Prognostic value of Ki67 analysed by cytology or histology in primary breast cancer

J Clin Pathol. 2018 Sep;71(9):787-794. doi: 10.1136/jclinpath-2017-204976. Epub 2018 Mar 27.


Aims: The accuracy of biomarker assessment in breast pathology is vital for therapy decisions. The therapy predictive and prognostic biomarkers oestrogen receptor (ER), progesterone receptor, HER2 and Ki67 may act as surrogates to gene expression profiling of breast cancer. The aims of this study were to investigate the concordance of consecutive biomarker assessment by immunocytochemistry on preoperative fine-needle aspiration cytology versus immunohistochemistry (IHC) on the corresponding resected breast tumours. Further, to investigate the concordance with molecular subtype and correlation to stage and outcome.

Methods: Two retrospective cohorts comprising 385 breast tumours with clinicopathological data including gene expression-based subtype and up to 10-year overall survival data were evaluated.

Results: In both cohorts, we identified a substantial variation in Ki67 index between cytology and histology and a switch between low and high proliferation within the same tumour in 121/360 cases. ER evaluations were discordant in only 1.5% of the tumours. From cohort 2, gene expression data with PAM50 subtype were used to correlate surrogate subtypes. IHC-based surrogate classification could identify the correct molecular subtype in 60% and 64% of patients by cytology (n=63) and surgical resections (n=73), respectively. Furthermore, high Ki67 in surgical resections but not in cytology was associated with poor overall survival and higher probability for axillary lymph node metastasis.

Conclusions: This study shows considerable differences in the prognostic value of Ki67 but not ER in breast cancer depending on the diagnostic method. Furthermore, our findings show that both methods are insufficient in predicting true molecular subtypes.

Keywords: Ki67; breast cancer; immunocytochemistry; immunohistochemistry.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Biopsy, Fine-Needle*
  • Breast Neoplasms / chemistry*
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Cell Proliferation
  • Female
  • Humans
  • Immunohistochemistry*
  • Kaplan-Meier Estimate
  • Ki-67 Antigen / analysis*
  • Lymphatic Metastasis
  • Mastectomy
  • Microtomy
  • Middle Aged
  • Neoplasm Staging
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome


  • Ki-67 Antigen