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Kate U, Pais A, Kamble N, Kandoor S, Sharma K. Atypical Co-amplification with Co-localization of HER2 Gene in Breast Cancer: Combined IHC/FISH Approach as per ASCO/CAP 2018 Guidelines for Targeted Therapy Eligibility. Indian J Surg Oncol 2024; 15:8-11. [PMID: 38511042 PMCID: PMC10948631 DOI: 10.1007/s13193-023-01829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/28/2023] [Indexed: 03/22/2024] Open
Abstract
Breast cancer patients with HER2 gene amplification as assessed by FISH are eligible for HER2-targeted therapy. However, in a small subset of patients, unusual FISH pattern of co-localization and co-amplification can pose challenges in interpretation of the HER2 status and hence to assess the HER2 status accurately; our aim was to report their incidence and analyze them based on latest ASCO/CAP 2018 guidelines. We present seven cases with HER2/CEP17 co-amplification and co-localization from a total 4040 cases referred during the year 2017 to 2021 at Mumbai Reference Laboratory, SRL Diagnostics. Core needle biopsy/excision invasive breast carcinoma specimens from metastatic sites were tested for IHC for expressions of ER, PR, and HER2. The ones which came equivocal on HER2 IHC were then evaluated for HER2 amplification by FISH. Co-amplification and co-localization of HER2 and centromeric 17 was observed with a frequency of 0.1% that falls in the range of 0.5-0.1% as reported from other large-scale studies. Our study showed that implementation of a binary inhouse concurrent assessment with IHC as per the ASCO/CAP 2018 helps to reach the most definitive and accurate HER2 status. Our study is an attempt to report such challenging FISH patterns and their work-up for a better understanding on the interpretation. Cumulative data along with follow-up in these cases would bring an insight into exact therapeutic outcome.
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Affiliation(s)
- Ushang Kate
- Cytogenetics Department, Mumbai Reference Laboratory, SRL Diagnostics, Mumbai, India
| | - Anurita Pais
- Cytogenetics Department, Mumbai Reference Laboratory, SRL Diagnostics, Mumbai, India
| | - Neelam Kamble
- Cytogenetics Department, Mumbai Reference Laboratory, SRL Diagnostics, Mumbai, India
| | - Sandhya Kandoor
- Cytogenetics Department, Mumbai Reference Laboratory, SRL Diagnostics, Mumbai, India
| | - Kunal Sharma
- Centre of Excellence and Histopathology, Mumbai Reference Laboratory, SRL Diagnostics, Lead-DP & AI Initiatives, Mumbai, India
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Gambella A, Bertero L, Rondón-Lagos M, Verdun Di Cantogno L, Rangel N, Pitino C, Ricci AA, Mangherini L, Castellano I, Cassoni P. FISH Diagnostic Assessment of MDM2 Amplification in Liposarcoma: Potential Pitfalls and Troubleshooting Recommendations. Int J Mol Sci 2023; 24:ijms24021342. [PMID: 36674856 PMCID: PMC9863600 DOI: 10.3390/ijms24021342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
MDM2 amplification represents the leading oncogenic pathway and diagnostic hallmark of liposarcoma, whose assessment is based on Fluorescence In Situ Hybridization (FISH) analysis. Despite its diagnostic relevance, no univocal interpretation criteria regarding FISH assessments of MDM2 amplification have been established so far, leading to several different approaches and potential diagnostic misinterpretations. This study aims to address the most common issues and proposes troubleshooting guidelines for MDM2 amplification assessments by FISH. We retrospectively retrieved 51 liposarcomas, 25 Lipomas, 5 Spindle Cell Lipoma/Pleomorphic Lipomas, and 2 Atypical Spindle Cell Lipomatous Tumors and the corresponding MDM2 FISH analysis. We observed MDM2 amplification in liposarcomas cases only (43 out of 51 cases) and identified three MDM2-amplified patterns (scattered (50% of cases), clustered (14% of cases), and mixed (36% of cases)) and two nonamplified patterns (low number of signals (82% of cases) and polysomic (18% of cases)). Based on these data and published evidence in the literature, we propose a set of criteria to guide MDM2 amplification analysis in liposarcoma. Kindled by the compelling importance of MDM2 assessments to improve diagnostic and therapeutic liposarcoma management, these suggestions could represent the first step to develop a univocal interpretation model and consensus guidelines.
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Affiliation(s)
- Alessandro Gambella
- Division of Liver and Transplant Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Luca Bertero
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Milena Rondón-Lagos
- School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia, Tunja 150003, Colombia
| | - Ludovica Verdun Di Cantogno
- Department of Laboratory Medicine, Azienda Ospedaliera Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Nelson Rangel
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Chiara Pitino
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | | | - Luca Mangherini
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | | | - Paola Cassoni
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Correspondence: ; Tel.: +39-011-633-5588
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Fang C, Zhang J, Li J, Shang H, Li K, Jiao T, Yin D, Li F, Cui Y, Zeng Q. Clinical-radiomics nomogram for identifying HER2 status in patients with breast cancer: A multicenter study. Front Oncol 2022; 12:922185. [PMID: 36158700 PMCID: PMC9490879 DOI: 10.3389/fonc.2022.922185] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To develop and validate a clinical-radiomics nomogram based on radiomics features and clinical risk factors for identification of human epidermal growth factor receptor 2 (HER2) status in patients with breast cancer (BC). Methods Two hundred and thirty-five female patients with BC were enrolled from July 2018 to February 2022 and divided into a training group (from center I, 115 patients), internal validation group (from center I, 49 patients), and external validation group (from centers II and III, 71 patients). The preoperative MRI of all patients was obtained, and radiomics features were extracted by a free open-source software called 3D Slicer. The Least Absolute Shrinkage and Selection Operator regression model was used to identify the most useful features. The radiomics score (Rad-score) was calculated by using the radiomics signature-based formula. A clinical-radiomics nomogram combining clinical factors and Rad-score was developed through multivariate logistic regression analysis. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results A total of 2,553 radiomics features were extracted, and 21 radiomics features were selected as the most useful radiomics features. Multivariate logistic regression analysis indicated that Rad-score, progesterone receptor (PR), and Ki-67 were independent parameters to distinguish HER2 status. The clinical-radiomics nomogram, which comprised Rad-score, PR, and Ki-67, showed a favorable classification capability, with AUC of 0.87 [95% confidence internal (CI), 0.80 to 0.93] in the training group, 0.81 (95% CI, 0.69 to 0.94) in the internal validation group, and 0.84 (95% CI, 0.75 to 0.93) in the external validation group. DCA illustrated that the nomogram was useful in clinical practice. Conclusions The nomogram combined with Rad-score, PR, and Ki-67 can identify the HER2 status of BC.
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Affiliation(s)
- Caiyun Fang
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated Hospital of Shandong First Medical University, Jinan, China
- Postgraduate Department, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Juntao Zhang
- GE Healthcare Precision Health Institution, Shanghai, China
| | - Jizhen Li
- Department of Radiology, Shandong Mental Health Center, Jinan, China
| | - Hui Shang
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated Hospital of Shandong First Medical University, Jinan, China
- Postgraduate Department, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Kejian Li
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated Hospital of Shandong First Medical University, Jinan, China
- Postgraduate Department, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tianyu Jiao
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated Hospital of Shandong First Medical University, Jinan, China
- Postgraduate Department, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Di Yin
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fuyan Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated Hospital of Shandong First Medical University, Jinan, China
- *Correspondence: Qingshi Zeng,
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Geiersbach KB, Sill DR, Del Rosario KM, Meyer RG, Spears GM, Yuhas JA, Sukov WR, Jenkins RB, Ocal IT, Mounajjed T, Chen B. Detailed Reanalysis of 500 Breast Cancers With Equivocal HER2 Immunohistochemistry and Borderline ERBB2 Fluorescence In Situ Hybridization Results. Am J Clin Pathol 2021; 156:886-894. [PMID: 33942843 DOI: 10.1093/ajcp/aqab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We investigated the impact of our laboratory's reflex testing process for resolving ERBB2 (HER2) status on breast cancer samples that require additional workup after fluorescence in situ hybridization (FISH), per guideline recommendations published in 2018 by the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP). METHODS In total, 500 breast cancer specimens with ERBB2 FISH results in groups 2 through 4 (all reported as immunohistochemistry [IHC] equivocal [2+] at external laboratories) were resubmitted for IHC testing in our laboratory. Per the ASCO/CAP guideline, FISH was rescored when internal IHC was also equivocal (2+), targeted to tumor areas demonstrating more intense IHC staining, if observed. RESULTS Reflex IHC/FISH testing changed the final reported ERBB2 status in 185 of 500 (37.0%) samples. Result changes included discordant IHC (n = 4 score 0, n = 132 score 1+, and n = 16 score 3+) and discordant FISH (n = 33). Numerical differences in FISH scores were comparable for targeted vs nontargeted FISH rescoring (P = .086 for ERBB2 copy number; P = .49 for ERBB2 ratio). Two cases showed larger differences in FISH scores, suggesting heterogeneity. CONCLUSIONS Retesting of breast cancer samples with equivocal IHC frequently changes IHC results, but targeted reanalysis of borderline FISH results rarely identifies significant differences in ERBB2 copy number or ratio.
