Abstract
Gene-expression profiling of breast cancers has shown that distinct molecular subclasses are present within tumors that are apparently morphologically similar. The molecular subclasses of cohorts classified by the 'intrinsic' gene set include the luminal A and B, erbB-2+, normal-breast-like, and basal-like tumors. Basal-like breast cancers have been reported to be associated with worse overall and disease-free survival compared with the luminal A subtype. In addition, there is an immunohistochemical surrogate for the basal-like profile, which has considerably facilitated their study in non-specialty laboratories. Basal-like breast carcinomas have markedly reduced expression of genes related to estrogen receptors and erbB-2, and express proteins that are characteristic of the normal myoepithelial cell. This Review appraises the current state of knowledge on the clinical and pathologic features of breast cancers classified as 'basal-like' by gene-expression profiling and/or immunohistochemical criteria. These tumors seem to be relatively heterogeneous according to a multitude of clinicopathologic parameters, which indicates that their most prognostically relevant subsets have yet to be defined. Similarly to tumors of luminal epithelial differentiation, carcinomas of the 'basal' type have a spectrum of morphologic and clinical characteristics.
Key Points
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Gene-expression profiling has shown that approximately 20% of invasive breast carcinomas have an increased expression of genes present in the normal myoepithelial cell of the breast, with concurrent decreased expression of estrogen receptor and HER2-related genes
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Basal-like breast cancers (BLBCs) can be identified immunohistochemically, although international consensus on an immunohistochemical definition remains elusive
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BLBCs display high proliferative activity and seem to be over-represented in cancers arising in BRCA1 germline mutation carriers and premenopausal African American women
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Pathologically, most BLBCs are of the ductal histotype and display a pushing border, high histologic grade, stromal lymphocytic infiltrate, and necrosis
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Medullary cancers have a basal-like gene-expression profile, and traditional myoepithelial-type carcinomas, metaplastic carcinomas, and small subsets of other histotypes can also be classified as basal-like by immunohistochemical criteria
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Although prognostic data on BLBCs are not entirely congruent, most studies have shown that BLBCs are associated with decreased overall and disease-free survival compared with their luminal A counterparts; it is unclear whether the prognostic significance of the basal-like phenotype is truly independent of estrogen receptor status or histologic grade
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Fadare, O., Tavassoli, F. Clinical and pathologic aspects of basal-like breast cancers. Nat Rev Clin Oncol 5, 149–159 (2008). https://doi.org/10.1038/ncponc1038
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DOI: https://doi.org/10.1038/ncponc1038
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