Risk factors associated with discordant Ki-67 levels between preoperative biopsy and postoperative surgical specimens in breast cancers

Hyung Sun Kim, Seho Park, Ja Seung Koo, Sanghwa Kim, Jee Ye Kim, Sanggeun Nam, Hyung Seok Park, Seung Il Kim, Byeong Woo Park

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15 Citations (Scopus)


Purpose The Ki-67 labelling index is significant for the management of breast cancer. However, the concordance of Ki-67 expression between preoperative biopsy and postoperative surgical specimens has not been well evaluated. This study aimed to find the correlation in Ki-67 expression between biopsy and surgical specimens and to determine the clinicopathological risk factors associated with discordant values. Patients and Methods Ki-67 levels were immunohistochemically measured using paired biopsy and surgical specimens in 310 breast cancer patients between 2008 and 2013. ÄKi-67 was calculated by postoperative Ki-67 minus preoperative levels. The outliers of ÄKi-67 were defined as [lower quartile of ÄKi-67-1.5 ? interquartile range (IQR)] or (upper quartile + 1.5 ? IQR) and were evaluated according to clinicopathological parameters by logistic regression analysis. Results The median preoperative and postoperative Ki-67 levels were 10 (IQR, 15) and 10 (IQR, 25), respectively. Correlation of Ki-67 levels between the two specimens indicated a moderately positive relationship (coefficient = 0.676). Of 310 patients, 44 (14.2%) showed outliers of ÄKi-67 (range, -20 or 28). A significant association with poor prognostic factors was found among these patients. Multivariate analysis determined that significant risk factors for outliers of ÄKi-67 were tumor size >1 cm, negative progesterone receptor (PR) expression, grade III cancer, and age 35 years. Among 171 patients with luminal human epidermal growth factor receptor 2-negative tumors, breast cancer subtype according to preoperative or postoperative Ki-67 levels discordantly changed in 46 (26.9%) patients and a significant proportion of patients with discordant cases had 1 risk factor. Conclusion Ki-67 expression showed a substantial concordance between biopsy and surgical specimens. Extremely discordant Ki-67 levels may be associated with aggressive tumor biology. In patients with luminal subtype disease, clinical application of Ki-67 values should be cautious considering types of specimens and clinicopathological risk factors.

Original languageEnglish
Article numbere0151054
JournalPloS one
Issue number3
Publication statusPublished - 2016 Mar

Bibliographical note

Publisher Copyright:
© 2016 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

All Science Journal Classification (ASJC) codes

  • General


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