Expression, assessment and significance of Ki67 expression in breast cancer: an update

Lashen, Ayat Gamal; Toss, Michael S; Ghannam, Suzan Fathy; Makhlouf, Shorouk; Green, Andrew; Mongan, Nigel P; Rakha, Emad

Abstract

Ki67 expression is one of the most important and cost-effective surrogate markers to assess for tumour cell proliferation in breast cancer (BC). The Ki67 labelling index has prognostic and predictive value in patients with early-stage BC, particularly in the hormone receptor-positive, HER2 (human epidermal growth factor receptor 2)-negative (luminal) tumours. However, many challenges exist in using Ki67 in routine clinical practice and it is still not universally used in the clinical setting. Addressing these challenges can potentially improve the clinical utility of Ki67 in BC. In this article, we review the function, immunohistochemical (IHC) expression, methods for scoring and interpretation of results as well as address several challenges of Ki67 assessment in BC. The prodigious attention associated with use of Ki67 IHC as a prognostic marker in BC resulted in high expectation and overestimation of its performance. However, the realisation of some pitfalls and disadvantages, which are expected with any similar markers, resulted in an increasing criticism of its clinical use. It is time to consider a pragmatic approach and weigh the benefits against the weaknesses and identify factors to achieve the best clinical utility. Here we highlight the strengths of its performance and provide some insights to overcome the existing challenges.

Citation

Lashen, A. G., Toss, M. S., Ghannam, S. F., Makhlouf, S., Green, A., Mongan, N. P., & Rakha, E. (2023). Expression, assessment and significance of Ki67 expression in breast cancer: an update. Journal of Clinical Pathology, Article jcp-2022-208731. https://doi.org/10.1136/jcp-2022-208731

• Journal Article Type: Article
• Acceptance Date: Feb 6, 2023
• Online Publication Date: Feb 22, 2023
• Publication Date: Feb 22, 2023
• Deposit Date: Feb 21, 2023
• Publicly Available Date: Feb 23, 2023
• Journal: Journal of Clinical Pathology
• Print ISSN: 0021-9746
• Electronic ISSN: 1472-4146
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Article Number: jcp-2022-208731
• DOI: https://doi.org/10.1136/jcp-2022-208731
• Keywords: Ki67; Breast cancer; Assessment; Endocrine therapy; General Medicine; Pathology and Forensic Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/17655678
• Publisher URL: https://jcp.bmj.com/content/early/2023/02/22/jcp-2022-208731