Total Malignancy Score – A New Integrated Morphological Index for Breast Cancer

Introduction. One of the most common integrated morphological indices used in breast cancer (BC) patients is the Nottingham Prognostic Index (NPI). NPI can only be used after surgical treatment, as its calculation requires information on the status of axillary lymph nodes. Methods. We perform preoperative assessment of the axillary lymph node metastases risk in BC patients using the integrated morphological index – Total Malignancy Score (TMS). The TMS was calculated as the sum of the following parameters: tubule formation; nuclear pleomorphism; mitotic activity; invasive component; lymphoid infiltration; and lymphovascular invasion. The TMS was formed by summing the scores of the aforementioned micromorphological criteria and ranged from 5 to 20. Results. The study included 358 BC patients with a median age of 58.0 years (48.0–65.0). The TMS showed a statistically significant correlation with axillary lymph node metastases (p < 0.001). At the same time, a statistically significant direct moderate correlation was found between the TMS and the number of axillary lymph nodes metastases (r= 0.342; p< 0.001). The study demonstrated that the disease prognosis based on the TMS correlated statistically significantly with the prognosis based on the NPI (p< 0.001). Conclusion. The TMS is not inferior to the NPI in terms of prognostic value, but unlike the latter, it can be used at the preoperative stage. The TMS is a relatively simple, low-cost model for predicting recurrence risk and can be recommended for personalizing BC therapy in routine practice.