A Clinical Histomorphological and Immunohistochemical Analysis of Breast Neoplasms.

Breast Cancer Is The Most Common Carcinoma In Females Which Accounts For 22% Of All Female Cancers. It Is More Than Twice The Occurrence Of Carcinoma In Females At Any Other Site.29 In Southern India, Breast Cancer Is The Second Most Common Cancer Among Women.28 The Incidence Of The Disease Had Been Increasing In Both Developed And Developing Countries Until 1980, But Still Continues To Increase In The Developing Countries. Breast Disorders Encompass A Heterogenous Group Of Lesions That May Be Presenting As A Palpable Mass, Non-Palpable Abnormality Detected On Breast Imaging Or An Incidental Microscopic Finding. Women Who Have Undergone Breast Biopsies Reflect A Spectrum Of Histologic Conditions From Normal Breast Tissue Of Varying Physiologic States At One Extreme To Changes Approximating To Carcinoma At The Other End.60 Etiology Of Breast Cancer Is Multifactorial. It Includes Diet, Reproductive Life Style, Exogenous And Endogenous Hormones, Body Weight, Alcohol, Smoking And Physical Activity. However, More Than Most Other Neoplasms, Breast Cancer Shows Familial Clustering.29 Two High Penetrance Genes Brca1 & Brca2 Greatly Increase The Cancer Risk. Multigenic Traits Also Play A Significant Role In The Inherited Susceptibility To Cancer. Literatures Say Carcinoma Breast Is A Disease Of Affluent Societies Which Have Acquired The Western Style Characterized By High Calorie Diet Combined With Lack Of Exercise.29 There Have Been Two General Approaches To Prognostication Via Histopathologic Analysis. The First Categorizes Carcinomas Based On Specific Features, Recognizing The So Called Special Type Carcinoma. Histopathologic Features Have Been Recognized As A Necessary Element For Appropriate Management Of Breast Carcinoma. The Second Approach Evaluates Individual Characteristics Of The Carcinoma – Grading Which Is Shown To Be Robust Determinant Of Outcome Of Breast Carcinoma.15 Establishment Of A Uniform System Of Grading Will Increase The Frequency Of Grading By Pathologists, Significantly Reduce Observer Variation And Strengthen The Predictive Value Of Histologic Grade. The Most Widely Accepted System For Grading Invasive Breast Carcinoma Is The Elston-Ellis System Which Represents The Modification Of The Scarf-Bloom- Richardson System Established In The Middle Of The Last Century. It Is Performed By Combining Tissue Architecture (Tubule Formation), Cell Morphology (Nuclear Pleomorphism) And Assessment Of Cell Proliferation Rate (Mitotic Count).24,29,35,36,52. Histological Grading Has Been Considered As Too Subjective To Be Used Clinically And Grading May Be Associated With Lack Of Reproducibility Even When Performed By Experienced Pathologists. On The Other Hand, Numerous Studies Have Shown A Significant Association Between Histological Grade And Survival In Breast Cancer And There Is No Doubt That Grading Is Simple, Quick And Economical To Perform. Low Histological Grade Is Significantly Related To Recent Or Current Use Of Combined Hormone Replacement Therapy.42 Histological Grading Identifies Patients With Low Risk Of Breast Cancer Recurrence. Since It Is Associated With Minimal Cost, Its Use In Clinical Decision Making May Result In Substantial Savings. Omission Of Grading From Clinical Decision Making Results In Overseas Of Adjuvant Therapies. Histological Grade Was Correlated Strongly With Survival. Women With Well Differentiated Node Negative Cancer Had 97% 5year Distant Disease Free Survival Rate As Compared With 78% For Women With Poorly Differentiated Cancer.39 The Relative Importance Of Histologic Grade In Multivariate Analysis May Depend On Many Factors Such As The Selection Process Of Breast Cancers For The Series Being Analyzed, The Quality Of Assessment, End Points Chosen And Personal Skill Of The Pathologist Responsible For Grading.39 It Is Important To Evaluate The Prognostic Value Of Histologic Grade In Relation To Novel Molecular Genetic Markers. It Remains To Be Seen Whether Some Of The Novel Biologic Factors Can Replace Histologic Grade As A Simple And Powerful Prognostic Variable And Produce Superior Result When Performed In Routine Clinical Setting. A Recent Study Indicates That Grade May Yet Be A More Powerful Predictor Than Intensively Studied Molecular Genetic Factors Such As P53 And Cerb-2.39 This Study Is Undertaken In View Of Evaluating The Actual Incidence Of Breast Neoplasms In Semi-Urban Areas Like Thanjavur With Particular Attention To Demographic Characteristics, Clinical Presentation, Histopathology And Grading