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Ki67 and proliferation in breast cancer
  1. Nirmala Pathmanathan1,2,5,
  2. Rosemary L Balleine3,4,5
  1. 1Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia
  3. 3Department of Translational Oncology, Western Sydney and Nepean Blue Mountains Local Health Districts, Westmead, New South Wales, Australia
  4. 4Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
  5. 5Sydney Medical School–Westmead, University of Sydney, Westmead, New South Wales, Australia
  1. Correspondence to Dr Nirmala Pathmanathan, Westmead Breast Cancer Institute, Westmead Hospital, Wentworthville, NSW 2145, Australia; nirmala.pathmanathan{at}


New approaches to the prognostic assessment of breast cancer have come from molecular profiling studies. A major feature of this work has been to emphasise the importance of cancer cell proliferation as a key discriminative indicator of recurrence risk for oestrogen receptor positive breast cancer in particular. Mitotic count scoring, as a component of histopathological grade, has long formed part of a routine evaluation of breast cancer biology. However, there is an increasingly compelling case to include a specific proliferation score in breast cancer pathology reports based on expression of the cell cycle regulated protein Ki67. Immunohistochemical staining for Ki67 is a widely available and economical test with good tolerance of pre-analytical variations and staining conditions. However, there is currently no evidence based protocol established to derive a reliable and informative Ki67 score for routine clinical use. In this circumstance, pathologists must establish a standardised framework for scoring Ki67 and communicating results to a multidisciplinary team.

  • Breast Cancer
  • Breast Pathology
  • KI 67

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