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International Journal of Breast Cancer

Volume 2015, Article ID 964392, 5 pages
http://dx.doi.org/10.1155/2015/964392

Research Article
Preoperative Peripheral Blood Count in Breast Carcinoma:
Predictor of Prognosis or a Routine Test

Amrit Pal Singh Rana,1 Manjit Kaur,2 B. Zonunsanga,1

Arun Puri,2 and Amarjit Singh Kuka1
1
Department of Surgery, GGS Medical College, Faridkot 151203, India
2
Department of Pathology, GGS Medical College, Faridkot 151203, India

Correspondence should be addressed to Amrit Pal Singh Rana; [email protected]

Received 25 July 2015; Revised 8 November 2015; Accepted 11 November 2015

Academic Editor: Vladimir F. Semiglazov

Copyright © 2015 Amrit Pal Singh Rana et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Background. Peripheral blood count is the first investigation to be done in every patient before surgery. As strong relationship exists
between cancer and immune response of the body, clinical stage at presentation and altered hematological parameters can influence
the progression of cancer and vice versa. Settings and Design. It is a case control study of total 50 cases (35 cases of carcinoma
breast and 15 cases of benign breast disease). Methods. A case control study was carried out; 35 cases of breast cancer patients were
taken prior to surgery and chemotherapy with 15 cases of benign breast disease as control. Clinical staging according to the tumor,
node, and metastasis classification (TNMc) was done and was correlated with complete blood count (CBC). Results. All the cancer
patients were females with overall mean age of 47.96 ± 13.84 years. Amongst all altered blood parameters, correlation of absolute
lymphocytic count (𝑝 value 0.001) with TNMc staging was found significant. Particularly, decrease in absolute leucocytic count was
observed with increase in stage of breast carcinoma. Conclusions. The stage-specific mean values of absolute lymphocytic counts of
preoperative breast cancer patients can be used as an economical tool to know the evolution of disease.

1. Introduction 2. Methods
Complete blood count especially lymphocytic count reflects This was a case control study carried among the breast cancer
the response of cellular immunity in a cancer patient. patients (35 cases) who have undergone breast surgeries at a
Any alteration in hematological parameters influences the tertiary health care centre. Patients who had taken chemo-
disease progression. Depending upon the clinical presen- therapy were excluded. Breast cancer patients were staged
tation (TNMc staging), response of various hematological prior to surgery. The patients were staged clinically according
parameters has been correlated and studied. Hemoglobin to the tumor, node, and metastasis (TNM) classification.
(Hb) and packed cell volume (PCV) are indirectly associated Stage I tumor is <2 cm in greatest dimension, with no nodal
with increased risk of cardiac failure in cancer patients [1]. involvement and no metastasis. Stage II ranges from none-
Total leucocytic count (TLC), if elevated, predicts poorer vident tumor to tumor >5 cm in greatest dimension with
prognosis [2]. The prognostic significance of neutrophils, either no nodal involvement or metastases in movable ipsilat-
lymphocytes, plasma cells, mean platelet volume (MPV), eral axillary lymph node(s) but no distant metastases. Stage
platelet/lymphocyte ratio, and neutrophil/lymphocyte ratio III tumor size ranges from either not evident to tumor of
studied in gastric cancer patients showed influence on overall any size with direct extension to (a) chest wall or (b) skin,
survival [3]. with no evidence of regional lymph node metastases or meta-
So it is also important to study complete blood count in stases in ipsilateral infraclavicular lymph node(s) with or
breast carcinoma and its correlation with TNMc staging. without axillary lymph node involvement or in clinically
2 International Journal of Breast Cancer

Table 1: Age-wise distribution of cases in different stages of carcinoma and benign group.

