Molecular Classification of Breast Carcinoma Based on the Prognostic Marker: A Clinico-pathological Correlation

Umesh Kumar

IGIMS, Patna, India.

Anju Singh *

Department of Pathology, IGIMS, Patna, India.

Kalpana Chandra

Department of Pathology, IGIMS, Patna, India.

Kshiti Atreya

Department of Pathology, IGIMS, Patna, India.

Reecha Singh

Department of Pathology, IGIMS, Patna, India.

Manish Kumar

Department of Surgical Oncology, IGIMS, Patna, India.

*Author to whom correspondence should be addressed.


Background: Breast cancer (BC) has now surpassed lung cancer as the leading cause of global cancer incidence in 2020, with an estimated 2.3 million new cases, representing 11.7% of all cancer cases. It is a highly heterogeneous disease with a variety of morphologic and clinical manifestations which results in a range of responses to treatment. Recently, targeted therapies based on the genetic, hormonal, or immunohistochemical (IHC) subtypes of breast cancer have been used.

Objective: The study was a prospective hospital-based observational study with a sample size of 150 cases. The study aimed to determine the distribution of various molecular subtypes of breast carcinoma and also correlate the expression status of ER, PR, Her2neu, and Ki 67 with the patient's age, tumor size, tumor type, histological grade, lymph node status, and TNM staging.

Results: 96.7% of cases were invasive ductal carcinoma (NOS). Most of the grade 1 tumors (68.8%) were both ER and PR positive. Grade 2 tumors had almost equal distribution with 39.4% of patients being ER & PR positive and 43.7% being both ER & PR negative. Almost all grade 3 tumors (88.9%) were both ER and PR -negative.

Conclusion: IHC markers are cost-effective and easily available worldwide even in resource-poor countries like India. A greater understanding of the molecular classification of breast carcinoma based on triple markers will help in the development of targeted therapies that will lead to increased efficacy, decreased toxicity, increased disease-free survival, and better selection of patients who will benefit from treatment.

Keywords: Breast cancer, ductal carcinoma, mER & PR negative, BRCA1, BRCA2, TP53

How to Cite

Kumar, U., Singh, A., Chandra, K., Atreya, K., Singh, R., & Kumar, M. (2022). Molecular Classification of Breast Carcinoma Based on the Prognostic Marker: A Clinico-pathological Correlation. Journal of Advances in Medicine and Medical Research, 34(23), 237–247.


Download data is not yet available.


Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–249.

Bagadi SA, Dubey U S, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J ClinOncol. Malvia. 2017;13(4):289-295.

Zardavas D, Irrthum A, Swanton C, Piccart M. Clinical management of breast cancer heterogeneity. Nat Rev Clin Oncol. 2015; 12(7):381–394.

Lakhani SR, Ellis IO, Schnitt SJ, et al. World Health Organization classification of tumours of the breast. Lyon, France: IARC Press; 2012. 10. Perou CM, Sorlie T, Eisen MB, et al. Molecular portrait of human breast tumours. Nature. 2000;406(6797): 747–752.

Perou CM, Sorlie T, Eisen MB, et al. Molecular portrait of human breast tumours. Nature. 2000;406(6797): 747–752.

Kumar V, Abbas AK, Aster JC, Robbins SL. Robbins basic pathology. 9th ed. Philadelphia (PA): Elsevier, Saunders; 2013. pp. 708–710.

Goldhirsch A, Wood W C, Coates AS, Gelber RD, Thürlimann B, Senn HJ, et al. Strategies for subtypes--dealing with the diversity of breast cancer: Highlights of the St. Gallen International Expert Consensus on the primary therapy of early breast cancer 2011. Ann Oncol. 2011;22:1736–1747.

Rakha EA, Reis-Filho JS, Ellis IO. Combinatorial biomarker expression in breast cancer. Breast Cancer Res Treat. 2010;120(2):293–308.

Lester SC. The Breast. In: Robbins and Cotran Pathologic Basis of Disease, 8 th ed. Kumar V , Abbas A K , Fausto N , Aster JC , editors. Philadelphia : Saunders. 2010;1065-97.

Karangadan S, Patil AG, Andola SK. Immunohistochemical characterization of molecular classification of breast carcinoma and its relation with Ki-67. Clinical Cancer Investigation Journal. 2016;5:430-436.

