Breast cancer classification: Difference between revisions

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===Malignant Tumors===
===Malignant Tumors===
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'''Ductal'''
'''Ductal'''
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*[[Ductal carcinoma in situ]] (DCIS)<ref name = class> Breast Neoplasm. Radiopedia. (2015) http://radiopaedia.org/articles/breast-neoplasms Accessed on March 1, 2019</ref>
*[[Ductal carcinoma in situ]] (DCIS)<ref name="class">Breast Neoplasm. Radiopedia. (2015) http://radiopaedia.org/articles/breast-neoplasms Accessed on March 1, 2019</ref>
:*Comedo type: ~60%  
:*Comedo type: ~60%  
:*Non-comedo type: ~40%
:*Non-comedo type: ~40%
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*Apocrine carcinoma of the breast
*Apocrine carcinoma of the breast
|-
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'''Sarcoma'''
'''Sarcoma'''
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===Benign Tumors===
===Benign Tumors===
*[[Phyllodes tumor]]<ref name = class> Breast Neoplasms. Radiopaedia (2015) http://radiopaedia.org/articles/breast-neoplasms Accessed on january 16, 2016 </ref>
*[[Phyllodes tumor]]<ref name="class">Breast Neoplasms. Radiopaedia (2015) http://radiopaedia.org/articles/breast-neoplasms Accessed on january 16, 2016 </ref>
*Mammary fibromatosis: 0.2% of all breast tumors 5
*Mammary fibromatosis: 0.2% of all breast tumors 5
*Benign papillary lesions of the breast
*Benign papillary lesions of the breast
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*'''Hormone receptor positive''': either estrogen or progesterone receptors are present
*'''Hormone receptor positive''': either estrogen or progesterone receptors are present
*'''Hormone receptor negative''': breast cancer cells don’t have either estrogen or progesterone receptors
*'''Hormone receptor negative''': breast cancer cells don’t have either estrogen or progesterone receptors
*'''HER2 positive''': If excess copies of HER2 gene
*'''[[HER2]] positive''': If excess copies of [[HER2|HER2 gene]]
*'''HER2 negative''': If excess copies of HER2 gene are not present
*'''HER2 negative''': If excess copies of [[HER2|HER2 gene]] are not present
*'''Triple positive''': cancers that are ER-positive, PR-positive, and have too much HER2
*'''Triple positive''': cancers that are [[Estrogen receptor|ER]]-positive, PR-positive, and have too much HER2
*'''Triple negative''': If the breast cancer cells don’t have estrogen or progesterone receptors and don’t have too much HER2
*'''Triple negative''': If the breast cancer cells don’t have estrogen or progesterone receptors and don’t have too much HER2


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:*'''Luminal A''':  
:*'''Luminal A''':  
::*Expression of luminal (low molecular weight) cytokeratins, high expression of hormone receptors and related genes
::*Expression of luminal (low molecular weight) cytokeratins, high expression of hormone receptors and related genes
::*50% of invasive bresat cancer, ER/PR positive, HER2/neu negative
::*50% of invasive bresat cancer, [[Estrogen receptor|ER]]/[[Progesterone receptor|PR]] positive, [[HER2/neu]] negative
::*Tubular carcinoma, Cribriform carcinoma, Low grade invasive ductal carcinoma, NOS, Classic lobular carcinoma
::*Tubular carcinoma, Cribriform [[carcinoma]], Low grade invasive ductal carcinoma, NOS, Classic lobular carcinoma
::*Response to endocrine therapy
::*Response to endocrine therapy
::*Variable response to chemotherapy
::*Variable response to chemotherapy
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:*'''Luminal B :'''
:*'''Luminal B :'''
::*Expression of luminal (low molecular weight) cytokeratins, moderate-low expression of hormone receptors and related genes
::*Expression of luminal (low molecular weight) cytokeratins, moderate-low expression of hormone receptors and related genes
::*20% of invasive breast cancer, ER/PR positive, HER2/neu expression variable, higher proliferation than Luminal A, higher histologic grade than Luminal A
::*20% of invasive breast cancer, ER/PR positive, [[HER2/neu]] expression variable, higher proliferation than Luminal A, higher histologic grade than Luminal A
::*Invasive ductal carcinoma, NOS Micropapillary carcinoma
::*Invasive ductal carcinoma, NOS Micropapillary carcinoma
::*Response to endocrine therapy (tamoxifene and aromatase inhibitors) not as good as Luminal A
::*Response to endocrine therapy (tamoxifene and aromatase inhibitors) not as good as Luminal A
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::*Grows faster
::*Grows faster
:*'''HER2/neu'''
:*'''HER2/neu'''
::*High expression of HER2/neu, low expression of ER and related genes
::*High expression of [[HER2/neu]], low expression of ER and related genes
::*15% of invasive breast cancer, ER/PR negative, HER2/neu positive, high proliferation, diffuse TP53 mutation, high histologic grade and nodal positivity
::*15% of invasive breast cancer, ER/PR negative, [[HER2/neu]] positive, high proliferation, diffuse [[TP53]] mutation, high histologic grade and nodal positivity
::*High grade invasive ductal carcinoma, NOS
::*High grade invasive ductal carcinoma, NOS
::*Response to trastuzumab (Herceptin)
::*Response to trastuzumab (Herceptin)
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:*'''Basal like'''
:*'''Basal like'''
::*High expression of basal epithelial genes and basal cytokeratins, low expression of ER and related genes, low expression of HER2/neu
::*High expression of basal epithelial genes and basal cytokeratins, low expression of ER and related genes, low expression of HER2/neu
::*~15% of invasive breast cancer, most ER/PR/HER2/neu negative (triple negative), high proliferation, diffuse TP53 mutation, BRCA1 dysfunction (germline, sporadi
::*~15% of invasive breast cancer, most [[Estrogen receptor|ER]]/[[Progesterone receptor|PR]], [[HER2/neu]] negative (triple negative), high proliferation, diffuse [[TP53]] mutation, BRCA1 dysfunction (germline, sporadi
::*High grade invasive ductal carcinoma, NOS Metaplastic carcinoma, Medullary carcinoma
::*High grade invasive ductal carcinoma, NOS Metaplastic carcinoma, Medullary carcinoma
::*No response to endocrine therapy or trastuzumab
::*No response to endocrine therapy or trastuzumab

