Prognostic value of histological and nuclear grades and mitotic index for patients with stages II and III breast carcinoma with positive axillary lymph nodes

Abstract

Objective: To evaluate the histological and nuclear grades and mitotic index for metastasis in patients with clinical stages II and III breast carcinoma with positive axillary lymph nodes. Methods: Fifty-three women were submitted to primary surgical treatment by radical (Halsted) or modified-radical (Patey) mastectomy and chemotherapy and radiotherapy in the chest wall and supraclavicular fossa. Chemotherapy included: fluorouracil, adriamycin, and cyclophosphamide for patients 50 years or younger and fluorouracil, methotrexate, and cyclophosphamide for patients over 50 years of age. Presence of systemic disease was ruled out initially and all patients were monitored for at least five years or until the appearance of metastasis. Histological grade was determined by the modified Scarf-Bloom-Richardson method, nuclear grade by the modified Black method, and mitotic index in X10 fields in the tumor periphery. Results: Of the 53 patients, 27 (50.9%) presented distant metastases. Of these, 18.5% (5/27) had histological grade I tumors, 14.8% (4/27) histological grade II, and 66.7% (18/27) grade III. Twenty-six patients (49.1%) did not present metastases. Of these, 38.4% (10/26) were classified as grade I, 15.4% (4/26) grade II, and 46.2% (12/26) grade III. Among patients with metastases, 3.7% (1/27) presented nuclear grade I tumors, 22.2% (6/27) grade II, and 74.1% (20/27) grade III. Of those without metastases, 19.2% (5/26) were nuclear grade I, 34.6% (9/26) grade II, and 46.2% (12/26) grade III. As for mitotic index, 14.8% (4/27) of patients with metastases had up to five mitoses per X10 field, 25.9% (7/27) had six to ten mitoses, and 59.6% (16/27) more than 10 mitoses. In patients without metastases, 38.5% (10/26) had up to five mitoses, 42.6% (11/26) six to ten mitoses, and 19.2% (5/26) more than 10 mitoses. Conclusions: Mitotic index, but not histological grade or nuclear grade, was associated with distant metastases.