Number of cases (total = 50) Percent of cases (%) within group Age (mean ± SD) Minimum age Maximum age
Carcinoma stage-wise (𝑛 = 35)
1 08.5 49.0 ± 2.8 47 51
2 34.2 45.8 ± 11.0 18 60
3 42.8 48.3 ± 14.3 15 75
4 14.2 52.5 ± 18.8 35 80
Benign group (𝑛 = 15) 30 35.4 ± 12.6 24 58

Table 2: Hb, RBC, and PCV parameters in relation to four stages of carcinoma and benign group.

Carcinoma stage
Hb, RBC, and PCV parameters Benign group
1 2 3 4
Hb (mean ± SD) 12.6 ± 1.48 10.4 ± 2.1 11.6 ± 1.35 12.2 ± 1.66 10.5 ± 1.65
Minimum Hb 11.6 4.9 9.0 10.1 8.2
Maximum Hb 13.7 13.5 14.1 14.3 13.2
RBC (mean ± SD) 4.45 ± 0.02 4.16 ± 0.88 4.3 ± 0.44 4.5 ± 0.55 4.5 ± 0.62
Minimum RBC 4.5 2.57 5.36 3.89 3.3
Maximum RBC 4.6 5.97 3.36 5.31 5.6
PCV (mean ± SD) 42.8 ± 3.39 33.6 ± 7.7 35.9 ± 3.6 38.8 ± 3.8 35.0 ± 5.5
Minimum PCV 40.4 16.7 27.0 33.1 27.2
Maximum PCV 45.2 42.7 42.4 43.5 44.0

apparent ipsilateral internal mammary lymph node(s) and 4. Results

in the presence of clinically evident lymph node metastasis
in ipsilateral supraclavicular lymph node(s) with or without A total of 50 cases of breast disease were studied. Out of them,
axillary or internal mammary lymph node involvement. 35 cases of breast carcinoma were analyzed. All the patients
There is no distant metastasis. Stage IV shows involvement were females with overall mean age of 47.96 ± 13.84 years
of distant metastases regardless of tumor or nodal status. All (Table 1).
patients with a breast mass were carefully examined and the A total of 60.0% of the cases had Hb < 12 mg% at
mass was measured. The presence or absence of any signs of presentation. Using PCV > 38% as the cut-off, 62.9% of cases
local advancement (inflammation, peau d’orange, ulceration, were anaemic, while 37.1% had normal PCV. The minimum
satellite nodules, direct chest wall involvement, mobile or PCV for cases was 16.7%, maximum was 45.2%, and the mean
fixed axillary nodes, and supraclavicular lymph node) was was 35.87 ± 6.0%. The PCV was found not to be significantly
noted and recorded. Abdomen and spine were also examined associated with staging (𝑝 = 0.54). Also no significant corre-
for evidence of spread. CBC records were reevaluated for Hb, lation between PCV of the patients and the staging was noted
PCV, mean corpuscular volume (MCV), mean corpuscular on analysis of variance. Hb, RBC, and PCV parameters of
hemoglobin (MCH), and mean corpuscular hemoglobin con- all the cases in the context of carcinoma staging and benign
centration (MCHC), TLC, differential leucocytic count (DLC) group are given in Table 2.
with absolute counts, and platelet parameters and were com- Red cell indices for different stages of carcinoma are given
pared with CBC records of 15 cases of benign breast disease. in Table 3. The overall mean MCV, MCH, and MCHC of
cases of carcinoma were 89.98 ± 5.29 fl, 26.8 ± 0.90 g/L, and
3. Statistics 31.64 ± 0.84 g/L, respectively, with no significant correlation
with staging (𝑝 value 0.99, 𝑝 value 0.62, 𝑝 value 0.95, and 𝑝
The results of 35 histologically diagnosed, prechemotherapy value 0.96, resp.).
breast cancer patients were analyzed. Patients already on While the mean WBC counts (TLC), absolute neutrophil
chemotherapy before presentation were excluded from the count (N), absolute lymphocytic count (L), absolute mono-
study. Data were analyzed using SPSS version 16.0. The des- cytic count (M), and absolute eosinophilic count (E) of cases
criptive data were given as means ± SD. The Pearson chi- were 7.57 ± 1.0, 4.56 ± 8.8, 2.49 ± 1.2, 2.9 ± 1.4, and 1.34 ± 7.7,
square test and analysis of variance were used for the ana- respectively (Table 4), the mean platelet count was 2.61 ±
lytic assessment and the differences were considered to be 0.4 (Table 5). Very significant correlation of total leucocytic
statistically significant and very significant when the 𝑝 value count (𝑝 value 0.002) and lymphocytic count (𝑝 value 0.001)
obtained was <0.05, <0.002, respectively. Results were com- was noted. Significant correlation was observed in case of
pared with findings of 15 samples of benign breast lesions. monocytes (𝑝 value 0.008).
International Journal of Breast Cancer 3

