Forty-seven cases of breast cancer were analyzed for estrogen receptors (ERs) by three different techniques: (1) a biochemical assay using isoelectric focusing in polyacrylamide gel; (2) a monoclonal ER immunocytochemical assay (ERICA, Abbott Laboratories Diagnostics Division), and (3) a polyclonal antiestradiol immunohistochemical technique using formalin-fixed tissue. A high level of agreement (85%) was noted between the biochemical assay and ERICA. The ERICA-processed slides showed minimal background staining and were easy to interpret. Compared with the biochemical assay, ERICA achieved a positive predictive value of 86% and a negative predictive value of 82%. In contrast, results from the polyclonal antiestradiol histologic technique did not correlate with biochemical results and showed positive and negative predictive values of 61% and 25%, respectively. The authors conclude that the ERICA technique should prove to be a valuable adjunct to traditional biochemical ER assays.
Metastatic carcinoma to bone of uncertain primary origin is a common clinical problem that presents to practicing orthopaedic surgeons. The authors present a simple and effective staging system to identify primary malignancies. The role of clinical history, physical examination, laboratory studies, and limited radiographic studies are critical to the success of this diagnostic strategy. Needle or open biopsy frequently is needed yet is usually more effective as a confirmatory study for carcinoma or to rule out primary bone sarcomas. Patients who present with a displaced pathologic fracture require urgent diagnostic and treatment plans that do not compromise future treatment options particularly if the lesion is a primary sarcoma, in which durable skeletal reconstruction is possible.
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