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유방 질환에서 에스트로젠 수용체에 대한 단일 클론 항체를 이용한 면역 조직 화학적 연구
박웅채,김세민 고려대학교 의과대학 1990 고려대 의대 잡지 Vol.27 No.1
Estrogen receptor has been a guideline marker for prognosis and therapy of breast cancer since it had been named by Toft in 1966. Since then Dextran Coated Charcoal method from cytosolic homogenates as a biochemical estrogen receptor assay has been used. But estrogen receptor by using this method, has been lost enthusiasm as a marker for prognosis and therapy of breast cancer because it has low specifity. The reason for that low yield has been speculated that there are estrogen receptor positive and negative cell simultaneously in the same tissue or unpurified other protein in the breast cancer tissue. To identify those estrogen receptor distribution in the tissue, Greene had proposed peroxidase antiperoxidase stain after reacting with monoclonal antibody. It has opened new field of oncology since it had been introduced in 1980. To define clinical role of this peroxidase antiperoxidase staining in the field of surgical and adjuvant therapy for breast cancer, we carried out a retrospective study during 3 years period by the immunohistochemical study using monoclonal antibody against ER - D 5. Material were obtained from Dept. of pathology. 60 cases consisting 31 malignant lesions and 29 benign lesions of paraffin block breast specimen were elected for this study. There were 24(40.0%) positive ER staining in 60 specimen. These 24 positive ER consisted of 11 malignant and 13 benign lesions. There were 11 positive ER out of 31 cancer lesions (35.5%) and 13 positive ER out of 29 benign lesions(44.8%). The positivity of ER was dominant in infiltrating ductal carcinoma (41.7 % ) and fibrocystic disease (66.6 % ), sclerosing adenosis (66.6 % ) and fibroadenoma (37.5%). the pevalence of estrogen receptor in infiltrating ductal carcinoma provides a clue to ductal origin of carcinoma. There were 1 positive stain in 6 stage Ⅰ , 7 in 14 stage Ⅱ, 3 in 8 stage Ⅲ, and no in 3 stage Ⅳ breast carcinoma according to TNM system. 2 out of 8 permenopausal carcinoma (25.0%) and 9 out of 23 postmenopausal carcinoma (39.1 %) also showed ER positivity. There were 13 cases (54. 2%) of 1 + staining, 8 cases (33.3%) of 2 + staining and 3 cases (12.5%) of 3 + staining in 24 positive ER breast masses. Tamoxifen treatment was instituted in 6 ER positive cancer patients and all patients were survived at the end of this study. But 4 out of 20 ER negative cancer patients were recurred at the end of this study. Based on this result, we suggest that the immunohistochemical stain of ER using monoclonal antibody may be a simple and useful method for the decision of adjuvant endocrine therapy in breast cancer.
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