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Zhou S, Lv H, Li A, Li M, Zhong S, Lu H, Zhou X, Bai Q, Yang W. A clinicopathological study and survival analysis of 99 breast cancers with HER2/CEP17 ratio ≥ 2.0 and an average HER2 copy number < 4.0 per cell in China. BMC Cancer 2023; 23:84. [PMID: 36698078 PMCID: PMC9875391 DOI: 10.1186/s12885-023-10531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Breast cancer patients of American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) Group 2 were all HER2-negative according to the 2018 guideline, not HER2-positive as defined in the 2013 guideline. METHODS We aims to elucidate the unique clinicopathological features of ASCO/CAP Group 2 patients by comparing with classic HER2-nonamplified cancers, and reveal the efficacy of the former to anti-HER2 therapy. The clinicopathological features, treatment and prognosis information of 99 patients between 2014 and 2018 were collected. HER2 status was re-defined using the updated recommendations. RESULTS Of the 99 ASCO/CAP Group 2 tumors, 25.5% (25/99) tumors were immunohistochemical (IHC) 0/1+ and 74.7% (74/99) tumors were IHC 2+. According to the updated 2018 guideline, all of them were HER2 negative. When compared to ASCO/CAP Group 5, patients of ASCO/CAP Group 2 displayed higher ratio of histological grade 3 (P = .03), high Ki67 proliferation index (P = .03) and pN3 (more than 9 lymph nodes metastasis, P = .02), and lower estrogen receptor (ER) positivity (P = .04). There was no statistical difference in the survival of patients received anti-HER2 therapy and patients not received anti-HER2 therapy. CONCLUSIONS Patients of ASCO/CAP Group 2 did not received apparent benefit from anti-HER2 treatment. Although according to the updated guidelines and latest reports, HER2 is negative, but when compared with classic HER2-nonamplified cancers, patients of this group seemed to be more aggressive. We suggest that this group still be regarded as an independent category, in order to accumulate more cases in the future to expand the scope of research.
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Affiliation(s)
- Shuling Zhou
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Hong Lv
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Anqi Li
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Ming Li
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Siyuan Zhong
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Hongfen Lu
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Xiaoyan Zhou
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Qianming Bai
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Wentao Yang
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
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Morey AL, Brown B, Farshid G, Fox SB, Francis GD, McCue G, von Neumann-Cosel V, Bilous M. Determining HER2 (ERBB2) amplification status in women with breast cancer: final results from the Australian in situ hybridisation program. Pathology 2016; 48:535-42. [PMID: 27567228 DOI: 10.1016/j.pathol.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/23/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
Appropriate and accurate determination of HER2 status in women with breast cancer is critical for stratifying anti-HER2 therapies, and for access to subsidised treatment in the Australian setting. We conducted a regulated, nationwide program providing HER2 in situ hybridisation (ISH) testing for patients with newly diagnosed breast cancer. Cases with equivocal or non-diagnostic ISH test results at the local laboratory were sent to a high volume central testing laboratory for analysis using fluorescence ISH (FISH). We tested 78,408 early breast cancers and 3469 metastatic cancers using ISH. Of these, 12,405 early breast cancers (15.8%) and 798 metastatic cancers (23.0%) were HER2 positive. During the testing period, the proportion of core biopsy samples increased, the number of repeat tests remained stable and testing turnaround time declined. Discordant 3+ IHC, ISH negative results dropped from 20% to 13% in early breast cancers and from 35% to 8% among metastatic breast cancers. Following central laboratory FISH testing only 87 samples remained non-diagnostic (1.9% of FISH-tested samples, 0.1% of the whole cohort), most being decalcified specimens. This is a successful story of a cohesive service determining HER2 status in women with breast cancer in a 'real-world' setting.