Table 3: Red cell indices in relation to four stages of carcinoma and benign group.

Carcinoma stage
Red cell indices parameters Benign group
1 2 3 4
MCV (mean ± SD) 93.6 ± 8.2 82.8 ± 11.7 84.2 ± 7.5 85.4 ± 2.5 79.5 ± 8.1
Minimum MCV 87.8 62.1 65.6 81.9 63.0
Maximum MCV 99.4 100.3 95.0 89.0 88.9
MCH (mean ± SD) 27.6 ± 3.11 26.2 ± 4.3 26.78 ± 2.1 26.0 ± 0.7 26.2 ± 4.2
Minimum MCH 25.4 18.3 22.0 26.0 18.0
Maximum MCH 29.8 32.5 30.9 28.1 30.3
MCHC (mean ± SD) 31.1 ± 3.95 30.5 ± 1.8 32.1 ± 2.1 31.8 ± 1.0 31.8 ± 1.9
Minimum MCHC 28.3 26 25.0 30.5 28.0
Maximum MCHC 33.9 32.6 34.1 32.9 34.0

Table 4: Relation of various leucocytic parameters with four stages of carcinoma and benign group.

Carcinoma stage
Leucocytic parameters Benign group
1 2 3 4
TLC (mean ± SD) 9.100 ± 2.998 8.619 ± 2.930 7.404 ± 1.686 6.222 ± 1.580 8.543 ± 2.400
Minimum TLC 7.000 16.560 10.970 3.550 4.900
Maximum TLC 11.240 5.200 4.630 7.670 14.200
N (mean ± SD) 3.800 ± 0.325 5.829 ± 2.907 4.614 ± 1.209 4.454 ± 1.098 5.380 ± 1.760
Minimum N 3.600 2.180 7.680 2.730 3.000
Maximum N 4.060 14.170 2.850 5.500 9.200
L (mean ± SD) 5.800 ± 3.676 2.289 ± 1.024 2.127 ± 0.641 1.379 ± 0.762 2.753 ± 0.656
Minimum L 3.200 1.100 0.840 0.500 1.600
Maximum L 8.400 4.200 3.500 2.277 3.800
M (mean ± SD) 0.33 ± 0.25 0.33 ± 0.26 0.30 ± 0.23 0.20 ± 0.05 0.226 ± 0.209
Minimum M 0.150 0.100 0.010 0.138 0.010
Maximum M 0.510 1.106 1.106 0.260 0.650
E (mean ± SD) 0.06 ± 0.04 0.12 ± 0.07 0.21 ± 0.15 0.10 ± 0.03 0.066 ± 0.066
Minimum E 0.030 0.000 0.000 0.040 0.008
Maximum E 0.100 0.250 0.550 0.138 0.200