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Affiliation(s)
| | - Daniel R Sill
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Reid G Meyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Grant M Spears
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jason A Yuhas
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Idris T Ocal
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Taofic Mounajjed
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Grimm EV, Allison KH, Hicks DG, Swenson KK, Krueger J, Yaziji H, Downs-Kelly E, Rendi MH, Susnik B, Tsai ML, Lillemoe TJ. HER2 Testing: Insights From Pathologists' Perspective on Technically Challenging HER2 FISH Cases. Appl Immunohistochem Mol Morphol 2021; 29:635-642. [PMID: 34282066 DOI: 10.1097/pai.0000000000000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE College of American Pathologists and the American Society of Clinical Oncology guidelines provide straightforward criteria for HER2 interpretation in breast carcinomas; however, a subset of cases present unusual diagnostic dilemmas. MATERIALS AND METHODS Ten challenging HER2 fluorescence in situ hybridization (FISH) cases were selected for analysis. The study included a variety of problematic cases such as those with discordant immunohistochemistry (IHC) and FISH results, cases with high intratumoral variability in HER2 copy number, a case with a highly amplified clone in 5% to 10% of the tumor sample, and a case with tumor cells containing tightly clumped HER2 signals. Six high volume HER2 FISH laboratories performed and interpreted HER2 FISH (adding HER2 IHC if necessary). Interpretation strategies were discussed. RESULTS There was 100% concordance between laboratories in 4/10 cases. Tumors with increased intratumoral variability (tumors with high variability in HER2 copy number per cell but which otherwise do not fulfill College of American Pathologists and the American Society of Clinical Oncology criteria for heterogeneity) exhibited 100% concordance in 3/4 cases, but 1 case had only 50% agreement. Low positive HER2 cases (group 1 cases with <6 average HER2 copies/cell) had 1 laboratory disagreeing with the majority in 4/4 cases, and this was the only category with discordance between IHC and FISH methodologies. All laboratories identified the case with heterogeneity and interpreted it as positive. Five of the 6 laboratories interpreted the case with tightly clustered HER2 signals as positive. CONCLUSIONS This study offers specific observations and interpretation strategies that laboratories can use when confronted with difficult HER 2 cases. It then highlights communication strategies a laboratory may use to discuss these unusual HER2 results with the clinical team.
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Affiliation(s)
- Erin V Grimm
- Allina Health Laboratories/Hospital Pathology Associates
| | | | - David G Hicks
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY
| | - Karen K Swenson
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN
| | - Janet Krueger
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | - Mara H Rendi
- Allina Health Laboratories/Hospital Pathology Associates
| | - Barbara Susnik
- Allina Health Laboratories/Hospital Pathology Associates
| | - Michaela L Tsai
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN
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Fujii S, Magliocco AM, Kim J, Okamoto W, Kim JE, Sawada K, Nakamura Y, Kopetz S, Park WY, Tsuchihara K, Kim TW, Raghav K, Yoshino T. International Harmonization of Provisional Diagnostic Criteria for ERBB2-Amplified Metastatic Colorectal Cancer Allowing for Screening by Next-Generation Sequencing Panel. JCO Precis Oncol 2020; 4:6-19. [DOI: 10.1200/po.19.00154] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE ERBB2 amplification (human epidermal growth factor receptor 2 positivity [HER2+]) in metastatic colorectal cancer (mCRC) has important therapeutic implications that necessitate the need for accurate diagnostics. The study purpose was to establish and validate harmonized diagnostic criteria for HER2+ mCRC among 3 groups (GI-SCREEN-Japan, NCTN-SWOG-USA, and Korea). PATIENTS AND METHODS We assessed HER2 status by immunohistochemistry (IHC), ERBB2/CEP17 ratio, gene copy number (GCN) by fluorescence in situ hybridization (FISH), and copy number variation (CNV) using two targeted next-generation sequencing (NGS) panels. Tumor samples from 475 and 16 patients with mCRC in exploratory and validation cohorts, respectively, were used for cross-validation of the NGS panels. RESULTS Consensus diagnostic criteria among the 3 groups for HER2+ mCRC were established as follows: IHC 3+ or IHC 2+ and ERBB2/CEP17 ratio by FISH ≥ 2.0, tumor content > 10% for surgically resected specimens, and necessary tumor content not defined for biopsy specimens. The median GCN and CNV for HER2+ patients were 10.9 and 27.7 compared with 2.5 ( P < .0001) and 3.5 ( P < .0001), respectively, in HER2-negative patients. These findings were validated in a validation cohort (GCN, 16.2 v 2.4 [ P = .0002]; CNV, 42.5 v 2.0 [ P = .0003]). GCN correlated with CNV in both cohorts (exploratory, r = 0.90; validation, r = 0.97; P < .0001). CNV in cross-validation of the 2 NGS panels also showed a strong correlation ( r = 0.98; P < .0001). CNV in patients who fulfilled the consensus criteria was > 4.0 in all, which demonstrates the accuracy of the IHC/FISH criteria and cross-validation of NGS panels. CONCLUSION We have established and verified harmonized diagnostic criteria for HER2+ and demonstrated consistency between IHC/FISH and CNV determined by NGS in mCRC.
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Affiliation(s)
- Satoshi Fujii
- Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | | | - Jihun Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Wataru Okamoto
- Biobank Translational Research Support Section, Translational Research Management Division, Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kentaro Sawada
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshiaki Nakamura
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, South Korea
| | - Katsuya Tsuchihara
- Division of Translational Informatics, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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DiScala M, Najor MS, Yung T, Morgan D, Abukhdeir AM, Cobleigh MA. Loss of STAT6 leads to anchorage-independent growth and trastuzumab resistance in HER2+ breast cancer cells. PLoS One 2020; 15:e0234146. [PMID: 32525891 PMCID: PMC7289443 DOI: 10.1371/journal.pone.0234146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022] Open
Abstract
Approximately 20% of breast cancers are HER2-positive. Trastuzumab has improved patient outcomes significantly for these cancers. However, acquired resistance remains a major hurdle in the clinical management of these patients. Therefore, identifying molecular changes that cause trastuzumab resistance is worthwhile. STAT6 is a transcription factor that regulates a variety of genes involved in cell cycle regulation, growth inhibition, and apoptosis. STAT6 expression is lost in approximately 3% of breast cancers, but little work has been done in the context of trastuzumab resistance in breast cancer. In isogenic cell line pairs, we observed that trastuzumab-resistant cells expressed significantly lower levels of STAT6 compared to trastuzumab-sensitive cells. Therefore, in order to study the consequences of STAT6 loss in HER2+ breast cancer, we knocked out both alleles of the STAT6 gene using somatic cell gene targeting. Interestingly, loss of STAT6 resulted in anchorage-independent growth and changes in several genes involved in epithelial to mesenchymal transition. This study suggests that STAT6 may play a role in the pathophysiology of HER2+ human breast cancer.
