The global incidence of cancer is steadily rising, making it one of the leading causes of death worldwide. According to GLOBOCAN 2022, breast carcinoma ranks second in incidence (11.6% of all cancers) and fourth in cancer-related mortality (6.9% of all cases). It is the most commonly diagnosed cancer among women across all levels of Human Development Index (HDI), including India.⁽¹⁾ Higher incidence rates in developed countries are associated with reproductive, hormonal, and lifestyle-related risk factors such as early menarche, late menopause, delayed first childbirth, low parity, reduced breastfeeding, use of hormonal therapy and oral contraceptives, alcohol consumption, obesity, physical inactivity, and widespread mammographic screening.⁽²⁾

The management of breast carcinoma is largely guided by established clinical, pathological, and predictive prognostic factors.⁽³⁾ According to the WHO classification, the majority of cases are invasive ductal carcinoma, no special type.⁽⁴⁾ Prognostic evaluation includes clinical parameters (age, gender, laterality, tumour location, and tumour size), histopathological factors (tumour grade, stage, lymphovascular invasion, perineural invasion, necrosis, and lymph node metastasis), and molecular markers such as estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptors 2 (HER 2), Ki-67 index, BRCA1 and BRCA2 mutations, molecular subtypes (Luminal A, Luminal B, HER2-enriched, Basal-like), and multigene assays including(Oncotype^DX, Mammaprint^TM, Blueprint^TM, Breast Cancer Index and the PAM50-based Prosigna^TM assay). However, despite advances in molecular diagnostics, histopathological assessment remains the cornerstone of routine prognostic evaluation, particularly in resource-limited settings. ^(5,6)

AIM

To evaluate the clinical and histopathological prognostic markers of breast carcinoma in operable cases received at a tertiary care center.

OBJECTIVES

1. To evaluate the clinical and histopathological prognostic markers in operable cases of breast carcinoma.
2. To study the distribution of breast carcinoma with respect to age, gender, laterality of breast, tumour location, and tumour size.
3. To assess histopathological grading using the Nottingham modification of Bloom– Richardson system.
4. To determine tumour stage (pT) in the studied
5. To evaluate the presence of adverse histopathological parameters including:
   • Lymphovascular invasion
   • Perineural invasion
   • Necrosis (including comedo type)
   • Lymphnode metastasis

MATERIAL AND METHODS

This retrospective, observational, descriptive, cross-sectional study was conducted on 50 cases of operable breast carcinoma received as lumpectomy or mastectomy specimens in the Department of Pathology at P.D.U. Medical College, Rajkot, from January 2022 to December 2025.

Trucut biopsies, wedge biopsies, primary mesenchymal and hematolymphoid breast tumours, metastatic tumours to the breast, and primary breast carcinomas treated with neoadjuvant chemotherapy or radiotherapy were excluded from the study.

Clinical and gross pathological details, including patient age, gender, breast laterality, tumour location, and tumour size, were obtained from case records. All routine histopathological parameters such as tumour grade, tumour stage, lymphovascular invasion, perineural invasion, necrosis, and lymph node metastasis were evaluated following detailed microscopic examination. Hematoxylin and Eosin (H&E) staining was performed in all cases. Tumour grading was carried out according to the Nottingham modification of the Bloom–Richardson grading system.

RESULTS

The age of the patients ranged from 32 to 78 years. The majority of cases were observed in the fourth decade (24 cases) followed by the fifth decade (20 cases) (Table 1). All patients (100%) in the present study were females.

Among the 50 cases, left breast involvement was observed in 27 patients (54%), while 23 patients (46%) had right breast involvement (Table 2).

Tumours were most commonly located in the subareolar region (25 cases, 50%), while the lower inner quadrant showed the least involvement (2 cases, 4%) (Table 3).

The tumour size ranged from 1.2 to 9.8 cm. The majority of tumours (27 cases, 54%) measured between 2 and 5 cm (Table 4).

Tumour grading was performed according to the Nottingham modification of the Bloom– Richardson system. The majority of cases were Grade 2 tumours (24 cases, 48%), followed by Grade 3 tumours (21 cases, 42%) (Table 5).

The most common pathological tumour stage (pT) observed among the 50 cases was stage 2 (pT2) in 24 cases (48%), followed by stage 3 (pT3) in 18 cases (36%) (Table 6).

