ArticleBiomarkers in medicine2026
Analytical validity of CD20 as a biomarker in breast cancer patients using tissue microarrays and whole slide sections.
Article in Biomarkers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundClinical utility of biomarker-based treatment depends on both analytical and clinical validity. CD20+ B-lymphocytes often form nodular lymphoid structures within tumors, presenting potential analytical issues if using tissue microarrays (TMA). We compared CD20 expression in TMAs and whole-slide sections (WS) using digital image analysis. MATERIALS AND
methodsImmunohistochemical CD20+ expression was assessed on 1 TMA core/patient and corresponding WS from 221 breast cancer patients. CD20+ area fractions were quantified within four spatial tissue compartments: (1) tumor epithelium; (2) tumor margin; (3) tumor-related stroma; (4) total tumor area. Bland-Altman analysis and t-test compared CD20+ area fractions of WS and TMA.
resultsCD20+ cells were predominantly located in the stroma and often formed nodules. Across all compartments, the absolute area fraction of CD20+ was significantly lower in TMAs than in WS. Mean ratios of CD20+ area fractions (WS vs. TMA) ranged from 2.5 (95% confidence interval: 1.7-3.6;
conclusionsThese findings indicate that TMAs may underestimate the presence of CD20+ cells in breast cancer, presumably due to the formation of nodules. This heterogeneity in distribution is important to consider when exploring the use of CD20 as a potential clinical biomarker.
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