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Immunohistochemical Expression of Anaplastic Lymphoma Kinase in Invasive Breast Carcinomas- A Retrospective Study
Introduction: Breast carcinoma remains one of the most common
causes of mortality among female cancer patients inspite of
improvements in treatment modalities. Increased survival rate can
be achieved by identification of new targeted therapies. Anaplastic
Lymphoma Kinase (ALK) alterations are present in many solid and
haematological tumours indicating its role in pathogenesis and
treatment. There are studies regarding the expression of ALK in
few breast cancers but its importance was not clearly mentioned.
Hence, identification of ALK overexpression in breast cancers,
particularly in Triple Negative Breast Cancers (TNBC) might play a
role in their chemotherapy with the help of ALK inhibitors.
Aim: To study the ALK expression in different subtypes of
invasive carcinomas of breast.
Materials and Methods: This was a retrospective cross-sectional
study conducted in the Department of Pathology at Great Eastern
Medical School (GEMS) and Hospital, Srikakulam, Andhra Pradesh,
India, from January 2022 to July 2022. The data of 60 patients,
from January 2021 to December 2021 was retrieved using Hospital
Information Management System (HIMS) and the Haematoxylin
and Eosin (H&E)-stained slides and formalin fixed paraffin
embedded tissue blocks of breast tumour were retrieved and
reviewed. Estrogen receptor (ER), Progesterone receptor (PR) and
Human Epidermal growth factor Receptor 2 (HER2) immunostains
were performed and categorised based on molecular classification as Luminal, Her2 and Triple negative. ALK Staining was performed
on all cases and its expression was studied. Statistical Package for
Social Sciences (SPSS) software version 2.0 was used for analysis
of data. Mean with standard deviation is used for quantitative
variables and prevalence, ratio is used for quantitative variables.
Chi-square test and Fischer exact test were used for detecting
significance. The p-value <0.05 was considered as significant.
Results: Out of 60 cases, majority (N=22; 36.66%) of patients
were in the age group of 51-60 years. The mean tumour size
was 3.2±0.5 cm. The most common histological type was
invasive breast carcinoma, No Special Type (N=44; 73.34%).
Majority of the tumours showed grade 1 and 2 with 24 (40%)
and 25 (41.67%) cases, respectively. A total of 30 cases (50%)
of tumours belonged to stage T2. Luminal molecular subtype
was the most common 31 (51.67%) cases followed by TNBC,
16 (26.67%) cases and Her2neu 13 (21.67%) cases. Among all
the cases, ALK overexpression was seen in 17 (28.33%) cases
and among different molecular subtypes, its expression was
seen in 5 (8.33%) cases of Luminal type, 3 (5.0%) cases of
HER2 type and in 9 (15.0%) cases of TNBC cases.
Conclusion: Immunohistochemical analysis showed ALK over
expression in a substantial proportion of cases and possibly
plays a significant role in aggressive behaviour of breast cancer.
ALK inhibitors offer an opportunity to treat aggressive subtypes
of breast cancer