Investigating the role of core needle biopsy in evaluating tumor-stroma ratio (TSR) of invasive breast cancer: a retrospective study

Abstract PurposeTumor-stroma ratio (TSR) of invasive breast carcinoma has gained attention in recent years due to its prognostic significance. Previous studies showed TSR is a potential biomarker for indicating the tumor response to neoadjuvant chemotherapy. However, it is not clear how well TSR evaluation in biopsy specimens might reflect the TSR in resection specimens. We conducted a study to investigate whether biopsy evaluation of TSR can be an alternative method.MethodWe collected cases with invasive breast carcinoma of no special type (IBC-NST) from University of Yamanashi hospital between 2011 and 2017 whose biopy and resection specimens both had a pathologically diagnosis of IBC-NST (n=146). We conceptualized a method for evaluating TSR in biopsy specimens within a preliminary cohort (n=50). Within the studied cohort (n=96), biopsy-based TSR (b-TSR) and resection-based TSR (r-TSR) were scored by two pathologists. We then evaluated our method’s validity and performance by measuring interobserver variability between the two pathologists, Spearman’s correlation between b-TSR and r-TSR, and the receiver operating characteristics (ROC) analysis for defining stroma-rich and stroma-poor tumors.ResultsIntra-class coefficient between the two pathologists was 0.59. The correlation coefficients between b-TSR and r-TSR in the two pathologists were 0.45 and 0.37. The ROC areas under the curve were 0.7 and 0.67. By considering an r-TSR of < 50% as stroma-poor, the sensitivity and specificity of detecting stroma-poor tumors were 66% and 64.1%, respectively, when b-TSR was <40%.ConclusionAlthough b-TSR provides useful information about r-TSR in breast carcinoma, it should be combined with imaging investigations.