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Affiliation(s)
- Molly DiScala
- Division of Hematology, Oncology, and Cell Therapy, Department of Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Matthew S. Najor
- Division of Hematology, Oncology, and Cell Therapy, Department of Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Timothy Yung
- Division of Hematology, Oncology, and Cell Therapy, Department of Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Deri Morgan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Missouri, United States of America
| | - Abde M. Abukhdeir
- Division of Hematology, Oncology, and Cell Therapy, Department of Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Melody A. Cobleigh
- Division of Hematology, Oncology, and Cell Therapy, Department of Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
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Greenwell K, Hussain L, Lee D, Bramlage M, Bills G, Mehta A, Jackson A, Wexelman B. Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2/CEP17 ratio in HER2 overexpressing breast cancer: analysis of the National Cancer Database (NCDB). Breast Cancer Res Treat 2020; 181:249-254. [PMID: 32277375 DOI: 10.1007/s10549-020-05599-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND HER2-positive breast cancer is an aggressive subtype of breast cancer that overexpresses human epidermal growth factor receptor 2 promoting cancer cell growth. Monoclonal antibodies targeting the HER2 receptor have improved survival for this patient population. Achieving pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) has correlated with disease-free survival in multiple trials, but we do not know why some HER2-positive tumors respond better to these therapies. We evaluated the correlation between HER2/CEP17 ratio and partial versus complete response following NAC. We evaluated whether patients with higher HER2/CEP17 ratios would have higher rates of pCR after NAC. METHODS Using the National Cancer Database (NCDB), we performed a retrospective review comparing pCR rates after NAC based on HER2 ratio between 2005 and 2014. Patients were excluded if they were HER2 negative, did not undergo NAC, or if the HER2 ratio was not recorded. Trends in percentage of pCR versus partial response were analyzed using SPSS. RESULTS The NCDB included 237,118 patients with HER2 equivocal or HER2-positive breast tumors. 29,291 of these patients underwent NAC, and HER2/CEP17 ratios were recorded in 14,597 of the NAC cases. A pCR was noted in 9752 patients and 11,402 patients had a partial response. The ratios were significantly different between complete vs. partial response groups (include ratios), P < 0.001. Using linear regression analysis, we identified a direct relationship between increasing the ratio and response to NAC. CONCLUSION Our study demonstrates a linear relationship between HER2/CEP17 ratio and pCR to NAC in patients included in the NCDB. The NCDB reflects current clinical practices across the country, and in this patient population, higher HER2 ratio is predictive of pCR to NAC and thus may be used in guiding decisions regarding the therapies that a patient receives in order to enhance pCR.
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Affiliation(s)
| | - Lala Hussain
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - David Lee
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Matthew Bramlage
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Gordon Bills
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Apurva Mehta
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Amie Jackson
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Barbara Wexelman
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
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9
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Ahn S, Woo JW, Lee K, Park SY. HER2 status in breast cancer: changes in guidelines and complicating factors for interpretation. J Pathol Transl Med 2019; 54:34-44. [PMID: 31693827 PMCID: PMC6986968 DOI: 10.4132/jptm.2019.11.03] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/03/2019] [Indexed: 12/16/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) protein overexpression and/or HER2 gene amplification is found in about 20% of invasive breast cancers. It is a sole predictive marker for treatment benefits from HER2 targeted therapy and thus, HER2 testing is a routine practice for newly diagnosed breast cancer in pathology. Currently, HER2 immunohistochemistry (IHC) is used for a screening test, and in situ hybridization is used as a confirmation test for HER2 IHC equivocal cases. Since the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines on HER2 testing was first released in 2007, it has been updated to provide clear instructions for HER2 testing and accurate determination of HER2 status in breast cancer. During HER2 interpretation, some pitfalls such as intratumoral HER2 heterogeneity and increase in chromosome enumeration probe 17 signals may lead to inaccurate assessment of HER2 status. Moreover, HER2 status can be altered after neoadjuvant chemotherapy or during metastatic progression, due to biologic or methodologic issues. This review addresses recent updates of ASCO/CAP guidelines and factors complicating in the interpretation of HER2 status in breast cancers.
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Affiliation(s)
- Soomin Ahn
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Won Woo
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoungyul Lee
- Department of Pathology, Kangwon National University Hospital, Chuncheon, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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10
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Duncan DJ, Vandenberghe ME, Scott MLJ, Barker C. Fast fluorescence in situ hybridisation for the enhanced detection of MET in non-small cell lung cancer. PLoS One 2019; 14:e0223926. [PMID: 31613934 PMCID: PMC6793848 DOI: 10.1371/journal.pone.0223926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/01/2019] [Indexed: 01/29/2023] Open
Abstract
The c-Met/hepatocyte growth factor receptor pathway is frequently dysregulated in multiple cancer types, including non-small cell lung cancer (NSCLC). MET amplification has been shown to develop as a resistance mechanism to treatment in NSCLC. The identification of increased MET copy number within tumour cells is increasingly important to stratify those tumours and patients which are susceptible to treatment targetting MET kinase inhibition. Fluorescence in situ hybridisation (FISH) has been successfully employed to identify patients with abnormal MET gene copy number with numerous probes available for use. Here we report a FISH protocol that reduces probe hybridisation time in NSCLC tissue to 1 hour and compare the results with other protocols. MET gene copy number was determined in 20 NSCLC cases using 3 FISH probes: 1. Kreatech FISH, MET (7q31) SE 7 ready to use probes, hybridised using an overnight protocol; 2. Dako MET IQFISH probe with CEP7 ready to use probe, hybridised for 2 hours; 3. Kreatech MET (7q31) SE 7 XL FISH probe, prepared in SwiftFISH buffer and hybridised for 1 hour. The MET gene copy number and MET: centromere 7 gene ratio were determined for each tissue and cases categorised as having MET high or MET low status. All three FISH probes were shown to demonstrate good agreement with each other. Overall percentage agreement between probes was ≥90%. Intraclass correlation showed good agreement (ICC ≥0.80) between all three assays for MET gene copy number and MET: centromere 7 gene ratio. These FISH protocols provide evidence that rapid laboratory developed FISH assays with short turnaround time perform consistently with standard protocols, potentially enabling faster treatment decisions.
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Affiliation(s)
- David Jonathan Duncan
- Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, England, United Kingdom
- * E-mail:
| | | | | | - Craig Barker
- Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, England, United Kingdom
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Comparison of Dual-ISH (DISH) With Fluorescence In Situ Hybridization (FISH) and Correlation With Immunohistochemical Findings for HER2/Neu Status in Breast Carcinoma. Appl Immunohistochem Mol Morphol 2019; 25:231-236. [PMID: 26766122 DOI: 10.1097/pai.0000000000000304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The most widely used methods for determination of HER2/neu status in breast carcinoma are immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Both techniques are associated with technical and interpretive difficulties. Alternative methods exist including quantitative PCR and the newly developed chromogenic dual in situ hybridization (DISH). METHODS We evaluated HER2 DISH as an alternative to FISH and report our findings from 101 cases. In addition, we correlated HER2 DISH and FISH results with HercepTest and 4B5 immunohistochemistry. RESULTS Eight cases failed FISH analysis and none failed DISH analysis. A 95% (88/93) concordance was found between DISH and FISH for all cases in the series. When only 2+ IHC cases were evaluated, the concordance was 94% for DISH and FISH. Using the 2013 ASCO/CAP recommendations, none of the tested cases were equivocal by FISH or DISH despite 66% of cases being 2+ by HercepTest and 32% by the 4B5 antibody. COMMENT Our study, which utilizes a majority of IHC equivocal cases, demonstrates that HER2 FISH and DISH are concordant methodologies. HER2 DISH is therefore an acceptable alternative to FISH.
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12
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The Use of Nutraceuticals to Counteract Atherosclerosis: The Role of the Notch Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5470470. [PMID: 31915510 PMCID: PMC6935452 DOI: 10.1155/2019/5470470] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
Abstract
Despite the currently available pharmacotherapies, today, thirty percent of worldwide deaths are due to cardiovascular diseases (CVDs), whose primary cause is atherosclerosis, an inflammatory disorder characterized by the buildup of lipid deposits on the inside of arteries. Multiple cellular signaling pathways have been shown to be involved in the processes underlying atherosclerosis, and evidence has been accumulating for the crucial role of Notch receptors in regulating the functions of the diverse cell types involved in atherosclerosis onset and progression. Several classes of nutraceuticals have potential benefits for the prevention and treatment of atherosclerosis and CVDs, some of which could in part be due to their ability to modulate the Notch pathway. In this review, we summarize the current state of knowledge on the role of Notch in vascular health and its modulation by nutraceuticals for the prevention of atherosclerosis and/or treatment of related CVDs.
