Morphology and Nottingham prognostic index in triple-negative breast carcinomas

Triple-negative breast carcinomas are defined by a lack of expression of the steroid hormone receptors i.e., Estrogen Receptor, Progesterone Receptor, and Human epidermal growth factor Receptor-2. They are characterized by distinct molecular, histological, and clinical features. With higher mortality and early relapse, management of these tumors relies on clinicopathologic prognostic factors. Nottingham's prognostic index is a widely used prognostic tool that integrates three independent prognostic factors, namely tumor size, lymph node status, and histologic grade. It is a sensitive index of clinical aggressiveness in breast carcinomas. This study aims to evaluate morphologic features of Triple negative breast carcinomas and correlate them with Nottingham prognostic index. 22 modified radical mastectomies with triple-negative status were considered for this study. Tumor size, histologic type, grade, node involvement, necrosis, lymphovascular invasion, and Nottingham prognostic index were assessed. All 22 Triple negative breast carcinomas were invasive ductal carcinomas [NOS]. One involved skin and six were larger than 5cms. 10 cases (45%) were histologic grade III, and 9 cases (41%) were grade II. 2 cases had more than 10 positive nodes. Nottingham's prognostic index ranged from 2 to 9.4. Lymphovascular invasion and necrosis in 16 cases (73%) and perineural invasion in 3 cases were noted. Prognostication of breast carcinomas using Nottingham prognostic index helps clinicians in decision-making, stratifying risks, and tailoring individual treatment plans. Including Nottingham's prognostic index routinely in breast carcinoma reporting offers a meaningful integrated indicator for clinicians to assess tumor behavior and aggressiveness.