Lymphovascular invasion and perineural invasion were identified in 19 cases (38%) and 11 cases (22%), respectively (Figures 1 and 2).

Necrosis was observed in 30 cases (60%), of which 12 cases (24%) exhibited comedo-type necrosis (Figures 3 and 4).

Lymph node metastasis was present in 33 out of 50 cases (66%) (Figure 5). (Table 7)

Figure no.1: H&E stain, 200x – Lymphovascular invasion

Figure no.2: H&E stain, 200x – Perineural invasion

Figure no.3: H&E stain, 100x - Comedo necrosis

Figure no.4: H&E stain, 400x – Necrosis

Figure no.5: H&E stain, 100x – Lymphnode metastasis

DISCUSSION

Histopathological evaluation plays a pivotal role in the diagnosis and management of breast carcinoma. Although several newer molecular predictive and prognostic markers are available, their high cost and limited accessibility make them less feasible for routine use in the Indian population.

In the present study, the majority of patients were in the fourth (48%) and fifth decades (40%), which was comparable to findings reported by Kaur et al⁽³⁾(64%), Ramchandwani et al⁽⁷⁾(62%) and Manjunatha Y A et al⁽⁸⁾(86.66%).

All 50 cases in the present study were females, demonstrating marked female predominance, which was consistent with observations by Kaur et al⁽³⁾(100%) and Imad Q et al⁽⁷⁾(93.33%), where the majority of patients were also females.

Left breast involvement (54%) was more common in the present study, which was comparable to findings reported by Papalexis P et al⁽⁸⁾(55.8%) and Manjunatha Y A et al⁽⁸⁾(60%). In contrast, Kaur et al⁽³⁾(60%) reported right breast involvement as more frequent.

The subareolar region (50%) was the most common tumour location in the present study. However, Kaur et al⁽³⁾(100%) and Imad Q et al⁽⁷⁾(93.33%) reported the upper outer quadrant as the most frequent site. According to the WHO bluebook literature, the upper outer quadrant is generally the most common location for breast carcinoma.⁽⁴⁾

In the present study, tumour size ranged from 1.2 to 9.8 cm, with the majority of cases (54%) measuring between 2 and 5 cm. Similarly, Kaur et al⁽³⁾reported tumour sizes ranging from 1 to 5 cm, with 70% of cases measuring 2–5 cm. Papalexis P et al⁽⁸⁾, reported a median tumour size of 2.6 cm (range: 0.4–12 cm).

In the present study, Grade 2 tumours were the most common (48%), which was comparable to findings reported by Papalexis P et al⁽⁸⁾(53.8%), Manjunatha Y A et al⁽⁸⁾(60%) and Soni et al⁽¹¹⁾(57.29%). In contrast, Kaur et al⁽³⁾ reported Grade 3 as the most prevalent tumour grade.

The most common pathological tumourstage in the present study was stage 2 (48%), similar to observations by Papalexis P et al⁽⁸⁾(53.8%) and Manjunatha Y A et al⁽⁸⁾(60%). However, Imad Q et al⁽⁷⁾(46.66%)reported stage 1 as the most frequent tumour stage (46.66%).

Lymphovascular invasion was identified in 38% of cases in the present study, which was slightly higher than the 32.36% reported by Soni et al⁽¹¹⁾.

In present study, perineural invasion was present in 22% of cases whereas in the study conducted bySoni et al⁽¹¹⁾, perineural invasion was present in only 6.1% of cases.

Necrosis was present in 60% of cases in the present study, with 24% demonstrating comedo-type necrosis, whereas Soni et al⁽¹¹⁾, reported necrosis in 46.15% of cases.

Lymph node metastasis was observed in 66% of cases, which was higher than the 55.23% reported by Soni et al⁽¹¹⁾.

CONCLUSION

Breast cancer incidence and mortality increase with advancing age. Histopathological parameters—including tumour grade, stage, lymphovascular invasion, perineural invasion, necrosis, and lymph node metastasis—remain vital prognostic indicators in breast carcinoma. Although Grade 2 tumours (48%) were the most prevalent in the present study, higher-grade tumours showed a stronger association with lymph node metastasis and adverse prognostic features. In resource-limited settings, careful histopathological evaluation continues to be essential for guiding therapeutic decisions and predicting patient outcomes.

Conflict of Interest: None

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