The reliability of assessment of oestrogen receptor expression on needle core biopsy specimens of invasive carcinomas of the breast

Abstract

Aim: To assess the reliability of assessment of oestrogen receptor expression on needle core biopsy specimens of invasive carcinomas of the breast. Previous studies have mostly been small, with a range of agreement from 62% to 100%. Methods: Retrospective audit of 338 tumours surgically excised within 60 days of core biopsy, that had had oestrogen receptor assessed on both the core biopsy and tumour specimens. Surgical specimens were incised when fresh to ensure good fixation. External controls including a weakly positive tumour were included in each immunohistochemistry run. Results: Oestrogen receptor expression was bimodal, with H score in both specimens of either 0 or .50 in 96% of tumours. Using H score cut-off of 10 for positivity, there was an agreement between core and excision in 334 of 338 tumours (98.8%). All discrepancies were between weakly positive and negative tumours. Intratumoral heterogeneity could explain the one tumour that was negative on core and positive on excision. H score tended to be slightly higher on core than excision (means 146 and 136). Better fixation on the core is the most likely explanation for this and for the three tumours that were positive on core and negative on excision. Repeat staining on tumours with discrepant results gave similar results in all except one case. An internal control was present in 97% of excisions and 55% of cores of oestrogen receptor-negative tumours; the internal control stained positively in all except two sections. Conclusion: Oestrogen receptor can be assessed reliably on needle core biopsies of invasive carcinomas of the breast.

Current issues in ER and HER2 testing by IHC in breast cancer

“…Whereas the published literature suggests a concordance rate of 60-100% in breast samples of individual patients when core needle vs resection specimens are examined, more recent studies employing the most up-to-date methodologies in the context of larger number of cases show near 100% concordance between needle core and resection specimens. 9 However, Mann and colleagues have demonstrated that as many as 9% of women may have falsenegative ER IHC studies if their resection, rather than needle core biopsy, is utilized. These falsenegative studies may be a consequence of inadequate fixation.…”

Downregulation of Rap1GAP in Human Tumor Cells Alters Cell/Matrix and Cell/Cell Adhesion

“…(A) Tissue sections containing adjacent normal colonic epithelium and tumor tissue were stained for Rap1GAP as previously described (37,47). (B) Rap1GAP staining was quantified by H score (23). The H scores in tumor versus normal tissue were compared using the nonparametric Wilcoxon signed-rank test and found to be significantly different (P ϭ 0.0007).…”

“…1A). Semiquantitative staining according to H score (23) revealed that Rap1GAP expression was significantly decreased in tumor tissue compared to that in the adjacent normal epithelium (Fig. 1B).…”

Contribuição da imuno-histoquímica na avaliação de fatores prognósticos e preditivos do câncer de mama e no diagnóstico de lesões mamárias

“…A biópsia por agulha é de particular valor para avaliação de marcadores tumorais em tumores grandes, em pacientes que vão se submeter à quimioterapia neoadjuvante. Trabalhos que avaliaram a determinação de RE na biópsia por agulha versus espécime cirúrgico mostram índice de concordância de até 98,8% (10,20) . Nos casos discrepantes, a maior positividade é obtida nas amostras de biópsia por agulha, e não nos espécimes cirúrgicos, provavelmente devido à melhor fixação tecidual que ocorre nas amostras menores e ao rápido processamento.…”

“…A expressão do RP é induzida pelo RE, por isso a maioria dos tumores RP+ também é RE+. Programas de controle de qualidade sugerem que, quando o estudo imuno-histoquímico revelar tumor RE-/RP+, deve-se repetir a análise para RE e, principalmente, melhorar a reativação antigênica (20) .…”