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Curado M, Caramelo AS, Eloy C, Polónia A. What to expect from the 2018 ASCO/CAP HER2 guideline in the reflex in situ hybridization test of immunohistochemically equivocal 2+ cases? Virchows Arch 2019; 475:303-311. [PMID: 30953146 DOI: 10.1007/s00428-019-02567-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 01/12/2023]
Abstract
To evaluate the effect of the 2018 ASCO/CAP guideline in the identification of HER2-positive breast carcinomas (BC) in reflex in situ hybridization (ISH) test. A total of 592 primary invasive BC cases from before and after the publication of the updated ASCO/CAP guideline were evaluated for HER2 amplification by silver ISH according to the 2013 and 2018 guidelines. Cases were mostly (95%) HER2 equivocal by immunohistochemistry (IHC), not centrally reviewed. Other reasons for referring cases were IHC confirmation, IHC discordancy (either between needle-core-biopsy (NCB) and surgical excision specimen (SES) or between different laboratories) and IHC result unexpected for histopathologic features. Cases evaluated with the 2013 guideline (1st cohort) were 14.6% HER2-positive, decreasing significantly after the reclassification with the 2018 guideline due to the exclusion of group 2 cases without HER2 protein overexpression. Cases studied after the implementation of the 2018 guideline (2nd cohort) were 8.7% HER2-positive, a frequency that was not significantly different from the reclassification of the 1st cohort with the 2018 guideline. All cases referred for IHC confirmation had the expected ISH result. Cases with IHC discordancy between NCB and SES were ISH concordant. Only one out of 14 cases with an IHC score 3+ and classified as histological grade 1 or with a Ki67 below 10% was classified as ISH HER2-positive. The 2018 ASCO/CAP guideline resulted in a decrease of HER2-positive cases in reflex ISH test, selecting less patients for anti-HER2-targeted therapy.
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Affiliation(s)
- Mónica Curado
- Department of Pathology, Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal
| | - Ana Sofia Caramelo
- Department of Pathology, Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal
| | - Catarina Eloy
- Department of Pathology, Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal.,Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - António Polónia
- Department of Pathology, Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal. .,I3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Rua Júlio Amaral de Carvalho, 45, 4200-135, Porto, Portugal.
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Mittendorf EA, Bartlett JMS, Lichtensztajn DL, Chandarlapaty S. Incorporating Biology Into Breast Cancer Staging: American Joint Committee on Cancer, Eighth Edition, Revisions and Beyond. Am Soc Clin Oncol Educ Book 2018; 38:38-46. [PMID: 30231409 DOI: 10.1200/edbk_200981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Higher-quality imaging, refined surgical procedures, enhanced pathologic evaluation, and improved understanding of the impact of tumor biology on treatment and prognosis have necessitated revisions of the AJCC breast cancer staging system. The eighth edition includes clinical and pathologic prognostic stages that incorporate biologic variables-grade, estrogen and progesterone receptor status, HER2 status, and multigene panels-with the anatomic extent of disease defined by tumor, node, and metastasis categories. The prognostic staging systems facilitate more refined stratification with respect to survival than anatomic stage alone. Because the prognostic staging systems are dependent on biologic factors, accuracy is dependent on rigorous pathologic evaluation of tumors and on administration of treatment dictated by tumor biology. It is anticipated that technological advances will facilitate even more refined determination of underlying biology within tumors and in the peripheral blood, which increasingly is being evaluated as a compartment that reflects the primary tumor and sites of distant metastases. Diseases should be staged according to the eighth edition staging system to accurately reflect prognosis and to allow standardized data collection. Such standardization will facilitate assessment of the impact of advances in diagnosis and treatment of patients with breast cancer.
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Affiliation(s)
- Elizabeth A Mittendorf
- From the Dana-Farber Cancer Institute and Brigham and Women's Cancer Center, Boston, MA; Ontario Institute for Cancer Research, Ontario, Canada; Cancer Prevention Institute of California, Fremont, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - John M S Bartlett
- From the Dana-Farber Cancer Institute and Brigham and Women's Cancer Center, Boston, MA; Ontario Institute for Cancer Research, Ontario, Canada; Cancer Prevention Institute of California, Fremont, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daphne L Lichtensztajn
- From the Dana-Farber Cancer Institute and Brigham and Women's Cancer Center, Boston, MA; Ontario Institute for Cancer Research, Ontario, Canada; Cancer Prevention Institute of California, Fremont, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sarat Chandarlapaty
- From the Dana-Farber Cancer Institute and Brigham and Women's Cancer Center, Boston, MA; Ontario Institute for Cancer Research, Ontario, Canada; Cancer Prevention Institute of California, Fremont, CA; Memorial Sloan Kettering Cancer Center, New York, NY
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Hoshino I, Imai K, Nanjo H, Nakamura R, Saito Y, Fujishima S, Saito H, Terata K, Wakita A, Sato Y, Motoyama S, Akagami Y, Minamiya Y. Reagent-saving immunohistochemistry for HER2 using non-contact alternating current electric field mixing. J Clin Pathol 2018; 72:25-30. [DOI: 10.1136/jclinpath-2018-205325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/02/2018] [Accepted: 08/22/2018] [Indexed: 11/04/2022]
Abstract
AimsHuman epidermal growth factor receptor 2 (HER2)-targeted agents are an effective approach to treating patients with HER2-positive breast cancer. However, the lack of survival benefit in HER2-negative patients, as well as the toxic effects and high cost of the drugs, highlight the need for accurate and prompt assessment of HER2 status. Our aim was to evaluate the clinical utility of a novel reagent-saving immunohistochemistry method (AC-IHC) that saves HER2 antibody by taking advantage of the non-contact mixing effect in microdroplets subjected to an alternating current electric field.MethodsNinety-five specimens were used from patients diagnosed with primary breast cancers identified immunohistochemically as HER2 0/1+, 2+ or 3+ using ASCO/CAP guideline-certified standard IHC. The specimens were all tested using the conventional IHC method (1:50 antibody dilution) as well as AC-IHC (1:50 dilution) and reagent-saving AC-IHC (1:100 dilution).ResultsThe reagent-saving AC-IHC produced stable results with less non-specific staining using smaller amounts of labelled antibody. Moreover, the staining and accuracy of HER2 status evaluated with the reagent-saving AC-IHC method was equal to that achieved with standard IHC.ConclusionsThese results suggest reagent-saving AC-IHC could be used as a clinical tool for accurate and stable HER2 IHC, even when reagent concentrations vary.
