ki-67 and grade on RFS in breast cancer patients among IHC-based subtypes.

When we treated Ki-67 as a continuous variable rather than as a categorical parameter, the results were similar to the above findings .

What If A Carcinoma Is Infiltrating Or Invasive

Difference Between the Ki-67 Tumor Marker Test and the Oncotype DX Test

These words are used to mean that the cancer is not a pre-cancer , but is a true cancer.

The normal breast is made of tiny tubes that end in a group of sacs . Cancer starts in the cells lining the ducts or lobules, when a normal cell becomes a carcinoma cell. As long as the carcinoma cells are still confined to the breast ducts or lobules, without breaking out and growing into surrounding tissue, it is considered in-situ carcinoma .

Once the carcinoma cells have grown and broken out of the ducts or lobules, it is called invasive or infiltrating carcinoma. In an invasive carcinoma, the tumor cells can spread to other parts of your body.

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The Correlation Between Ki

As shown in Table , Pearsons test and Students t-test indicated that Ki-67 expression levels were significantly associated with histological grade in all patients and in each IHC-based different subtype .

Table 1 Correlation of Ki-67 and tumoral grade in breast cancer patients among IHC-based subtypes.

In addition, the analysis results showed that to some extent, Ki-67 can predict histological grade, with an area under the curve of 0.73 in all patients. Similar results were observed when restricted to certain subtypes .

The Role Of Ki67 In Evaluating Neoadjuvant Endocrine Therapy Of Hormone Receptor

  • 1Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
  • 2Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences of China Medical University, Shenyang, China

Ki67 is a proliferation marker. It has been proposed as a useful clinical marker for breast cancer subtype classification, prognosis, and prediction of therapeutic response. But the questionable analytical validity of Ki67 prevents its widespread adoption of these measures for treatment decisions in breast cancer. Currently, Ki67 has been tested as a predictive marker for chemotherapy using clinical and pathological response as endpoints in neoadjuvant endocrine therapy. Ki67 can be used as a predictor to evaluate the recurrence-free survival rate of patients, or its change can be used to predict the preoperative window of opportunity in neoadjuvant endocrine therapy. In this review, we will elaborate on the role of Ki67 in neoadjuvant endocrine therapy in breast cancer.

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Statistic Analysis And Software


The prospective database was built by Microsoft® Access. The statistical analysis was carried out by IBM-SPSS®. In order to compare categorical and continuous variables, Chi-square test and Students t test were used. Disease-Related Survival and Disease-Free Survival were calculated from the surgical procedure, plotting the curves by the KaplanMeier method and the Log-rank test was used for statistical comparisons.

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Understanding Your Pathology Report: Breast Cancer

When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.

In a needle biopsy, a needle is used to remove a sample of an abnormal area. An excision biopsy removes the entire abnormal area, often with some of the surrounding normal tissue. An excision biopsy is much like a type of breast-conserving surgery called a lumpectomy.

How Is The Stage Determined

The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:

  • The pathologic stage is determined by examining tissue removed during an operation.
  • Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.

In both staging systems, 7 key pieces of information are used:

  • The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
  • The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
  • The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
  • Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
  • Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
  • HER2 status: Does the cancer make too much of a protein called HER2?
  • Grade of the cancer : How much do the cancer cells look like normal cells?

In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.

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Availability Of Data And Materials

The datasets generated and/or analysed during the current study are not publicly available due to issues of sensitivity and limitations determined in the conditions for approval by the Regional Ethics Committee. However, they can be made available from the corresponding author on reasonable request.

What To Know About Triple Negative Breast Cancer Treatment

Dr. Ellis Discusses Ki67 as a Treatment Monitoring Biomarker
  • an oral chemo drug called capecitabine for 18 to 24 weeks. This might help some women live longer.
  • more pembrolizumab after surgery to reduce the chances of the cancer coming back.
  • the targeted drug olaparib for one year for women who have a BRCA mutation to help lower the chance of the cancer recurring.

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Does Ki67 Ihc Have Analytical Validity Methodological Issues In Ki67

As outlined in our original article , the key element preventing implementation of Ki67 as a diagnostic assay has been a lack of analytical validity. For any tumor biomarker test, including Ki67, there are many factors that may affect the result, including collection, processing, and archiving of the specimen to staining, analysis, and reporting , and finally to ensuring ongoing quality of the analytical assessment.

Luminal B Breast Cancer

Luminal B is a specific type of breast cancer. Each type is different, so identifying which you have is key to choosing the treatments that are most likely to help.

Read on to learn what it means to have luminal B breast cancer, how its diagnosed, and what you can expect from treatment.

