Assessment of Epithelial to Mesenchymal Transition Markers in Breast Carcinoma and its Association with Histopathological Grading, Size and Metastasis

Abstract

Introduction: Carcinoma breast is the most common malignancy affecting women worldwide. Early detection is key to its effective management. Epithelial to Mesenchymal Transition (EMT) has implications in progression of breast carcinoma and metastasis. Aim: To assess use of EMT Immunohistochemical (IHC) markers in breast carcinoma. Materials and Methods: This is a hospital-based descriptive study and was carried on patients of breast carcinoma attending the Outpatient Department of Surgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India, from July 2011 to October 2013. Histopathological examination of 67 mastectomy specimen was done and graded using Scarff-Bloom-Richardson (SBR) grading system. Lymph nodes found were screened for metastasis. Subsequently IHC study with cytokeratin 5/6 and vimentin were done to assess EMT. Statistical analysis was done using Chi-square or Fisher’s exact test on Statistical Package for Social Sciences software (SPSS) version 15.0 USA. Results: Using SBR grading system, 11 (16.4%) cases were of grade I, 34 (50.7%) cases of grade II and 22 cases were of grade III (32.8%). Out of total, 27.3% (3/11) of grade I, 67.6% (23/34) of grade II and 90.9% (20/22) of grade III tumor were found to have metastasis. Positivity for cytokeratin 5/6 and vimentin were 27.3%(3/11) and 63.6% (7/11) respectively in grade I tumours. Grade II tumours showed 5.9% (2/34) positivity for cytokeratin 5/6 and 82.4% (28/34) for vimentin. Positivity for cytokeratin 5/6 was 0 and 95.5% (21/22) for vimentin in grade III tumors. Conclusion: Increase in metastasis was seen with progression of grade. Down regulation of cytokeratin5/6 and up-regulation of vimentin was observed as the grade of tumour increased. Cytokeratin 5/6 and vimentin may be used to assess EMT which in turn shows higher chances of metastasis.