Revision as of 13:59, 15 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2] Soroush Seifirad, M.D.[3]

Overview

Breast cancer may be classified according to anatomy into 4 subtypes: ductal, lobular, sarcoma, and lymphoma.

Classification Based on Histopathology

Malignant Tumors
Type Subtype

Ductal

  • Comedo type: ~60%
  • Non-comedo type: ~40%
  • Papillary
  • Micropapillary
  • Cribriform
  • Solid
  • Intracystic papillary carcinoma in situ
  • Invasive ductal carcinoma
  • Invasive ductal carcinoma not otherwise specified (NOS): ~65%
  • Tubular carcinoma of breast: ~7-8%
  • Tubulolobular carcinoma of breast
  • Medullary carcinoma of breast: ~2%
  • Mucinous (colloid) carcinoma: ~2%
  • Malignant papillary lesions of the breast
  • Papillary carcinoma of breast: 1-2% 1

Lobular

Other malignant breast tumors

Sarcoma

Lymphoma

Metastases to the breast

The most common extra-mammary cancers that metastasise to breast are:

Benign Tumors

  • Phyllodes tumor[1]
  • Mammary fibromatosis: 0.2% of all breast tumors 5
  • Benign papillary lesions of the breast
  • Intraductal papilloma
  • Solitary papilloma of breast
  • Central solitary papilloma of breast
  • Peripheral solitary papilloma of breast
  • Multiple papillomata of breast
  • Juvenile papillomatosis of breast
  • Granular cell tumor of the breast

Classification Based on Hormone Receptors Present

  • Hormone receptor positive: either estrogen or progesterone receptors are present
  • Hormone receptor negative: breast cancer cells don’t have either estrogen or progesterone receptors
  • HER2 positive: If excess copies of HER2 gene
  • HER2 negative: If excess copies of HER2 gene are not present
  • Triple positive: cancers that are ER-positive, PR-positive, and have too much HER2
  • Triple negative: If the breast cancer cells don’t have estrogen or progesterone receptors and don’t have too much HER2

Classification Based on Gene Expression

  • Luminal type: are estrogen receptor (ER)–positive
  • Luminal A:
  • Expression of luminal (low molecular weight) cytokeratins, high expression of hormone receptors and related genes
  • 50% of invasive bresat cancer, ER/PR positive, HER2/neu negative
  • Tubular carcinoma, Cribriform carcinoma, Low grade invasive ductal carcinoma, NOS, Classic lobular carcinoma
  • Response to endocrine therapy
  • Variable response to chemotherapy
  • Low grade,
  • Grows slowly,
  • Good prognosis (the best prognosis)
  • Luminal B :
  • Expression of luminal (low molecular weight) cytokeratins, moderate-low expression of hormone receptors and related genes
  • 20% of invasive breast cancer, ER/PR positive, HER2/neu expression variable, higher proliferation than Luminal A, higher histologic grade than Luminal A
  • Invasive ductal carcinoma, NOS Micropapillary carcinoma
  • Response to endocrine therapy (tamoxifene and aromatase inhibitors) not as good as Luminal A
  • Variable response to chemotherapy (better than Luminal A)
  • Prognosis not as good as Luminal A
  • Grows faster
  • HER2/neu
  • High expression of HER2/neu, low expression of ER and related genes
  • 15% of invasive breast cancer, ER/PR negative, HER2/neu positive, high proliferation, diffuse TP53 mutation, high histologic grade and nodal positivity
  • High grade invasive ductal carcinoma, NOS
  • Response to trastuzumab (Herceptin)
  • Response to chemotherapy with antracyclins
  • Usually unfavorable prognosis
  • Basal like
  • High expression of basal epithelial genes and basal cytokeratins, low expression of ER and related genes, low expression of HER2/neu
  • ~15% of invasive breast cancer, most ER/PR, HER2/neu negative (triple negative), high proliferation, diffuse TP53 mutation, BRCA1 dysfunction (germline, sporadi
  • High grade invasive ductal carcinoma, NOS Metaplastic carcinoma, Medullary carcinoma
  • No response to endocrine therapy or trastuzumab
  • Sensitive to platinum group chemotherapy and PARP inhibitors
  • Not all, but usually worse prognosis[2]

References

  1. ↑ 1.0 1.1 Breast Neoplasm. Radiopedia. (2015) http://radiopaedia.org/articles/breast-neoplasms Accessed on March 1, 2019
  2. ↑ Eliyatkın N, Yalçın E, Zengel B, Aktaş S, Vardar E (2015) Molecular Classification of Breast Carcinoma: From Traditional, Old-Fashioned Way to A New Age, and A New Way. J Breast Health 11 (2):59-66. DOI:10.5152/tjbh.2015.1669 PMID: 28331693

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