Dokument: Hormon- und HER2-Rezeptorstatus beim Mammakarzinom: Bestimmung an der sonografisch gesteuerten Stanzbiopsie und Vergleich mit dem Exzisionspräparat unter Berücksichtigung der Tumorheterogenität

Titel:Hormon- und HER2-Rezeptorstatus beim Mammakarzinom: Bestimmung an der sonografisch gesteuerten Stanzbiopsie und Vergleich mit dem Exzisionspräparat unter Berücksichtigung der Tumorheterogenität
URL für Lesezeichen:https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=66463
URN (NBN):urn:nbn:de:hbz:061-20240808-082432-7
Kollektion:Dissertationen
Sprache:Deutsch
Dokumententyp:Wissenschaftliche Abschlussarbeiten » Dissertation
Medientyp:Text
Autor: Török, Janet Yvonne [Autor]
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Dateien vom 05.08.2024 / geändert 05.08.2024
Beitragende:Prof. Dr. med. Fehm, Tanja N. [Gutachter]
Prof. Dr. Baldus, Stephan [Gutachter]
Dewey Dezimal-Klassifikation:600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit
Beschreibungen:Die sonografisch gesteuerte Stanzbiopsie ist ein fester Bestandteil der präoperativen Abklärungsdiagnostik von unklaren Brustbefunden. Zusammen mit der histologischen Untersuchung der Gewebeproben ermöglicht die Stanzbiopsie zuverlässige, präzise Diagnosen und erlaubt darüber hinaus eine umfangreiche Primärdiagnostik bei Mammakarzinomen für eine gezielte Therapieplanung. Um Brustkrebspatientinnen eine individuell maßgeschneiderte Therapie anzubieten, ist es umso wichtiger, dass die Stanzbiopsie verlässliche Informationen liefert, die ansonsten erst die Untersuchung der operativ entfernten Karzinome ergeben würde. Zu diesen zählen u. a. die Hormonrezeptoren für Östrogen (ER) und Progesteron (PR) sowie der humane epidermale Wachstumsfaktorrezeptor 2 (HER2). Diese können Aufschluss über die Wirkung einer bestimmten Systemtherapie geben und erlauben eine vorausschauende Einschätzung des weiteren Krankheitsverlaufs.
Im Rahmen der vorliegenden retrospektiven Studie wurden die diagnostische Genauigkeit der Stanzbiopsie im Vergleich mit den operativ entfernten Mammakarzinomen sowie mögliche Faktoren, die die Aussagekraft der Stanzbiopsie beeinflussen können, untersucht. Dem Vergleich von sonografisch gesteuerten Stanzbiopsien mit den dazugehörigen Exzisionspräparaten lagen 223 adjuvant behandelte Mammakarzinome sowie eine kleine als Subgruppe geführte, neoadjuvant therapierte Mammakarzinome aus der Zeit zwischen Januar 2002 und Dezember 2005 zugrunde. Im Vergleich mit den Exzisionspräparaten ergab die Stanzbiopsie eine hohe Sensitivität und Spezifität zur Bestimmung der Hormonrezeptoren ER (94,9 % und 85,4 %) und PR (95,2 % und 86,8 %) sowie für HER2 (75,0 % und 96,2 %). Vergleichbare Ergebnisse lagen für den positiven und den negativen Vorhersagewert von ER (96,1 % und 81,4 %), PR (95,2 % und 86,8 %) und HER2 (77,4 % und 95,7 %) vor. Somit bestätigen sie die Stanzbiopsie nicht nur als zuverlässiges, sondern auch als genaues Untersuchungsverfahren. Obwohl eine hohe Rate an Überstimmungen vorlag, traten ebenfalls Unterschiede bezüglich der Histologie und der biologischen Eigenschaften der Mammakarzinome auf − jeweils 14 diskrepante ER (7,1 %) und PR (7,1 %) sowie 15 diskrepante HER2 (7,0 %) −, die nicht auf technische Faktoren zurückzuführen waren aber möglicherweise für einzelne Rezeptoren mit dem Grading der Mammakarzinome zusammenhängen. Nach Alpha-Adjustierung bestand ein signifikanter Zusammenhang zwischen dem Grading und PR (p = 0,002).
Maligne Tumore, wie das Mammakarzinom, sind z. T. komplexe Tumore, die heterogene Tumorareale aufweisen können. Obwohl die Stanzbiopsie zuverlässig ein umschriebenes Tumorareal repräsentiert, definiert sie möglicherweise nicht den gesamten Tumor oder das komplette Ausmaß der Tumorheterogenität.

Sonographically guided core needle biopsy is an essential part of the preoperative diagnosis of unclear breast tumors. Together with a pathological examination of the tissue samples, core needle biopsy enables reliable and precise diagnoses and allows comprehensive primary diagnosis of breast carcinomas for targeted therapy planning. To offer breast cancer patients an individually tailored therapy, it is important that the core needle biopsy provides reliable information that would otherwise only be obtained by examining the surgically removed tumor. This includes the hormone receptors for estrogen (ER) and progesterone (PR) as well as the human epidermal growth factor receptor 2 (HER2), because they can provide information about the effect of a systemic treatment and allow a predictive assessment of the further course of the disease.
In this retrospective study the diagnostic accuracy of the core needle biopsy with the corresponding surgically removed tumors and possible factors, that may influence the significance of the biopsy, were investigated. The comparison of sonographically guided core needle biopsies with the corresponding tumors was based on 223 breast carcinomas and a small subgroup of neoadjuvantly treated patients from the period between January 2002 and December 2005. Compared with the data derived from the removed total tumors, the core needle biopsy showed high sensitivity and specificity for the determination of the hormone receptors ER (94.9 % and 85.4 %) and PR (95.2 % and 86.8 %) and for HER2 (75.0 % and 96.2 %). Comparable results were available for the positive and negative predictive value: ER (96.1 % and 81.4 %), PR (95.2 % and 86.8 %) and HER2 (77.4 % and 95.7 %). These findings confirm the core needle biopsy as a reliable and accurate procedure. Although there was a high rate of biomarker concordance, we also found differences in the histology and biological characteristics of the breast carcinomas − respectively 14 discrepant ER (7.1 %) and PR (7.1 %) and 15 discrepant HER2 (7.0 %) compared with the data derived from the total tumor, which were not due to technical factors, but maybe related to the grading of the breast carcinomas. After alpha adjustment, there was a significant correlation between grading and PR (p = 0.002).
Malignant tumors such as breast carcinoma are sometimes complex tumors that may have heterogeneous tumor areas. Although the core needle biopsy reliably represents a defined tumor area, it may not reflect the entire tumor or the full extent of tumor heterogeneity.
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Dokument erstellt am:08.08.2024
Dateien geändert am:08.08.2024
Promotionsantrag am:15.09.2023
Datum der Promotion:20.06.2024
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