Estrogen receptor, progesterone receptor, and nuclear size features in female breast cancer in Libya: correlation with clinical features and survival

BACKGROUND

The features of Libyan patients with breast cancer have not been fully investigated. The aim of this study was to evaluate the expression patterns of estrogen (ER) and progesterone receptor (PR), as well as nuclear morphometric features, in patients with breast cancer, and to correlate them with clinicopathological features and prognosis.

PATIENTS AND METHODS

Data for a total of 62 female Libyan patients with breast cancer, diagnosed between 2000 and 2006, were retrospectively studied. Their clinical and pathological data were collected and analysed. Immunohistochemical evaluation of ER and PR expression was also performed. Further more nuclear morphometry was carried out.

RESULTS

Of the 62 patients, disease in 10 was of the lobular type, 43 had invasive ductal and 9 had other carcinoma types; 47 out of 62 had lymph node involvement. Positive hormonal receptor expression was more common among those with lymph node-negative than lymph node-positive tumours. ER- and PR-positive patients appeared to have a better survival than ER- and PR-negative patients. The most significant difference, with respect to survival, was found between those bearing tumors with completely negative hormonal staining (J score 0) and those with positive staining (J score 1, 2 and 3). Larger nuclear size was associated with lymph node involvement and high-grade tumours (p<0.01 and p<0.0001, respectively), with shorter survival, larger tumour size and higher stage.

CONCLUSION

The cut-off points for defining the groups with good or worse prognosis might be set, between score 0 and 1 (corresponding to 1% or fewer positive cells). Patients with ER- and PR-positive cancer had better overall survival than patients with hormonal receptor-negative cancer. In our hospital setting, ER and PR expressions and mean nuclear area (MNA) in breast carcinoma may be prognostically useful markers in guiding future treatment in prospective studies.

Breast cancer patients in Libya: Comparison with European and central African patients

The present study evaluated the incidence of breast cancer in Libya and described the clinicopathological and demographic features. These features were then compared with corresponding data from patients from sub-Saharan Africa (Nigeria) and Europe (Finland). The study consisted of 234 patients with breast carcinoma, admitted to the African Oncology Institute in Sabratha, Libya, during the years 2002-2006. The pathological features were collected from pathology reports, patient histories from hospital files and the Sabratha Cancer Registry. The demographic differences between the Libyan, Nigerian and Finnish populations were prominent. The mean age of breast cancer patients in Libya was 46 years which was almost identical to that of Nigeria, but much lower than that of Finland. The Libyan breast cancer incidence was evaluated as 18.8 per 100,000 female individuals. This incidence was markedly higher in Finland, but was also high in Nigeria. Libyan and Nigerian breast cancer is predominantly of premenopausal type and exhibits unfavorable characteristics such as high histological grade and stage, large tumor size and frequent lymph node metastases. However, the histological types and histopathological risk features show similar importance regarding survival as European breast cancer cases. Survival in Libya ranks between the rates of survival in Nigeria (lowest) and Finland (highest). In conclusion, in Libya and other African countries, premenopausal breast cancer is more common than postmenopausal breast cancer. However, the opposite is true for Europe. Population differences may be involved, as suggested by the known variation, in the distribution of genetic markers in these populations. Different types of environmental impacts, however, cannot be excluded.

Image DNA cytometry in FNABs of Libyan breast disease

BACKGROUND

The sensitivity for identification of malignant cells in conventional fine-needle aspiration biopsy (FNAB) investigation is about 80%. This percentage is dependent on the number of examined cells, type of breast cancer, and experience of the examiner. The aim of our study was to estimate the supporting value of image DNA cytometry of FNAB of the breast, and do so by using different sampling methods.

MATERIALS AND METHODS

This retrospective study was based on 41 cases with an available histological diagnosis: 18 benign lesions and 23 malignant tumours were examined. The smears were submitted to image DNA analysis in a three-step protocol: (i) smears stained with HE method were destained and (ii) then restained with Feulgen staining for DNA and (iii) finally analysed using image cytometry.

RESULTS

All non-malignant cases had diploid histogram. However, a few of them had one or two cells of >5c category. Most histologically malignant cases were aneuploid. Only three invasive ductal carcinomas showed diploid histograms. All samples with aneuploid histograms were malignant.

CONCLUSION

The results confirm earlier published data in the Finnish population and indicate that image DNA cytometric analysis of nuclear content is a useful marker for identification of malignant cells in FNAB, especially after free cell sampling. The method can be used to increase the cytological sensitivity and specificity in doubtful breast lesions.