Sinn P, Aulmann S, Wirtz R, Schott S, Marmé F, Varga Z, Lebeau A, Kreipe H, Schneeweiss A. Multigene Assays for Classification, Prognosis, and Prediction in Breast Cancer: A Critical Review on the Background and Clinical Utility. GeburtshilfeFrauenheilkd. 2013;73(9): 932-940.

Nabi MG, Ahangar A, Wahid MA, Kuchay S. Clinicopathological comparison of triple negative breast cancers with non-triple negative breast cancers in a hospital in North India. Niger J Clin Pract. 2015; 18:381-6.

Kumar N, Patni P, Parashar N. Prevalence of molecular subtypes of breast cancer: A retrospective study. Med J Armed Forces India. 2015;71(3):254-258

PMID: 26288493

Adedayo A. Onitilo, Jessica M.Engel, Robert T. Greenlee, Bickol N. Mukesh. Breast cancer subtypes based on ER/PR and HER2 expression : Comparison of clinicopathologic features and survival. Clinical Medicine & Research 2009;7:4-13.

Zhu X, Ying J, Wang F, Wang J et al. Estrogen receptor, Progesterone receptor, and human epidermal growth factor receptor 2 status in invasive cancer: A3,198 case study at National cancer centre, china. Breast cancer Res Treat. 2014;147:551-555.

Ghanghoria S, Chhattrasal CS, Kulkarni CV et al. Study of morphological features of carcinoma of breast in relation to ER/PR and Her2/neu status. Journal of Medcal Sciences and Clin Research. 2018; 06(06):897-901

Stierer M, Rosen H, Weber R, Hanak H, Spona J, Tüchler H. Immunohistochemical and biochemical measurement of estrogen and progesterone receptors in primary breast cancer. Correlation of histopathology and prognostic factors. Ann Surg. 1993;218(1):13-21.

Nadji M, Gomez-Fernandez C, Ganjei-Azar P, Morales AR. Immunohistochemistry of estrogen and progesterone receptors reconsidered: Experience with 5,993 breast cancers. Am J Clin Pathol. 2005; 123(1):21-7.

Yamamoto-Ibusuki M, Yamamoto Y, Yamamoto S, Fujiwara S, Fu P, Honda Y, et al. Comparison of prognostic values between combined immunohistochemical score of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67 and the corresponding gene expression score in breast cancer. Mod Pathol. 2013;26:79-86.

Inwald EC, Klinkhammer-Schalke M, Hofstädter F, Zeman F, Koller M, Gerstenhauer M, et al. Ki-67 is a prognostic parameter in breast cancer patients: Results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat. 2013;139:539-52.

Nishimura R, Osako T, Okumura Y, Hayashi M, Toyozumi Y, Arima N. Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer. Exp Ther Med. 2010;1:747-54.

Sofi GN, Sofi JN, Nadeem R, Shiekh RY, Khan FA, Sofi AA, et al. Estrogen receptor and progesterone receptor status in breast cancer in relation to age, histological grade, size of lesion and lymph node involvement. Asian Pac J Cancer Prev. 2012;13:5047-52.4

Verma S, Bal A, Joshi K, Arora S, Singh G. Immunohistochemical characterization of molecular subtypes of invasive breast cancer: A study from North India. APMIS. 2012;120:1008-19.

Onitilo AA, Engel JM, Greenlee RT, Mukesh BN. Breast cancer subtypes based on ER/PR and Her2 expression: Comparison of clinicopathologic features and survival. Clin Med Res 2009;7:4-13.

Munjal K, Ambaye A, Evans MF, Mitchell J, Nandedkar S, Cooper K. Immunohisto chemical analysis of ER, PR, Her2 and CK5/6 in infiltrative breast carcinomas in Indian patients. Asian Pac J Cancer Prev. 2009;10(5):773-8.

Engstrøm MJ, Opdahl S, Hagen AI, Romundstad PR, Akslen LA, Haugen OA, et al. Molecular subtypes, histopathological grade and survival in a historic cohort of breast cancer patients. Breast Cancer Res Treat. 2013;140:463-73.

Ge Y, Sneige N, Eltorky MA, Wang Z, Lin E, Gong Y, et al. Immunohistochemical characterization of subtypes of male breast carcinoma. Breast Cancer Res. 2009; 11:R28.

Wang-Rodriguez J, Cross K, Gallagher S, Djahanban M, Armstrong JM, Wiedner N, et al. Male breast carcinoma: Correlation of ER, PR, Ki-67, Her2- Neu, and p53 with treatment and survival, a study of 65 cases. Mod Pathol. 2002;15:853-61.