Assessment of prognostic factors in breast fine-needle aspirates

Because of the enhanced effects of new chemotherapeutic agents on the survival of patients with breast cancer, there has been increased interest in the use of prognostic factors. In the last several years, the literature has been saturated with new information about the prognostic/predictive value of traditional factors as well as the newly recognized biomarkers. Controversy, however, remains about the validity of each of the factors as independent prognostic indicators. The standard prognostic factors, recognized by the National Cancer Institute in 1990, include lymph node status, tumor size, nuclear grade, steroid receptor content, tumor type, and cellular proliferation rate. It is also recommended that for patients who undergo preoperative chemotherapy or radiotherapy, breast fine-needle aspirates can be used to provide prognostic information. This article is designed to discuss the traditional and also the newly recognized factors, such as DNA ploidy and proliferation rate, HER-2/neu oncogene, and tumor suppressor gene p53, in breast fine-needle aspirates and their clinical application in breast cancer management. An overview of the proposed guidelines developed by the National Cancer Institute is also presented.