Other parameters have not shown any significant corre- investigations are part and parcel of follow-up of carcinoma
lation. patients as well as first investigation being done prior to
Benign group showed significant correlation of lympho- surgery for carcinoma, it can help in the assessment of disease
cytic count with clinical staging of carcinoma patients (𝑝 progression. So it is important to make out that a complete
value = 0). Other parameters showed no significant corre- blood cell count (CBC) being low cost, standardized, rou-
lation. tinely used tests can still offer useful information regarding
the behavior of different malignancies. In the current study
5. Discussion no significant correlation between anaemia and breast cancer
could be identified. In patients with cancer, >60% cases have
Breast cancer is the second most common carcinoma among Hb < 12 gm% along with altered red cell indices; amongst
females with 99% female prevalence. In the present study that 4.7% of the cases had Hb < 7 gm%. Anorexia associated
conducted, cases considered for analysis were found to be of with cancers generally can result in nutritional anaemia seen
females only. As evidenced in a study conducted in the past, in the cases. On the other hand metastasis to the bone
only one percent of breast cancer develops in males. However, marrow from breast cancer can be associated with suppres-
in a study done in Nigeria, 2.0% prevalence of breast cancer sion of erythropoiesis. Benign group also have shown
was reported amongst male population. Although prevalence anaemia (mean Hb < 10 gm%) probably due to lower socioe-
of breast carcinoma is different in both males and females, conomic status and poor nutrition [5, 8].
prognosis is similar [4–6]. The mean TLC was decreased with progression of disease
Breast carcinoma is the leading cause of death in women from stage 1 to stage 4. It was in contrast with the Blue Moun-
with more than 1,00,000 cases occurring annually [7]. With tains Eye Study cohort of older Australians, where an elevated
the advent of many new techniques, prognosis as well as WBC count was seen with cancer mortality, independent of
progression of cancer can be estimated. As routine blood smoking, diabetes mellitus, fasting glucose levels, and other
4 International Journal of Breast Cancer

Table 5: Relation of platelets parameters with four stages of carcinoma and benign group.

Carcinoma stage
Platelets parameters Benign group
1 2 3 4
Platelets (mean ± SD) 1.91 ± 1.32 2.87 ± 0.73 2.59 ± 0.88 2.65 ± 1.1 2.63 ± 0.54
Minimum platelets 0.97 1.2 1.36 1.58 1.57
Maximum platelets 2.85 3.75 4.81 4.65 3.34

related factors [9]. However, few prospective studies have The mean platelet count of cases (291.51 ± 103.38)
examined the putative association between systemic markers was also higher than that of benign group (222.82 ±
of inflammation and incident cancer [2, 10]. However, abso- 57.62). Preoperative thrombocytosis has been identified as an
lute neutrophil counts of cases have not shown any statistical adverse prognostic indicator in some malignancies [20, 21]. In
significance in comparison with staging. But, in cases of stage another study done on patients with esophageal carcinoma,
1, in comparison with control group and other stages, low a high platelet count was found to be associated with tumor
counts were observed. The various studies done in the past progression and poor survival [22].
have emphasized that the patients with an absolute granulo-
cyte count of 6000/mm3 or more have a shorter survival than 6. Conclusion
the patients with less than 6000/mm3 . More or less similar
phenomenon was observed independently in patients with In summary, breast cancer patients who presented with
advanced carcinoma of the colon in another study [11, 12]. deranged full blood count pattern were compared with the
In the present study conducted, decrease in mean abso- benign cases. It was observed that stage-specific mean values
lute TPLC was noted with progression of the disease. It was of absolute lymphocytic counts of breast cancer patients can
observed that localized tumor in stage 1 has shown lymphocy- be employed as a useful guide to assess the progression of
tosis (5.800 ± 36.76) and lymphocytopenia (1.379 ± 0.762) was disease; however, further work with large sample sized studies
noted in stage 4. This finding was comparable with reports of is needed in this field.
Parkin DM and fellows, who observed that the decrease in
TPLC was directly proportional to the progress of the disease Conflict of Interests
[7]. In addition, when compared with benign group, stage
The authors declare that there is no conflict of interests
1 of breast carcinoma showed significantly raised absolute
regarding the publication of this paper.
TPLC and, on the other hand, stage 4 showed significant
decreases in absolute TPLC. Many other studies conducted
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