Tumour Budding with Epithelial Mesenchymal Transition Markers - A Novel Prognostic Tool for Breast Carcinoma.

Introduction: Breast cancer is a leading cause of cancer-related deaths among women worldwide. Prior to metastasis, carcinomas undergo epithelial-mesenchymal transition (EMT), a process wherein cancer cells acquire mobility, form tumor buds (TBs), and invade the stroma. The presence and number of TBs are directly proportional to tumor invasion and metastasis. By scoring TBs and using immunohistochemistry (IHC) to detect EMT process, we can identify patients with poor prognosis after surgical resection. This enables early recognition of patients requiring aggressive treatment and follow-up.

Aim: The aim of this study was to propose an algorithm for measuring TB and to establish the correlation between TB with EMT markers expression and main clinical parameters.

Materials and methods: A retrospective analytical study in an urban tertiary health care center involving 47 cases of invasive breast carcinomas. TB was assessed in Haematoxylin & Eosin stained tissue sections followed by IHC with EMT markers. Association between TB, EMT markers, and main clinical parameters was statistically analyzed using the Chi-square test.

Results: Among 47 cases, 30 had mean-low TB score (≤4/ 10HPF) and 17 had mean-high TB score (>4/10 HPF). Tumors with high TB scoring showed strong SNAIL, TWIST, and N-cadherin expression. Tumors with low TB scores showed high E-cadherin expression and low SNAIL, TWIST, and N-cadherin expression.

Conclusion: The study established a positive correlation between TB and EMT markers. High TB scores are significantly associated with lymphovascular invasion, lymph node metastasis, and higher tumor grading. Using TB score and EMT markers in breast cancer management can facilitate patient-centered approach.