Stromal lymphocytes are associated with upgrade of B3 breast lesions

Kader, Tanjina; Provenzano, Elena; Jayawardana, Madawa W; Hendry, Shona; Pang, Jia-Ming; Elder, Kenneth; Byrne, David J; Tjoeka, Lauren; Frazer, Helen Ml; House, Eloise; Jayasinghe, Sureshni I; Keane, Holly; Murugasu, Anand; Rajan, Neeha; Miligy, Islam; Toss, Michael; Green, Andrew; Rakha, Emad; Fox, Stephen B; Mann, Bruce; Campbell, Ian G; Gorringe, Kylie L

Abstract

Various histopathological, clinical and imaging parameters have been evaluated to identify a subset of women diagnosed with lesions with uncertain malignant potential (B3 or BIRADS 3/4A lesions) who could safely be observed rather than being treated with surgical excision, with little impact on clinical practice. The primary reason for surgery is to rule out an upgrade to either ductal carcinoma in situ or invasive breast cancer, which occurs in up to 30% of patients. We hypothesised that the stromal immune microenvironment could indicate the presence of carcinoma associated with a ductal B3 lesion and that this could be detected in biopsies by counting lymphocytes as a predictive biomarker for upgrade. A higher number of lymphocytes in the surrounding specialised stroma was observed in upgraded ductal and papillary B3 lesions than non-upgraded (p < 0.01, negative binomial model, n = 307). We developed a model using lymphocytes combined with age and the type of lesion, which was predictive of upgrade with an area under the curve of 0.82 [95% confidence interval 0.77–0.87]. The model can identify some patients at risk of upgrade with high sensitivity, but with limited specificity. Assessing the tumour microenvironment including stromal lymphocytes may contribute to reducing unnecessary surgeries in the clinic, but additional predictive features are needed.

Citation

Kader, T., Provenzano, E., Jayawardana, M. W., Hendry, S., Pang, J.-M., Elder, K., Byrne, D. J., Tjoeka, L., Frazer, H. M., House, E., Jayasinghe, S. I., Keane, H., Murugasu, A., Rajan, N., Miligy, I., Toss, M., Green, A., Rakha, E., Fox, S. B., Mann, B., …Gorringe, K. L. (2024). Stromal lymphocytes are associated with upgrade of B3 breast lesions. Breast Cancer Research, 26, Article 115

• Journal Article Type: Article
• Acceptance Date: Jun 11, 2024
• Online Publication Date: Jul 8, 2024
• Publication Date: Jul 8, 2024
• Deposit Date: Aug 15, 2024
• Publicly Available Date: Aug 19, 2024
• Print ISSN: 1465-5411
• Electronic ISSN: 1465-542X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Article Number: 115
• Public URL: https://nottingham-repository.worktribe.com/output/38379456
• Publisher URL: https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-024-01857-y