Tumor Budding Unveiled: Clinicopathological Correlations and Survival Insights From a Tertiary Care Cancer Center of India.

Background: Tumor budding (TB), defined as isolated single cells or small clusters at the invasive front, has emerged as a potential adverse prognostic marker in breast cancer (BC), though its clinical utility remains uncertain. Methods: This retrospective study included 229 cases of invasive breast carcinoma. TB was assessed on hematoxylin and eosin (H&E) sections, with AE1/AE3 immunostaining in equivocal cases. TB was analyzed both as a continuous and categorical variable for its association with clinicopathological parameters, including lymph node metastasis, lymphovascular invasion (LVI), distant metastasis, tumor size, nodal stage, age, and hormone receptor status. Patients were followed for 5.75 years to evaluate progression-free survival (PFS) and overall survival (OS). Results: High tumor budding (HTB) was identified in a significant proportion of cases and showed strong correlation with adverse clinicopathological features, including lymph node positivity, LVI, higher nodal stage, and distant metastasis. HTB was more frequent in hormone receptor-positive tumors and less common in triple-negative BC. No significant association was observed between TB and PFS or OS during follow-up. Conclusion: TB is a cost-effective histopathological marker associated with adverse clinicopathological features in BC. Although no significant association with survival outcomes was observed in the present cohort, its correlation with established adverse pathological parameters highlights its potential clinical relevance. Larger prospective studies with standardized assessment criteria are needed to further clarify its prognostic significance and clinical utility.