Skill Checkup: A 51-Year-Old Woman With a 3 cm Lump in the Upper Right Quadrant of Right Breast

Stefania Morganti, MD


December 19, 2022

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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