Prognostic Implications of ER, PR and HER2/Neu Protein Expression in a Cohort of Breast Carcinoma
American Journal of Laboratory Medicine
Volume 4, Issue 6, November 2019, Pages: 91-96
Received: Oct. 12, 2019; Accepted: Oct. 30, 2019; Published: Nov. 6, 2019
Views 504      Downloads 136
Seneviratne Bimalka, Department of Pathology/Cancer Research Centre, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka
Seneviratne Senali, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
Adikaram Lakna, Department of Pathology, Lanka Hospital, Colombo, Sri Lanka
Article Tools
Follow on us
ER, PR and HER 2/neu receptor studies are known to be prognostic and predictive biomarkers of breast carcinoma. Hence the status of ER, PR and HER 2/neu receptors are routinely assessed in breast carcinoma by immunohistochemistry using paraffin embedded tissue blocks. The reason for assessing the receptor status is to decide on the best treatment regime for breast cancer patients. Ki 67 which is a biomarker of cellular proliferation is also assessed to guide the oncologist by determining the proliferative capacity of the tumour. A descriptive cross-sectional study conducted during January 2016 to December 2018 in three specialized surgical centres. Study sample included 92 patients with histologically confirmed breast carcinoma. ER, PR, HER2/neu receptor status and Ki 67 proliferative index were assessed to determine the prognostic implications of breast carcinoma. Mean age at presentation was 53.99 years and the most common histological type was invasive ductal carcinoma (84.78%). In the cohort of 92 patients with breast carcinoma 73.91% were ER positive, 58.69% were PR positive, and 11.95% were HER2/neu positive. Lymph nodal involvement was seen in 31.52% of the patients. There was no statistically significant association with HER2/neu status and nodal involvement (p = 0.629). Distant metastasis was seen in 4.35% cases. The association with HER2/neu status and distant metastasis was not statistically significant (p = 0.085). ER status showed a significant negative correlation with HER2 status (rho = -0.634, p < 0.0001). PR status showed a significant negative correlation with HER2 status (rho = -0.834, p < 0.0001). Ki67 index showed a significant positive correlation with HER2 status (rho = 0.248, p = 0.017).
Breast Carcinoma, HER 2/Neu Protein, Hormone Receptors
To cite this article
Seneviratne Bimalka, Seneviratne Senali, Adikaram Lakna, Prognostic Implications of ER, PR and HER2/Neu Protein Expression in a Cohort of Breast Carcinoma, American Journal of Laboratory Medicine. Vol. 4, No. 6, 2019, pp. 91-96. doi: 10.11648/j.ajlm.20190406.11
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Pineros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int. J. Cancer. 2019; 144: 1941-1953.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136: E359–86.
Steven S. Coughlin, Donatus U. Ekwueme. Breast cancer as a global health concern. Cancer Epidemiology. 2009; 33 (5): 315-318.
Pesce K, Orruma MB, Hadad C, Cano YB, Secco R, Cernadas A. BI-RADS Terminology for Mammography Reports: What Residents Need to Know. RadioGraphy. 2019; 39 (2): online From the Department of Breast Radiology, Hospital Italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, Capital Federal C1199 ABB, Argentina. Address correspondence to K. P.
Pustahija AH, Ivanac G, Brkljacic B. US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications. Diagn Intery Radiol. 2018; 24 (4): 187-194. doi: 10.5152/dir.2018.17414.
Badowska-Kozakiewicz AM, Patera J, Sobol M, Przybylski J. The role of oestrogen and progesterone receptors in breast cancer – immunohistochemical evaluation of oestrogen and progesterone receptor expression in invasive breast cancer in women. Contemp. Oncol (Pozn). 2015; 19 (3): 220-225. doi: 10.5114/wo.2015.51826.
Iqbal BM, Buch A. Hormone receptor (ER, PR, HER2/neu) status and proliferation index marker (Ki-67) in breast cancers: Their onco-pathological correlation, shortcomings and future trends. Med J DY Patil Univ. 2016; 9: 674-9. doi: 10.4103/0975-2870.194180.
Moasser MM. The oncogene HER2; its signaling and transforming functions and its role in human cancer pathogenesis. Oncogene. 2007; 26 (45): 6469-6487.
Abubakar M, Figueroa J, Ali HR, Blos F, Lissowska J, Caldas C, Easton DF, Sherman ME, Garcia-Closas M, Dowsett M, Pharoah PD. Combined quantitative measures of ER, PR, HER2, and KI67 provide more prognostic information than categorical combinations in luminal breast cancer. Modern Pathology.2019; 32: 1244-1256.