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Clinical utility of RT-PCR in assessing HER 2 gene expression versus traditional IHC and FISH in breast cancer patients. Breast Cancer 2018; 25:416-430. [PMID: 29427123 DOI: 10.1007/s12282-018-0840-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/25/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND IHC and FISH are used for categorizing HER 2 status in breast cancer at the protein and DNA level, respectively. HER 2 expression at the RNA level is quantitative, cheaper, easier to standardize and free from interobserver variation. METHODS 115 consecutive patients were tested by IHC, FISH and RT-PCR (test cohort). Assuming FISH result to be the response variable, ROC curves for RT-PCR ratio were analyzed to label HER 2 negative, equivocal and positive cases as RT-PCR score 1, 2 and 3, respectively. Inter-relationships between RT-PCR, IHC and FISH were defined. 'Clinical benefit' of a test was defined as proportion of patients labeled unequivocally as HER 2 positive or negative. Population for 1 year was simulated constraint to previous reports of HER 2 positivity and IHC category distribution by a meta-analysis of previous studies that evaluated concordance between IHC and FISH to determine HER 2 status (simulation cohort). Four diagnostic pathways in the simulation cohort were defined-(1) initial IHC, followed by FISH (conventional pathway); (2) initial RT-PCR, followed by FISH; (3) initial IHC, followed by RT-PCR and then by FISH; (4) initial RT-PCR, followed by IHC and then by FISH. The clinical benefit of IHC and RT-PCR in the four pathways was analyzed and sensitivity analysis for incremental cost-effectiveness ratio and cost-benefit comapring RT-PCR against IHC, both as first-line tests and among those with IHC score 2 as a reflex second-line test was performed by the Monte Carlo technique. FINDINGS 115 patients comprised the study population. While none with IHC score of 0 or 1 was FISH positive for HER 2, all cases with IHC score of 3 were FISH positive. 43 cases were assigned IHC score of 2. Thus, 72 patients benefited from the initial IHC testing [clinical benefit 62.6%], with the overall concordance between IHC and FISH being 100% for those with IHC score of 0, 1 and 3 (conclusive IHC categories). For RT-PCR with 100% concordance, 15.7% (115-97 = 18) patients would have benefited from RT-PCR testing if it was used as a first-line test. If RT-PCR would have been used as a second-line test among those with IHC score 2 (n = 43), then only 6 patients would have been assigned a conclusive RT-PCR category (category 1 or 3) translating to a clinical benefit of 14% (6/43) as a second-line test. As a second-line test it had 51% probability to prove more cost-effective than the conventional pathway, provided the cost of RT-PCR was 0.4 times the cost of IHC. Also in a three-step pathway, RT-PCR upfront would have 56% probability of higher cost-benefit provided the cost of RT-PCR was 0.1 times the cost of IHC. CONCLUSION RT-PCR results were found to be suboptimal to IHC in terms of discriminative ability and clinical benefit; thus, it is unlikely to replace IHC as a first-line test in the near future.
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Pai T, Shet T, Patil A, Shetty O, Singh A, Desai SB. Utility of Alternate, Noncentromeric Chromosome 17 Reference Probe for Human Epidermal Growth Factor Receptor Fluorescence In Situ Hybridization Testing in Breast Cancer Cases. Arch Pathol Lab Med 2018; 142:626-633. [PMID: 29384691 DOI: 10.5858/arpa.2017-0252-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context PathVysion-a US Food and Drug Administration-approved dual-probe human epidermal growth factor receptor ( HER2) fluorescence in situ hybridization (FISH) assay-provides the HER2: CEP17 ratio, a centromeric enumeration probe ratio for determining HER2 status in breast cancers. However, pericentromeric amplifications might then skew the HER2: CEP17 ratio, underestimating the HER2 status, which calls into question the use of CEP17 as the reference probe. Objective To analyze the utility of a noncentromeric chromosome 17 reference locus ( D17S122) to assess HER2 gene status in cases showing "nonclassical" FISH patterns with the CEP17 probe. Design The HER2 status of breast cancers accessioned in the years 2015-2017, displaying "nonclassical" or "equivocal" results by the PathVysion (Abbott Molecular Inc, Des Plaines, Illinois) HER2 DNA Probe Kit were reflex tested using an alternate FISH probe (ZytoLight SPEC/D17S122, ZytoVision, Bremerhaven, Germany) and interpreted with American Society of Clinical Oncology/College of American Pathologists 2013 guidelines. Results Of 37 cases, 17 were FISH equivocal. With the alternate D17S122 probe, 13 (76.4%) were reclassified as amplified, 3 (17.6%) as nonamplified, and a single case retained an equivocal result. Of the 17 cases with a chromosome 17 polysomy pattern, disomy, polysomy, and monosomy patterns were seen with 14 cases, 2 cases, and 1 case, respectively. Within the 17 cases with polysomy pattern, 3 (17.6%) demonstrated an unusual colocalization pattern of HER2 and CEP17, which was not observed with the alternate probe. Conclusions The denominator-stable alternate probe is a useful adjunct in the diagnostic armamentarium to analyze HER2 status in cases with FISH equivocal and complex patterns.
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Affiliation(s)
| | | | | | | | | | - Sangeeta B Desai
- From the Division of Molecular Pathology (Drs Pai, Shetty, Singh, and Desai) and the Department of Pathology (Drs Pai, Shet, Patil, Shetty, Singh, and Desai), Tata Memorial Centre, Mumbai, India
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18
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Guo Q, Chen K, Lin X, Su Y, Xu R, Dai Y, Qiu C, Song X, Mao S, Chen Q. A nomogram to predict HER2 status in breast cancer patients with HER2-borderline disease as determined via immunohistochemistry. Oncotarget 2017; 8:93492-93501. [PMID: 29212167 PMCID: PMC5706813 DOI: 10.18632/oncotarget.19313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/11/2017] [Indexed: 01/03/2023] Open
Abstract
This study aimed to develop a nomogram to predict fluorescence in situ hybridization (FISH) assay results for HER2-borderline breast cancer as determined via immunohistochemistry (IHC) among patients in China. We reviewed a database of breast cancer patients diagnosed between January 2007 and April 2013 at our institutions. We used logistic regression to develop a nomogram and we used receiver operating characteristic curve analysis and calibration plots to validate our nomogram. In total, 1138, 301 and 344 patients had IHC-determined HER2-negative, HER2-borderline and HER2-positive disease, respectively. Within the training cohort, univariate and multivariate analyses suggested that estrogen receptor (ER) status, progesterone receptor (PR) status and tumor grade were significantly associated with HER2 status (P<0.01). A nomogram was developed and the AUCs for the training and validation cohorts were 0.795 and 0.749, respectively. The calibration plots suggested that the model was well calibrated. This new nomogram can be used to predict HER2 status in HER2-borderline breast cancer patients and will be particularly helpful to resource-limited countries.
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Affiliation(s)
- Qianqian Guo
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Xiaojie Lin
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Yi Su
- Department of Intensive Care, Foshan Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Rui Xu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Yan Dai
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Chang Qiu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Xue Song
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Siying Mao
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Qianjun Chen
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China
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Eswarachary V, Mohammed IG, Jayanna PK, Patilokaly GV, Nargund AR, Dhondalay GK, Prabhudesai S, Sahoo R. HER2/ neu Testing In 432 Consecutive Breast Cancer Cases using FISH and IHC - A Comparative Study. J Clin Diagn Res 2017; 11:EC01-EC05. [PMID: 28571140 PMCID: PMC5449786 DOI: 10.7860/jcdr/2017/25625.9521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The development of trastuzumab, a HER-2/neu targeted monoclonal antibody resulted in significant improvements in clinical response and survival in HER-2/neu gene amplified group of patients. Thus, accurate assessment of HER-2/neu status becomes critical. Fluorescence In Situ Hybridization (FISH) and Immunohistochemistry (IHC) are the most commonly used methods for this purpose and specific recommendations exist with regard to the concordance to be observed between the two tests. AIM Here, we report and evaluate the concordance rate between FISH and IHC for HER-2/neu status in breast cancer specimens. MATERIALS AND METHODS Archival paraffin blocks of tumour tissue from 450 patients of breast cancer were analyzed for Her-2/neu status using FISH and IHC. RESULTS There was a highly significant concordance between the results of FISH and IHC assays in HER-2/neu status assessment in invasive breast cancer cases. There were inverse associations between the expression of Oestrogen Receptors/Progesterone Receptors (ER/PR) and HER-2/neu amplification. CONCLUSION Although, IHC gave significant concordant results with FISH in determining HER-2/neu status, its subjective grading system precludes its use as a gold standard. FISH should always be used to determine true gene amplification when the IHC results are equivocal.
