Evaluation of tumor-infiltrating lymphocytes across breast cancer stages at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Q: What was the study’s main objective regarding TILs and breast cancer stages?

To evaluate tumor-infiltrating lymphocyte (TIL) scores across breast cancer stages in Northwest Ethiopia.

Q: What relationship did the study find between TIL score and TNM stage?

A positive correlation was found between TIL score and TNM stage, with intermediate and high TIL scores more common in advanced stages and low scores prevalent in early stages.

Sep 22, 2026

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Tumor-infiltrating lymphocytes (TILs) are prognostic biomarkers, yet TIL scoring has shown inconsistency across breast cancer stages and evidence is limited for Ethiopian patients. A cross-sectional study evaluated stromal TILs across breast cancer stages in Northwest Ethiopia from 20 June 2024 to 19 June 2025. Sixty-two patients were assessed using H&E-stained tissue sections and International TIL Working Group guidelines, with statistical analyses including Kruskal-Wallis, Mann-Whitney U, and Spearman correlation. Low TILs predominated in stage II while higher scores were frequent in advanced stages, with positive correlations between TILs and TNM stage, lymph node stage, and grade.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background

Tumor microenvironment and TIL types

TILs and breast cancer outcomes

Methods

Study design and participants

TIL assessment and staining

Statistical analysis

Results

TIL scores across stages, lymph node stages, and grade

Correlations with clinicopathological variables

Conclusions

Clinical implications and future directions

Getnet et al. BMC Cancer (2026) 26:1049 BMC Cancer [https://doi.org/10.1186/s12885-026-16359-7](https://doi.org/10.1186/s12885-026-16359-7) RESEARCH Open Access Evaluation of tumor-infiltrating lymphocytes across breast cancer stages at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Emiyamrew Getnet1*, Gashaw Adane2, Ephrem Awoke Shiferaw3, Tadele Ayelegn Nibret3, Gebremariam MaruYemru3, Minyahl Kassye Mengstu4, Abebe Birhanu5, Afewerk Habtamu1, Habtu Debash 1, Tadelo Wondmagegn2 and Mulualem Lemma2 Abstract Background Tumor-infiltrating lymphocytes (TILs) are recognized as prognostic biomarkers. However, inconsistent TIL scores across breast cancer stages, and data are scarce for Ethiopian patients. Thus, this study evaluated TIL scores across breast cancer stages in Northwest Ethiopia. Methods A cross-sectional study was conducted from 20 June 2024 to 19 June 2025. Using consecutive sampling, 62 breast cancer patients were enrolled, and their socio-demographic and clinicopathological data were collected using questionnaires and chart reviews. Formalin-fixed, paraffin-embedded tissue sections were stained with hematoxylin and eosin, and stromalTILs were evaluated according to the International TIL Working Group guidelines. Data were analyzed using SPSS version 27. Median TILs across clinicopathological variables were assessed using Kruskal-Wallis and Mann-Whitney U tests. Spearman correlation assessed the association of TIL scores and clinicopathological variables. P ≤ 0.05 was considered statistically significant. Results Low TIL scores were observed in 76. 5% of stage II cases, whereas high TIL scores were observed in 54. 5% of stage IV cases. Median TIL percentages in stage IV (48%) and III (33%) were significantly higher than in stage II (7%), and in N2–N3 (33%) than in N0–N1 (9%) (p < 0. 001) . Moreover, the median TIL percentage in grade III (48%) was higher than in grade I (9%) (p = 0 . 028) . TILs were positively correlated with TNM stage, lymph node stage, and grade. Conclusions A positive correlation was found between TIL score and TNM stage. Intermediate and high TIL scores were common in advanced stages, whereas low TIL scores were prevalent in early stages. The findings suggest that advanced tumors may harbor higher mutation burdens and immunogenicity. Future research should explore the molecular subtypes of immune profiles. Keywords Breast cancer, Tumor-infiltrating lymphocytes, Ethiopia *Correspondence: Emiyamrew Getnet [emiyamrewgetnet280@gmail.com](emiyamrewgetnet280@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Getnet et al. BMC Cancer (2026) 26:1049 Background Breast cancer (BC) is the most commonly diagnosed cancer worldwide, with about 2.3 million new cases and 685,000 deaths per ye

FAQs

What was the study’s main objective regarding TILs and breast cancer stages?

To evaluate tumor-infiltrating lymphocyte (TIL) scores across breast cancer stages in Northwest Ethiopia.

How were stromal TILs measured in the study?

Formalin-fixed, paraffin-embedded tissue sections were stained with hematoxylin and eosin (H&E), and stromal TILs were evaluated using International TIL Working Group guidelines.

What relationship did the study find between TIL score and TNM stage?

A positive correlation was found between TIL score and TNM stage, with intermediate and high TIL scores more common in advanced stages and low scores prevalent in early stages.

Sep 22, 2026

Upload by CatatanPagi