Difference between revisions of "Invasive breast cancer"

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==Types of invasive breast cancer==
==Types of invasive breast cancer==
*Ductal also known as no specific type (NST) - 79%,  ???includes DCIS???
Types:Ref.: <ref name=Ref_PBoD1143>{{Ref PBoD|1143}}</ref>
*Lobular 10%,
*Ductal - also known as no specific type (NST) - 79%.
*Cribriform (tubular) 6%,
*Lobular 10%.
*Mucinous (colloid) 2%,
*Cribriform (tubular) 6%.
*Medullary 2%,
*Mucinous (colloid) 2%.
*Papillary 1%,
*Medullary 2%.
*Metaplastic <1%
*Papillary 1%.
Ref.: <ref>PBoD NEED PAGE No.</ref>
*Metaplastic <1%.


==Standard IHC work-up==
==Standard IHC work-up==
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**Sunnybrook uses ''CAM5.2''.
**Sunnybrook uses ''CAM5.2''.
*ER (estrogen receptor).
*ER (estrogen receptor).
**Positive in most breast cancers; +ve in ~75-80%.<ref>Lester. 2nd Ed. PP.241-2.</ref>
**Positive in most breast cancers; +ve in ~75-80%.<ref name=Ref_Lester241-2>{{Ref Lester|241-2}}</ref>
*PR (progesterone receptor).
*PR (progesterone receptor).
**Positive in most breast cancers; +ve in ~65-70%.<ref>Lester. 2nd Ed. PP.241-2.</ref>
**Positive in most breast cancers; +ve in ~65-70%.<ref name=Ref_Lester241-2>{{Ref Lester|241-2}}</ref>
*HER2/neu.
*HER2/neu.
**Usually negative; -ve in 70-80%.<ref>Lester. 2nd Ed. PP.241-2.</ref>
**Usually negative; -ve in 70-80%.<ref name=Ref_Lester241-2>{{Ref Lester|241-2}}</ref>
**Positivity association with a worse prognosis.
**Positivity association with a worse prognosis.


===ER & PR scoring<ref>Lester. 2nd Ed. PP.241-2.</ref>===
===ER & PR scoring<ref name=Ref_Lester241-2>{{Ref Lester|241-2}}</ref>===
*Give a percentage, i.e. 0-100%.
*Give a percentage, i.e. 0-100%.
**Important cut points: 1% and 10%.  
**Important cut points: 1% and 10%.  
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*Normal breast epithelial cells have a patchy staining for ER and PR.
*Normal breast epithelial cells have a patchy staining for ER and PR.
*Evaluated on the invasive component.
*Evaluated on the invasive component.
===HER2 scoring<ref>Lester. 2nd Ed. PP.241-2.</ref>===  
===HER2 scoring<ref name=Ref_Lester241-2>{{Ref Lester|241-2}}</ref>===  
{| class="wikitable"
{| class="wikitable"
| '''Score'''  
| '''Score'''  
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**Useful to assess lymphovascular invasion.
**Useful to assess lymphovascular invasion.


*ADH and DCIS:<ref>Lester P.122.</ref>
*ADH and DCIS:<ref name=Ref_Lester122>{{Ref Lester|122}}</ref>
**E-cadherin.
**E-cadherin.
***Present in most epithelial cells.
***Present in most epithelial cells.
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===General===
===General===
*Cells in the epithelium, i.e. skin, that look like they don't belong.
*Cells in the epithelium, i.e. skin, that look like they don't belong.
*Associated with underlying breast carcinoma.<ref name=emed_pagets>[http://emedicine.medscape.com/article/1101235-diagnosis http://emedicine.medscape.com/article/1101235-diagnosis]</ref>
*Associated with underlying breast carcinoma.<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-diagnosis http://emedicine.medscape.com/article/1101235-diagnosis]</ref>


Note:
Note:
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Images:
Images:
*[http://commons.wikimedia.org/wiki/File:Extramammary_Pagets_disease_low.jpg Paget's disease - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Extramammary_Pagets_disease_low.jpg Paget's disease - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Extramammary_Pagets_disease_high.jpg Paget's disease - high mag. (WC) ].
*[http://commons.wikimedia.org/wiki/File:Extramammary_Pagets_disease_high.jpg Paget's disease - high mag. (WC)].


===DDx===
===DDx===
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