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Evaluation of Tumor Cell Proliferation by Ki-67 Expression and Mitotic Count in Lymph Node Metastases from Breast Cancer

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  • Sura Aziz
  • Elisabeth Wik
  • Gøril Knutsvik
  • Tor Audun Klingen
  • Ying Chen
  • Benedicte Davidsen
  • Hans Aas
  • Turid Aas
  • Lars A Akslen

Abstract

Few studies have addressed the risk of recurrence by assessing proliferation markers in lymph node metastasis from breast cancer. Here, we aimed to examine Ki-67 expression and mitotic count in lymph nodes in comparison with primary tumors. A cohort of node positive breast cancer (n = 168) was studied as a part of the prospective Norwegian Breast Cancer Screening Program (1996–2009). The percentage of Ki-67 positivity was counted per 500 tumor cells in hot-spot areas (x630). Mitotic count was conducted in the most cellular and mitotic active areas in 10 high power fields (x400). Our results showed that Ki-67 and mitotic count were significantly correlated between primary tumor and lymph nodes (Spearman`s correlation 0. 56 and 0.46, respectively) and were associated with most of the histologic features of the primary tumor. Univariate survival analysis (log-rank test) showed that high Ki-67 and mitotic count in the primary tumor and lymph node metastasis significantly predicted risk of recurrence. In multivariate analysis, mitotic count in the lymph node metastasis was an independent predictor of tumor recurrence. In conclusion, proliferation markers in lymph node metastases significantly predicted disease free survival in node positive breast cancer.

Suggested Citation

  • Sura Aziz & Elisabeth Wik & Gøril Knutsvik & Tor Audun Klingen & Ying Chen & Benedicte Davidsen & Hans Aas & Turid Aas & Lars A Akslen, 2016. "Evaluation of Tumor Cell Proliferation by Ki-67 Expression and Mitotic Count in Lymph Node Metastases from Breast Cancer," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-14, March.
    • Handle: RePEc:plo:pone00:0150979
    DOI: 10.1371/journal.pone.0150979
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    1. Gøril Knutsvik & Ingunn M Stefansson & Sura Aziz & Jarle Arnes & Johan Eide & Karin Collett & Lars A Akslen, 2014. "Evaluation of Ki67 Expression across Distinct Categories of Breast Cancer Specimens: A Population-Based Study of Matched Surgical Specimens, Core Needle Biopsies and Tissue Microarrays," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-11, November.
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