Burstein HJ. The distinctive nature of HER2-positive breast cancers. N Eng J Med. 2005; 353 (16): 1652-1654.
Mohammed RA, Ellis IO, Lee AH, Martin SG. Vascular invasion; an overview of recent prognostic developments & molecular pathophysiological mechanisms. Histopathology. 2009; 55: 1-9.
Arteaga CL, Sliwkowski MX, Osborne CK, perez EA, Puglisi F, Gianni Luca. Treatment of HER2-positive breast cancer: current status and future perspectives. Nature Reviews Clinical Oncology. 2012; 9: 16–32.
Henderson AR. Testing experimental data for univariate normality. Clin Chim Acta. 2006; 366 (1–2): 112–29.
Adesunkanmi ARK, Lawal OO, Adelusola KA, Durosimi MA. The severity, outcome and challenges of breast cancer in Nigeria. Breast. 2006; 15 (3): 399–409. [PubMed] [Google Scholar].
Health Wales NHS Trust Public. WCISU Annual Publication No. SA10/01: Cancer Incidence in Wales 2004–2008. Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK, 2010,
Bowen RL, Duffy SW, Ryan DA, Hart IR, Jones JL. Early onset of breast cancer in a group of British black women. British Journal of Cancer. 2008; 98 (2): 277–281. [PMC free article] [PubMed] [Google Scholar].
Elmore JG, Moceri VM, Carter D, Larson EB. Breast carcinoma tumor characteristics in black and white women. Cancer. 1998; 83 (12): 2509–2515. [PubMed] [Google Scholar].
Haffty BG, Silber A, Matloff E, Chung J, Lannin D. Racial differences in the incidence of BRCA1 and BRCA2 mutations in a cohort of early onset breast cancer patients: African American compared to white women. Journal of Medical Genetics. 2006; 43 (2): 133–137. [PMC free article] [PubMed] [Google Scholar].
WHO Classification of tumours of the Breast, 4th Edition, ISBN -13: 978-9283224334.
Rambau PF, Chalya PL, Manyama MM, Jackson KJ. Pathological features of Breast Cancer seen in Northwestern Tanzania: A nine years retrospective study. BMC Research Notes. 2011: p. 214. [PMC free article] [PubMed] [Google Scholar].
Yager JD, Davidson NE. Estrogen Carcinogenesis in Breast Cancer. N Eng J Med. 2006; 354: 270-282. doi: 10.1056/NEJMra050776.
Francis GD, Dimech M, Giles L et al. Frequency and reliability of oestrogen receptor, progesterone receptor and HER2 in breast carcinoma determined by immunohistochemistry in Australasia: Results of the RCPA Quality Assurance Program. J Clin Pathol 60: 1277–1283. 2007. [Crossref] [Google Scholar].
Potemski P, Kusińska R, Kubiak R, et al. The predictive value and prognostic significance of the degree of expression of steroid receptors in breast cancer operation. Oncol Pol. 2007; 10: 49–54. [Google Scholar].
Park K, Han S, Kim HJ, Kim J, Shin E. HER2 status in pure ductal carcinoma in situ and in the intraductal and invasive components of invasive ductal carcinoma determined by fluorescence in situ hybridization and immunohistochemistry. Histopathology. 2006; 48 (6): 702-707. [Google Scholar].
Gabos Z, Sinha R, Hanson J et al. Prognostic significance of human epidermal growth factor receptor positivity for the development of brain metastasis after newly diagnosed breast cancer. Journal of clinical oncology. 2006; 24 (36): 5658-5663. [Google scholar].
Horiguchi J, Koibuchi Y, Iijima K, et al. Co-expressed type of ER and HER2 protein as a predictive factor in determining resistance to antiestrogen therapy in patients with ER-positive and HER2-positive breast cancer. Oncol Rep. 2005; 14: 1109–1116. [Google Scholar].
Allemani C, Sant M, Berrino F, et al. Prognostic value of morphology and hormone receptor status in breast cancer – a population-based study. Br J Cancer. 2004; 91: 1263–8. [PubMed] [Google Scholar].
Tsutsui S, Ohno S, Murakami S, Hachitanda Y, Oda S. Prognostic value of epidermal growth factor receptor (EGFR) and its relationship to the estrogen receptor status in 1029 patients with breast cancer. Breast Cancer Res Treat. 2002; 71: 67–75. [PubMed] [Google Scholar].
Barzanti F, Dal Susino M, Volpi A, et al. Comparison between different cell kinetic variables in human breast cancer. Cell Prolif. 2000; 33: 75–89. [PubMed] [Google Scholar].
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186