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Affiliation(s)
- Venkataswamy Eswarachary
- Senior Scientist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Imran Gorur Mohammed
- Consultant Pathologist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Prashanth K Jayanna
- Scientist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Geeta V Patilokaly
- Consultant Pathologist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Ashwini R Nargund
- Consultant Pathologist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Gopal Krishna Dhondalay
- Scientist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Shilpa Prabhudesai
- Consultant Pathologist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
| | - Rashmita Sahoo
- Senior Scientist, Department of Triesta Reference Laboratory, HealthCare Global Enterprise Ltd (HCG), Bengaluru, Karnataka, India
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Bethune GC, Pettit ASL, Veldhuijzen van Zanten D, Barnes PJ. Well-differentiated invasive breast cancers with equivocal HER2 immunohistochemistry: what is the yield of routine reflex in-situ hybridization testing? Histopathology 2017; 70:966-974. [PMID: 28032917 DOI: 10.1111/his.13160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/26/2016] [Indexed: 01/29/2023]
Abstract
AIMS The 2013 American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) HER2 guidelines recommend testing all invasive breast cancers for HER2, typically with immunohistochemistry (IHC) followed by in-situ hybridization (ISH) when IHC is equivocal. As well-differentiated breast cancers are rarely HER2-positive, we assessed the value of routine reflex HER2 ISH testing for this subset of breast cancers. METHODS AND RESULTS We collected HER2 IHC 2+ cases and fluorescence in-situ hybridization (FISH) data from primary breast cancers with well-differentiated tumour types (grade 1 ductal carcinomas, classic lobular carcinomas, tubular, cribriform and pure mucinous carcinomas) at our centre from 2010 to 2015. Haematoxylin and eosin (H&E) and IHC slides were reviewed to confirm tumour type, grade and IHC score based on ASCO/CAP 2013 guidelines and their recent revisions. Of 4633 invasive carcinomas, 1133 had a well-differentiated tumour type; 177 of these were HER2 IHC equivocal, three of which were low-level amplified by FISH (0.3% of all well-differentiated tumours). One amplified case was classic invasive lobular carcinoma and two were invasive ductal carcinomas, grade 1. One amplified case had chromosome 17 monosomy, and one was rescored as HER2 IHC 1+ upon review. 'Basolateral' staining was noted in one amplified case and in 65 of 174 (37.4%) non-amplified cases. This incomplete membranous staining pattern was observed in the majority of invasive ductal carcinomas that were rescored as 1+ according to the revised 2013 guidelines. CONCLUSIONS The rate of HER2 amplification among well-differentiated breast cancers is very low. Basolateral staining in well-differentiated tumours may be overinterpreted as HER2 IHC 2+, but is rarely associated with HER2 amplification.
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Affiliation(s)
- Gillian C Bethune
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexandra S L Pettit
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Veldhuijzen van Zanten
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Penelope J Barnes
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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Pinder SE, Campbell AF, Bartlett JMS, Marshall A, Allen D, Falzon M, Dunn JA, Makris A, Hughes-Davies L, Stein RC. Discrepancies in central review re-testing of patients with ER-positive and HER2-negative breast cancer in the OPTIMA prelim randomised clinical trial. Br J Cancer 2017; 116:859-863. [PMID: 28222072 PMCID: PMC5379140 DOI: 10.1038/bjc.2017.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 12/23/2022] Open
Abstract
Background: There is limited data on results of central re-testing of samples from patients with invasive breast cancer categorised in their local hospital laboratories as oestrogen receptor (ER) positive and human epidermal growth factor receptor homologue 2 (HER2) negative. Methods: The Optimal Personalised Treatment of early breast cancer usIng Multiparameter Analysis preliminary study (OPTIMA prelim) was the feasibility phase of a randomised controlled trial to validate the use of multiparameter assay-directed chemotherapy decisions in the UK National Health Service (NHS). Eligibility criteria included ER positivity and HER2 negativity. Central re-testing of receptor status was mandatory. Results: Of the 431 patients tested centrally, discrepant results between central and local laboratory results were identified in only 19 (4.4% 95% confidence interval 2.5–6.3%) patients (with 21 tumours). On central review, seven patients had cancers that were ER-negative (1.6%) and 13 (3.0%) patients with 15 tumours had HER2-positive disease, including one tumour discrepant for both biomarkers. Conclusions: Central re-testing of receptor status of invasive breast cancers in the UK NHS setting shows a high level of reproducibility in categorising tumours as ER-positive and HER2-negative, and raises questions regarding the cost effectiveness and clinical value of central re-testing in this sub-group of breast cancers in this setting.
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Affiliation(s)
- S E Pinder
- Division of Cancer Studies, King's College London, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - A F Campbell
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - J M S Bartlett
- Ontario Institute of Cancer Research, Toronto, Ontario M5G 0A3, Canada
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - D Allen
- UCL-Advanced Diagnostics, University College London, 21 University Street, London WC1E 6JJ, UK
| | - M Falzon
- Department of Pathology, University College London Hospitals, 235, Euston Road, London NW1 2BU, UK
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - A Makris
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, HA6 2RN, UK
| | - L Hughes-Davies
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R C Stein
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK
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22
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Ooi A, Oyama T, Nakamura R, Tajiri R, Ikeda H, Fushida S, Dobashi Y. Gene amplification of CCNE1, CCND1, and CDK6 in gastric cancers detected by multiplex ligation-dependent probe amplification and fluorescence in situ hybridization. Hum Pathol 2016; 61:58-67. [PMID: 27864121 DOI: 10.1016/j.humpath.2016.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/19/2016] [Accepted: 10/28/2016] [Indexed: 12/18/2022]
Abstract
New and effective treatments for advanced gastric cancer are urgently needed. Cyclins E and D1 form a complex with cyclin-dependent kinase 2, 4, or 6 to regulate G1-S transition. The G1-S regulatory genes encoding cyclin E (CCNE1), cyclin D1 (CCND1), and CDK6 (CDK6) are frequently amplified in gastric cancer and may therefore influence molecularly targeted therapies against ERBB2 or EGFR when coamplified. A total of 179 formalin-fixed and paraffin-embedded gastric cancer specimens were examined for these gene amplifications by multiplex ligation-dependent probe amplification and fluorescence in situ hybridization. Amplification of at least 1 G1-S regulatory gene was found in 35 tumors (CCNE1 amplification, 15% of samples; CCND1, 6%; CDK6, 1%). In 13 of the 35 tumors, dual-color fluorescence in situ hybridization identified coamplification of the G1-S regulatory genes with ERBB2, EGFR, and/or KRAS in single cancer nuclei. The observation that cells with G1-S regulatory gene amplification contained clonal subpopulations with coamplification of ERBB2, EGFR, or KRAS in 5 early and 3 advanced cancers suggests that amplification of the G1-S regulatory genes represents an early event, which precedes ERBB2, EGFR, or KRAS amplification. Amplified CCNE1, CCND1, and CDK6 in advanced gastric cancer may be potentially useful as direct targets for molecular therapy or for combination therapy with ERBB2 or EGFR inhibitors. Multiplex ligation-dependent probe amplification could be a useful tool for identification of patients who would benefit from such therapies.
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Affiliation(s)
- Akishi Ooi
- Department of Molecular and Cellular Pathology, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan; Pathology Section, University Hospital, Kanazawa University, Ishikawa 920-8641, Japan.
| | - Takeru Oyama
- Department of Molecular and Cellular Pathology, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan.
| | - Ritsuko Nakamura
- Department of Molecular and Cellular Pathology, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan.
| | - Ryousuke Tajiri
- Department of Molecular and Cellular Pathology, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan.
| | - Hiroko Ikeda
- Pathology Section, University Hospital, Kanazawa University, Ishikawa 920-8641, Japan.
| | - Sachio Fushida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan.
| | - Yoh Dobashi
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
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Willmore-Payne C, Damjanovich-Colmenares K, Pasi AV, Werner TL, Gulbahce HE, Downs-Kelly E, Geiersbach KB. Inconsistent Results With Different Secondary Reflex Assays for Resolving HER2 Status. Am J Clin Pathol 2016; 146:618-626. [PMID: 27773872 DOI: 10.1093/ajcp/aqw177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Guidelines suggest that secondary reflex testing may be useful for resolving HER2 status in breast cancers with equivocal results by both immunohistochemistry (IHC) and in situ hybridization (ISH). We compared two reflex ISH assays and a polymerase chain reaction (PCR) assay for this application. METHODS Twenty-nine breast cancers with equivocal IHC and ISH results were retested two ways: (1) ISH using differentially labeled probes targeting ERBB2 ( HER2 , 17q12) and either RAI1 (17p11.2) or ORC4 (2q22.3-2q23.1) in two separate assays and (2) real-time quantitative PCR amplification of ERBB2 and a control locus ( EIF5B , 2q11.2). RESULTS Results of the HER2 / RAI1 and HER2 / ORC4 ISH assays were concordant for 21 (72%) cases, and results of all three secondary reflex assays were concordant for only 18 (62%) cases. Result discrepancies between the two ISH readers were observed for cases close to the cutoff threshold. CONCLUSIONS Use of different control loci for ISH is associated with discordant results, and PCR is more likely to classify cases as nonamplified, possibly due to contamination with nontumor cells. While resolution of HER2 -equivocal results is desirable from a clinical perspective, different secondary reflex assays yield different results, and the correlation of these results with clinical outcomes is unknown.