Luminal B breast cancer is one of four main molecular subtypes of breast cancer. These subtypes are based on a molecular analysis of your cancer, including its:

  • hormone receptor status
  • human epidermal growth factor receptor 2 status
  • levels of a protein called Ki-67

Luminal B breast cancer is breast cancer that:

  • is HR-positive, including estrogen receptor -positive, progesterone receptor -positive, or both
  • is either HER2-positive or HER2-negative
  • has high levels of Ki-67

The other main breast cancer subtypes are:

  • Luminal A. Similar to luminal B, this subtype is ER-positive, PR-positive, or both but luminal A cancer is HER2-negative and has low levels of Ki-67.

Luminal B breast cancer has the same signs and symptoms as other breast cancers. These can include:

  • lump in the breast or underarm
  • thickening, swelling, or change in size or shape of breast
  • red, flaky, or dimpling skin
  • nipple inversion or nipple discharge

Breast cancer doesnt always cause symptoms in its early stages. It helps to get familiar with the way your breasts look and feel so youll notice changes sooner rather than later. Routine breast cancer screenings can also help detect cancer.

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What Is Histologic Grade Or Nottingham Grade Or Elston Grade

These grades are similar to what is described in the question above about differentiation. Numbers are assigned to different features seen under the microscope and then added up to assign the grade.

  • If the numbers add up to 3-5, the cancer is grade 1 .
  • If they add up to 6 or 7, it means the cancer is grade 2 .
  • If they add up to 8 or 9, it means the cancer is grade 3 .

What If My Report Mentions Her2/neu Or Her2


Some breast cancers have too much of a growth-promoting protein called HER2/neu . The HER2/neu gene instructs the cells to make this protein. Tumors with increased levels of HER2/neu are referred to as HER2-positive.

The cells in HER2-positive breast cancers have too many copies of the HER2/neu gene, resulting in greater than normal amounts of the HER2 protein. These cancers tend to grow and spread more quickly than other breast cancers.

All newly diagnosed breast cancers should be tested for HER2, because women with HER2-positive cancers are much more likely to benefit from treatment with drugs that target the HER2 protein, such as trastuzumab , lapatinib , pertuzumab , and T-DM1 .

Testing of the biopsy or surgery sample is usually done in 1 of 2 ways:

  • Immunohistochemistry : In this test, special antibodies that will stick to the HER2 protein are applied to the sample, which cause cells to change color if many copies are present. This color change can be seen under a microscope. The test results are reported as 0, 1+, 2+, or 3+.
  • Fluorescent in situ hybridization : This test uses fluorescent pieces of DNA that specifically stick to copies of the HER2/neu gene in cells, which can then be counted under a special microscope.

Many breast cancer specialists think that the FISH test is more accurate than IHC. However, it is more expensive and takes longer to get the results. Often the IHC test is used first:

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Cyclin Dependent Kinase 4/6 Inhibitors In Early Breast Cancer: What Is The Role Of Ki

  • Gabriele AntonarelliAffiliationsDivision of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan 20141, ItalyDepartment of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
  • Carmine ValenzaAffiliationsDivision of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan 20141, ItalyDepartment of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
  • Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USABreast Oncology Center, Harvard Medical School, Boston, MA, USA
  • German Breast Group, Neu-Isenburg, GermanyCenter for Hematology and Oncology Bethanien, Frankfurt, GermanyDepartment of Medicine and Research, Goethe University of Frankfurt, Frankfurt, Germany
  • ContactAffiliationsDivision of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan 20141, ItalyDepartment of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

J Clin Oncol.

Ann Oncol.

Underlying Molecular Interconnections Of The Estrogen Receptor Alpha And Associated Factors Involved In Breast Cancer Development: The Way To New Therapeutic Approaches

Keywords:Estrogen receptor alpha, Breast cancer, Ki 67, ERa

Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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What Does It Mean If My Report Mentions Microcalcifications Or Calcifications

Microcalcifications or calcifications are calcium deposits that can be found in both non-cancerous and cancerous breast lesions. They can be seen both on mammograms and under the microscope. Because certain calcifications are found in areas containing cancer, their presence on a mammogram may lead to a biopsy of the area. Then, when the biopsy is done, the pathologist looks at the tissue removed to be sure that it contains calcifications. If the calcifications are there, the doctor knows that the biopsy sampled the correct area .

Correlation Of Adc Histogram Parameters With Ki

Dr. Goncalves Discusses the Development of a Standardized Ki-67 Assay

The correlation between the ADC histogram parameters and Ki-67 expression are shown in Table 3. The mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles were negatively correlated with the expression of Ki-67 , with a correlation coefficient of 0.624, 0.749, 0.717, 0.621, 0.500, and 0.410, respectively. However, neither variance, skewness, nor kurtosis showed a significant correlation with Ki-67 expression .

Table 3

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