COX2 Expression In Ductal Carcinoma In Situ DCIS

Ductal carcinoma in situ (DCIS) of the breast is characterised by the proliferation of abnormal epithelial cells with morphological features of malignancy within the basement membrane of the mammary ductal system, without the presence of stromal invasion. It is clear that DCIS is a lesion capable of progressing to form an invasive malignancy. In an effort to understand the biology of the disease, and factors which may predict conversion into invasive ductal cancer, much attention has focused on clarifying patterns of protein expression. Surprisingly few studies have addressed the issue of COX-2 expression in DCIS, with varying conclusions (Table 4).

The general consensus of opinion appears to be that:

• COX-2 expression occurs in DCIS.

• A larger proportion of lesions express COX-2 compared to the case with invasive cancers (67-100%).

• Where specifically analysed, COX-2 expression in DCIS appears to correlate with HER2 expression, and hormone receptor negativity.

• COX-2 expression tends to correlate with increasing grade of lesion - but this is contentious.

Variations in findings might again, be explained by differences in experimental methodology. In addition, DCIS likely comprises a vast heterogeneous spectrum of disease, composed of subsets of lesion with differing biological potential.

The presence of COX-2 experssion in preinvasive breast cancer is an important finding. It suggests that COX-2 may play a role in the development of these lesions, or even in their transition into invasive cancers. Correlations with HER2 positivity and hormone receptor negativity may indicate the existence of a subgroup of DCIS lesions with more aggressive biological potential. Studies with large sample numbers and adequate follow-up are required to clarify why there is disparity between studies, and to give an insight into the mechanisms of this disease process.

Table 4. Findings of various studies examining COX-2 expression in DCIS

Immunochemical

No. of DCIS

% COX-2 expression

Clinicopathological

study

cases

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