Because four positive lymph nodes were identified at surgery, the current standard of care is to recommend adjuvant chemotherapy for this patient. Some practitioners might also consider use of a gene expression profile or biomarker assay, although they are not validated in the setting of four or more positive lymph nodes.
Ki-67 is an indirect measure of cell proliferation. Although a high Ki-67 value is often considered a marker for poorer prognosis in early breast cancer, it is not prospectively validated to predict benefit of chemotherapy. Recently, the International Ki67 in Breast Cancer Working Group concluded that "Ki-67 has limited value for treatment decisions due to questionable analytical limitations." However, Ki-67 can be helpful when genomic assays are not available.
The expression of an androgen receptor is not routinely assessed in early-stage breast tumors.
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Cite this: Stefania Morganti. Skill Checkup: A 51-Year-Old Woman With a 3 cm Lump in the Upper Right Quadrant of Right Breast - Medscape - Dec 19, 2022.