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Affiliation(s)
| | | | - Alexandra V Pasi
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
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Geiersbach KB, Willmore-Payne C, Pasi AV, Paxton CN, Werner TL, Xu X, Wittwer CT, Gulbahce HE, Downs-Kelly E. Genomic Copy Number Analysis of HER2-Equivocal Breast Cancers. Am J Clin Pathol 2016; 146:439-47. [PMID: 27614666 DOI: 10.1093/ajcp/aqw130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Guidelines for HER2 testing define an equivocal range for HER2 using two approved testing methods, immunohistochemistry (IHC) and in situ hybridization (ISH). We investigated genome-wide copy number alterations in this subgroup. METHODS Ten breast cancers with equivocal HER2 status by both IHC and ISH were analyzed by single-nucleotide polymorphism cytogenomic microarray (SNP array). DNA ploidy analysis by flow cytometry was performed on nine cases with sufficient material remaining. RESULTS SNP array analysis showed uniform gain of chromosome 17 (polysomy) in one case and segmental copy number gains encompassing HER2 and the centromere in five other cases. Flow cytometry revealed hyperdiploidy in six cases, all but one of which also had HER2 gains on SNP array. Although there was no evidence of HER2 amplification by SNP array, six cases showed amplification of other genomic regions, including known oncogenes in four cases. CONCLUSIONS A combination of hyperdiploidy and segmental copy number gains contributes to HER2 ISH-equivocal results in most breast cancers. Cases in which HER2 copy number gain is not corroborated by genomic analysis suggest the presence of other contributing variables influencing ISH results. Genomic copy number analysis also implicates non-HER2 oncogenic drivers in many cases that are HER2 equivocal.
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Affiliation(s)
| | | | - Alexandra V Pasi
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Christian N Paxton
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | | | - Xinjie Xu
- Department of Pathology, University of Utah, Salt Lake City
| | - Carl T Wittwer
- Department of Pathology, University of Utah, Salt Lake City
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Petroni S, Caldarola L, Scamarcio R, Giotta F, Latorre A, Mangia A, Simone G. FISH testing of HER2 immunohistochemistry 1+ invasive breast cancer with unfavorable characteristics. Oncol Lett 2016; 12:3115-3122. [PMID: 27899970 PMCID: PMC5103906 DOI: 10.3892/ol.2016.5125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/19/2016] [Indexed: 12/11/2022] Open
Abstract
Diagnostic assays for human epidermal growth factor receptor 2 (HER2) expression have a high predictive value because patients with HER2-positive tumors could benefit from HER2-targeted therapy. The aim of the present study is to analyze the incidence of HER2 gene amplification in selected tumors with adverse features that scored 1+ by immunohistochemistry (IHC). For that purpose, 331 consecutive invasive breast cancers (IBCs) were tested by IHC for HER2 expression between January and December 2013, 102 of which (31%) scored 1+. Of these 102 women with IBC who underwent surgery, 75 entered the study (73.5%). A total of 48 out of 75 (64%) IBC samples (patients' median age, 60.75 years) were selected according to ≥1 unfavorable tumor characteristics, and tested by fluorescence in situ hybridization (FISH). Of these 48 IBC samples scoring 1+ by IHC, 22 (46%) exhibited high histological grade (G3), 23 (48%) had a high proliferative index (Ki-67, >30%), 27 (56%) showed vascular invasion and 32 out of 41 evaluable cases (78%) were node-positive. Regarding hormone receptor expression, 3 (6%) and 10 (21%) cases were negative for estrogen and progesterone receptors expression, respectively. FISH was performed on 48 IBC cases scoring 1+ by IHC, and 7 infiltrating ductal carcinomas (IDCs) (14.6%) demonstrated HER2 amplification with a high proliferative index. In 42 IDC samples, statistical analysis evidenced a significant association between histological grade and high proliferative index (P=0.0200). In addition, in 48 HER2 scoring 1+ IBCs, Fisher's exact test evidenced a significant association between the presence of gene amplification and high proliferative index (P=0.0033). Based on these biopathological parameters, particularly a high proliferative index, the present results indicate that it is possible to of identify tumors scoring 1+ by IHC with HER2 amplification by FISH, thus aiding the selection of patients who are suitable for HER2-targeted therapy according to an acceptable cost/benefit ratio.
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Affiliation(s)
- Stella Petroni
- Department of Pathology, National Cancer Research Institute 'Giovanni Paolo II', Bari I-70124, Italy
| | - Lucia Caldarola
- Department of Pathology, National Cancer Research Institute 'Giovanni Paolo II', Bari I-70124, Italy
| | - Rachele Scamarcio
- Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari I-70124, Italy
| | - Francesco Giotta
- Medical Oncology Unit, National Cancer Research Centre Institute 'Giovanni Paolo II', Bari I-70124, Italy
| | - Agnese Latorre
- Medical Oncology Unit, National Cancer Research Centre Institute 'Giovanni Paolo II', Bari I-70124, Italy
| | - Anita Mangia
- Functional Biomorphology Laboratory, National Cancer Research Centre Institute 'Giovanni Paolo II', Bari I-70124, Italy
| | - Giovanni Simone
- Department of Pathology, National Cancer Research Institute 'Giovanni Paolo II', Bari I-70124, Italy
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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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Saito Y, Imai K, Nakamura R, Nanjo H, Terata K, Konno H, Akagami Y, Minamiya Y. Novel method for rapid in-situ hybridization of HER2 using non-contact alternating-current electric-field mixing. Sci Rep 2016; 6:30034. [PMID: 27443187 PMCID: PMC4957099 DOI: 10.1038/srep30034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-targeted agents are an effective approach to treating HER2-positive breast cancer patients. However, the lack of survival benefit in HER2-negative patients as well as the toxic effects and high cost of the drugs highlight the need for accurate and prompt assessment of HER2 status. Our aim was to evaluate the clinical utility of a novel rapid dual in-situ hybridization (RISH) method developed to facilitate hybridization. The method takes advantage of the non-contact mixing effect of an alternating current (AC) electric field. One hundred sixty-three specimens were used from patients diagnosed with primary breast cancers identified immunohistochemically as HER2 0/1(+), (2+) or (3+). The specimens were all tested using conventional dual in-situ hybridization (DISH), DISH with an automated slide stainer, and RISH. With RISH the HER2 test was completed within 6 h, as compared to 20–22 h needed for the standard protocol. Although RISH produced results more promptly using smaller amounts of labeled antibody, the staining and accuracy of HER2 status evaluation with RISH was equal to or greater than with DISH. These results suggest RISH could be used as a clinical tool to promptly determine HER2 status.
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Affiliation(s)
- Yoshitaro Saito
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
| | | | - Hiroshi Nanjo
- Division of Clinical Pathology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
| | - Kaori Terata
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
| | - Hayato Konno
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
| | | | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
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Pai T, Shetty O, Patil A, Shet T, Desai SB. Coamplification with colocalization of the human epidermal growth factor receptor 2 and centromeric-17 signals on fluorescence in situ hybridization in invasive breast carcinoma: An exceedingly rare finding. J Postgrad Med 2016; 62:210-1. [PMID: 27424555 PMCID: PMC4970353 DOI: 10.4103/0022-3859.186394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- T Pai
- Division of Molecular Pathology, Tata Memorial Centre; Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - O Shetty
- Division of Molecular Pathology, Tata Memorial Centre; Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A Patil
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - T Shet
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S B Desai
- Division of Molecular Pathology, Tata Memorial Centre; Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Dual PET and Near-Infrared Fluorescence Imaging Probes as Tools for Imaging in Oncology. AJR Am J Roentgenol 2016; 207:266-73. [PMID: 27223168 DOI: 10.2214/ajr.16.16181] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this article is to summarize advances in PET fluorescence resolution, agent design, and preclinical imaging that make a growing case for clinical PET fluorescence imaging. CONCLUSION Existing SPECT, PET, fluorescence, and MRI contrast imaging techniques are already deeply integrated into the management of cancer, from initial diagnosis to the observation and management of metastases. Combined positron-emitting fluorescent contrast agents can convey new or substantial benefits that improve on these proven clinical contrast agents.
