Histological assessment of the prognostic factors in female breast cancer.

Paraffin-embedded biopsy specimens from the primary breast carcinoma of 653 women were subjected to histopathological assessments of the potential prognostic factors. Histological type, histological grade, nuclear pleomorphism, tubule formation, intraductal growth pattern, tumour margin circumscription, tumour necrosis and inflammatory cell reaction were semiquantitatively analysed with special reference to disease outcome during the mean follow-up 12.8 years. Histological grade, nuclear grade and inflammatory cell reaction were related to axillary lymph node involvement at operation (p less than 0.001). Intensity of the inflammatory cell reaction was directly correlated to histological grade, histological type, nuclear pleomorphism and tumour necrosis (p less than 0.001). Tubule formation and tumour necrosis were significant predictors for tumour recurrence. Recurrence-free survival was related to tubule formation (p = 0.0048), histological grade (p = 0.0208) and intraductal growth pattern (p = 0.0441). Tubule formation accurately predicted the recurrence-free survival in axillary lymph node-negative tumours (p = 0.0386). In small (diameter less than or equal to 20 mm) axillary lymph node-negative tumours, the inflammatory cell reaction (p = 0.0377) as well as intraductal growth pattern (p = 0.0632) were related to recurrence-free survival. Cancer-related patient survival was predicted in decreasing order of significance by tubule formation (p = 0.0002), nuclear pleomorphism (p = 0.0010), intraductal growth (p = 0.0077), tumour necrosis (p = 0.0117) and histological type (p = 0.0651). In axillary lymph node-negative tumours, tubule formation (p = 0.0409), inflammatory cell infiltration (p = 0.0790) and intraductal growth (p = 0.0958) predicted the cancer-related survival. The results indicate that despite an intense search for a diversity of prognostic factors by increasingly sophisticated techniques (e.g., morphometric measurements, flow cytometry, immunohistochemistry, and DNA hybridization techniques), the relatively simple light microscopic assessment of the above morphological features seems to be still advocated in predicting the disease outcome in female breast cancer.