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Affiliation(s)
| | - Belinda Brown
- SydPath St Vincent's Hospital, Sydney, NSW, Australia
| | - Gelareh Farshid
- Divisions of Surgical Pathology and Cytopathology, SA Pathology, Adelaide, Australia; BreastScreen SA, Australia; Discipline of Medicine, Adelaide University, SA, Australia
| | - Stephen B Fox
- The Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, Vic, Australia
| | - Glenn D Francis
- Griffith University, Gold Coast, Australia; University of Queensland, St Lucia, Qld, Australia
| | | | | | - Michael Bilous
- Healthscope Pathology, Norwest Private Hospital, Bella Vista, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
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Kurozumi S, Padilla M, Kurosumi M, Matsumoto H, Inoue K, Horiguchi J, Takeyoshi I, Oyama T, Ranger-Moore J, Allred DC, Dennis E, Nitta H. HER2 intratumoral heterogeneity analyses by concurrent HER2 gene and protein assessment for the prognosis of HER2 negative invasive breast cancer patients. Breast Cancer Res Treat 2016; 158:99-111. [PMID: 27318853 PMCID: PMC4937084 DOI: 10.1007/s10549-016-3856-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/04/2016] [Indexed: 02/07/2023]
Abstract
HER2 gene-protein assay (GPA) is a new method for the simultaneous evaluation of HER2 immunohistochemistry (IHC) and HER2 dual in situ hybridization (DISH) on single tissue sections of breast cancer. We investigated the presence of HER2 gene and protein discrepancy and HER2-heterogeneity using HER2-GPA. HER2 status was analyzed for the correlation between the presence of HER2-heterogeneity and patient prognosis. Consecutive 280 invasive breast cancer were examined. Statuses of HER2 protein and gene were evaluated in whole tumor sections of HER2 GPA slides. HER2 protein and gene combination patterns were classified to six phenotypic and genotypic types for each case, as well as at individual cell levels: (A) IHC and DISH positive; (B) IHC positive and DISH negative; (C) IHC equivocal and DISH positive; (D) IHC equivocal and DISH negative; (E) IHC negative and DISH positive; and (F) IHC and DISH negative. The presence of HER2-heterogeneity was determined by the existence of at least two of six types within one tumor. HER2-IHC positive patients had significantly worse survival than IHC negative patients and HER2-DISH positive patients had significantly worse survival than DISH negative patients. HER2 IHC negative and DISH positive patients had significantly worse recurrence-free survival than IHC and DISH negative patients. In the HER2 IHC and DISH negative group, the HER2 heterogeneous group had significantly worse survival than the nonheterogeneous group. Notably, among triple negative breast cancer (TNBC), the HER2 heterogeneous group had significantly worse survival than the nonheterogeneous group. Our study suggests that the presence of HER2-heterogeneity might be a prognostic factor in HER2 negative breast cancer patients, especially in TNBC.
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Affiliation(s)
- Sasagu Kurozumi
- Division of Breast Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kitaadachi-gun, Saitama, Japan
| | - Mary Padilla
- Ventana Medical Systems, Inc., 1910 East Innovation Park Drive, Tucson, AZ, 85755, USA
| | - Masafumi Kurosumi
- Department of Pathology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan.
| | - Hiroshi Matsumoto
- Division of Breast Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kitaadachi-gun, Saitama, Japan
| | - Kenichi Inoue
- Division of Breast Oncology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kitaadachi-gun, Saitama, Japan
| | - Jun Horiguchi
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-city, Gunma, Japan
| | - Izumi Takeyoshi
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-city, Gunma, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-city, Gunma, Japan
| | - Jim Ranger-Moore
- Ventana Medical Systems, Inc., 1910 East Innovation Park Drive, Tucson, AZ, 85755, USA
| | - D Craig Allred
- Ventana Medical Systems, Inc., 1910 East Innovation Park Drive, Tucson, AZ, 85755, USA
| | - Eslie Dennis
- Ventana Medical Systems, Inc., 1910 East Innovation Park Drive, Tucson, AZ, 85755, USA
| | - Hiroaki Nitta
- Ventana Medical Systems, Inc., 1910 East Innovation Park Drive, Tucson, AZ, 85755, USA
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HER2 in situ hybridization in breast cancer: clinical implications of polysomy 17 and genetic heterogeneity. Mod Pathol 2014; 27:4-18. [PMID: 23807776 DOI: 10.1038/modpathol.2013.103] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/05/2013] [Accepted: 04/11/2013] [Indexed: 12/19/2022]
Abstract
Trastuzumab-containing therapy is a standard of care for patients with HER2+ breast cancer. HER2 status is routinely assigned using in situ hybridization to assess HER2 gene amplification, but interpretation of in situ hybridization results may be challenging in tumors with chromosome 17 polysomy or intratumoral genetic heterogeneity. Apparent chromosome 17 polysomy, defined by increased chromosome enumeration probe 17 (CEP17) signal number, is a common genetic aberration in breast cancer and represents an alternative mechanism for increasing HER2 copy number. Some studies have linked elevated CEP17 count ('polysomy') with adverse clinicopathologic features and HER2 overexpression, although there are numerous discrepancies in the literature. There is evidence that elevated CEP17 ('polysomy') count might account for trastuzumab response in tumors with normal HER2:CEP17 ratios. Nonetheless, recent studies establish that apparent 'polysomy' (CEP17 increase) is usually related to focal pericentromeric gains rather than true polysomy. Assigning HER2 status may also be complex where multiple cell subclones with distinct HER2 amplification characteristics coexist within the same tumor. Such genetic heterogeneity affects up to 40% of breast cancers when assessed according to a College of American Pathologists guideline, although other definitions have been proposed. Recent data have associated heterogeneity with unfavorable clinicopathologic variables and poor prognosis. Genetically heterogeneous tumors harboring HER2-amplified subclones have the potential to benefit from trastuzumab, but this has yet to be evaluated in clinical studies. In this review, we discuss the implications of apparent polysomy 17 and genetic heterogeneity for assigning HER2 status in clinical practice. Among our recommendations, we support the use of mean HER2 copy number rather than HER2:CEP17 ratio to define HER2 positivity in cases where coamplification of the centromere might mask HER2 amplification. We also highlight a need to harmonize in situ hybridization scoring methodology to support accurate HER2 status determination, particularly where there is evidence of heterogeneity.
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