Introduction

  • MammaTyper can be an excellent alternative to immunohistochemistry (IHC) for the four biomarkers reducing the limitation of this semi-quantitative staining method. Based on the precise subtyping MammaTyper® also provides prognostic information on a patient’s risk of developing distant metastases and overall survival.
  • According Eurostat, breast cancer killed more than 92 000 women in the EU in 2013. This type of neoplasia is the most spread in women and one of the main causes of death in European women. In consequence the screening programs are extremely important and it became mandatory that each woman visits a physician when she recognizes first signs of breast abnormalities. To evaluate any suspicious symptoms many techniques can be used like: mammography, ultrasonography, radiology or magnetic resonance.
  • Over the last decade the personalized therapy was intensively promoted. Breast cancer is not considered anymore as a single malady but a complex of diseases. Characterization of breast cancer tumors based on the expression levels of estrogen receptor, progesterone receptor, Her2 and proliferation marker Ki67 divide this type of cancer in different subtypes that are important for the oncologist in order to apply the most appropriate therapy to the patient (hormonal, chemotherapy, immunological or combined).
  • The precise subtyping using a high quality technique (e.g. reverse transcription quantitative real time PCR (RT-qPCR)), which is reproducible, objective, reliable and provides automatically assessed results, becomes an essential step towards treatment success in the patient diagnosed with invasive breast cancer. Determining the correct subtype is a prerequisite for additional genetic analysis and complements the molecular picture to assess the patient’s clinical outcome. The determination of the subtype is a key parameter for the treatment decision and allows a precise molecular picture of the individual tumor type.
  • Currently immunohistochemistry shows poor reproducibility and some technical limitations and the evolution to molecular biology techniques which are more precise and reproducible is a natural consequence.

Articles

Kerstin Hartmann, Kornelia Schlombs, Hans-Anton Lehr, Mark Laible, Claudia Gürtler, Marcus Schmidt, Ugur Sahin

Zsuzsanna Varga, Annette Lebeau, Hong Bu, Arndt Hartmann, Frederique Penault-Llorca, Elena Guerini-Rocco, Peter Schraml, Fraser Symmans, Robert Stoehr, Xiaodong Teng, Andreas Turzynski, Reinhard von Wasielewski, Claudia Gürtler, Mark Laible, Kornelia Schlombs, Heikki Joensuu, Thomas Keller, Peter Sinn, Ugur Sahin, John Bartlett and Giuseppe Viale

Guides

  • ESMO 2015 Guide (European Society of Medical Oncology) recommends:
    „It must be stressed that IHC / fluorescence in situ hybridisation determination of intrinsic phenotype, is not fully accurate.“ …„For luminal cases with unclear chemotherapy indications the decision of adjuvant therapies should be based on the surrogate intrinsic phenotype that is determined by ER/PgR, HER2 and KI67 assessment with the selective help of genomic tests“.

  • 2013 St Gallen guidelines recommended the breast cancer subtyping using the analysis of the 4 markers : estrogen receptor, progesterone receptor, Her 2 and Ki67