Microarray profiling of invasive
breast carcinomas has identified subtypes including
luminal A,
luminal B, HER2-overexpressing, and basal-like. The poor-prognosis, basal-like
tumors have been immunohistochemically characterized as
estrogen receptor (ER)-negative, HER2/neu-negative, and
cytokeratin 5/6-positive and/or
epidermal growth factor receptor (EGFR)-positive. The aim of this study was to determine the prevalence of basal-like
ductal carcinoma in situ in a population-based series of cases using immunohistochemical surrogates. A total of 245 pure
ductal carcinoma in situ cases from a population-based, case-control study were evaluated for histologic characteristics and immunostained for ER, HER2/neu, EGFR,
cytokeratin 5/6, p53, and Ki-67. The subtypes were defined as:
luminal A (ER+, HER2-),
luminal B (ER+, HER2+), HER2 positive (ER-, HER2+), and basal-like (ER-, HER2-, EGFR+, and/or
cytokeratin 5/6+). The prevalence of
breast cancer subtypes was basal-like (n = 19 [8%]);
luminal A, n = 149 (61%);
luminal B, n = 23 (9%); and HER2+/ER-, n = 38 (16%). Sixteen
tumors (6%) were unclassified (negative for all 4 defining markers). The basal-like subtype was associated with unfavorable prognostic variables including high-grade nuclei (P < .0001), p53 overexpression (P < .0001), and elevated Ki-67 index (P < .0001). These studies demonstrate the presence of a basal-like in situ
carcinoma, a potential precursor lesion to invasive basal-like
carcinoma.