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Kasai F, Hirayama N, Ozawa M, Iemura M, Kohara A. Changes of heterogeneous cell populations in the Ishikawa cell line during long-term culture: Proposal for an in vitro clonal evolution model of tumor cells. Genomics 2016; 107:259-66. [PMID: 27107655 DOI: 10.1016/j.ygeno.2016.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 01/17/2023]
Abstract
Genomic changes in tumor cell lines can occur during culture, leading to differences between cell lines carrying the same name. In this study, genome profiles between low and high passages were investigated in the Ishikawa 3-H-12 cell line (JCRB1505). Cells contained between 43 and 46 chromosomes and the modal number changed from 46 to 45 during culture. Cytogenetic analysis revealed that a translocation t(9;14), observed in all metaphases, is a robust marker for this cell line. Single-nucleotide polymorphism microarrays showed a heterogeneous copy number in the early passages and distinct profiles at late passages. These results demonstrate that cell culture can lead to elimination of ancestral clones by sequential selection, resulting in extensive replacement with a novel clone. Our observations on Ishikawa cells in vitro are different from the in vivo heterogeneity in which ancestral clones are often retained during tumor evolution and suggest a model for in vitro clonal evolution.
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Affiliation(s)
- Fumio Kasai
- Japanese Collection of Research Bioresources (JCRB) Cell Bank, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan.
| | - Noriko Hirayama
- Japanese Collection of Research Bioresources (JCRB) Cell Bank, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Midori Ozawa
- Japanese Collection of Research Bioresources (JCRB) Cell Bank, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Masashi Iemura
- Japanese Collection of Research Bioresources (JCRB) Cell Bank, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Arihiro Kohara
- Japanese Collection of Research Bioresources (JCRB) Cell Bank, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
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Chang HR, Park HS, Ahn YZ, Nam S, Jung HR, Park S, Lee SJ, Balch C, Powis G, Ku JL, Kim YH. Improving gastric cancer preclinical studies using diverse in vitro and in vivo model systems. BMC Cancer 2016; 16:200. [PMID: 26955870 PMCID: PMC4784390 DOI: 10.1186/s12885-016-2232-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/29/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND "Biomarker-driven targeted therapy," the practice of tailoring patients' treatment to the expression/activity levels of disease-specific genes/proteins, remains challenging. For example, while the anti-ERBB2 monoclonal antibody, trastuzumab, was first developed using well-characterized, diverse in vitro breast cancer models (and is now a standard adjuvant therapy for ERBB2-positive breast cancer patients), trastuzumab approval for ERBB2-positive gastric cancer was largely based on preclinical studies of a single cell line, NCI-N87. Ensuing clinical trials revealed only modest patient efficacy, and many ERBB2-positive gastric cancer (GC) patients failed to respond at all (i.e., were inherently recalcitrant), or succumbed to acquired resistance. METHOD To assess mechanisms underlying GC insensitivity to ERBB2 therapies, we established a diverse panel of GC cells, differing in ERBB2 expression levels, for comprehensive in vitro and in vivo characterization. For higher throughput assays of ERBB2 DNA and protein levels, we compared the concordance of various laboratory quantification methods, including those of in vitro and in vivo genetic anomalies (FISH and SISH) and xenograft protein expression (Western blot vs. IHC), of both cell and xenograft (tissue-sectioned) microarrays. RESULTS The biomarker assessment methods strongly agreed, as did correlation between RNA and protein expression. However, although ERBB2 genomic anomalies showed good in vitro vs. in vivo correlation, we observed striking differences in protein expression between cultured cells and mouse xenografts (even within the same GC cell type). Via our unique pathway analysis, we delineated a signaling network, in addition to specific pathways/biological processes, emanating from the ERBB2 signaling cascade, as a potential useful target of clinical treatment. Integrated analysis of public data from gastric tumors revealed frequent (10 - 20 %) amplification of the genes NFKBIE, PTK2, and PIK3CA, each of which resides in an ERBB2-derived subpathway network. CONCLUSION Our comprehensive bioinformatics analyses of highly heterogeneous cancer cells, combined with tumor "omics" profiles, can optimally characterize the expression patterns and activity of specific tumor biomarkers. Subsequent in vitro and in vivo validation, of specific disease biomarkers (using multiple methodologies), can improve prediction of patient stratification according to drug response or nonresponse.
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Affiliation(s)
- Hae Ryung Chang
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea. .,Cancer Biology Research Laboratory, Institut Pasteur Korea, Bundang, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Hee Seo Park
- Animal Sciences Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Young Zoo Ahn
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Seungyoon Nam
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea. .,Department of Life Sciences, College of BioNano Technology, Gachon University, Sungnam, South Korea. .,College of Medicine, Gachon University, Incheon, South Korea.
| | - Hae Rim Jung
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Sungjin Park
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea. .,Department of Life Sciences, College of BioNano Technology, Gachon University, Sungnam, South Korea. .,College of Medicine, Gachon University, Incheon, South Korea.
| | - Sang Jin Lee
- Animal Sciences Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Curt Balch
- Department of Pharmacology and Experimental Therapeutics, University of Toledo College of Pharmacy, Toledo, OH, USA.
| | - Garth Powis
- Cancer Center, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Ja-Lok Ku
- SNU Korean Cell Line Bank, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
| | - Yon Hui Kim
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Ilsan, Goyang-si, Gyeonggi-do, Republic of Korea. .,Cancer Biology Research Laboratory, Institut Pasteur Korea, Bundang, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Prendeville S, Corrigan MA, Livingstone V, Feeley L, Bennett MW, Browne TJ, O'Connell F. Optimal Scoring of Brightfield Dual-Color In Situ Hybridization for Evaluation of HER2 Amplification in Breast Carcinoma: How Many Cells Are Enough? Am J Clin Pathol 2016; 145:316-22. [PMID: 27124913 DOI: 10.1093/ajcp/aqw017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The purpose of this study was to determine the optimum number of cells that should be counted when scoring human epidermal growth factor receptor 2 (HER2) brightfield dual-color in situ hybridization (BDISH), including cases with HER2/chromosome 17 (Chr17) ratios in the 1.80 to 2.20 range. METHODS IN TOTAL, 131 cases of breast carcinoma with HER2 immunohistochemistry and BDISH were included. For cases with a HER2/Chr17 ratio of less than 1.80 or more than 2.20 (n = 115), BDISH scoring was performed for 60 cells using three tumor fields, and for cases with a HER2/Chr17 ratio of 1.80 to 2.20 (n = 16), scoring was performed for 120 cells using six tumor fields. Mean HER2/Chr17 ratio and HER2 copy number were calculated for cumulative cell counts. RESULTS The HER2 status as determined by the HER2/Chr17 ratio or HER2 copy number was unchanged following counting of additional cells in 100% of cases with ratio of less than 1.80 or more than 2.20. The HER2 status of two cases with ratios of 1.80 to 2.20 changed from positive to negative following counting of 120 cells. CONCLUSIONS Our findings support recommendations to score 20 nuclei in conjunction with careful assessment of immunohistochemistry and scan of the BDISH slide to identify areas of heterogeneity. Scoring of additional cells/fields is likely not of benefit and might be a disadvantage since the scorer moves out of the area of strongest signal.
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Affiliation(s)
| | - Mark A Corrigan
- Breast Cancer Research Centre, Cork University Hospital, Cork, Ireland
| | - Vicki Livingstone
- Breast Cancer Research Centre, Cork University Hospital, Cork, Ireland
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Polónia A, Leitão D, Schmitt F. Application of the 2013 ASCO/CAP guideline and the SISH technique for HER2 testing of breast cancer selects more patients for anti-HER2 treatment. Virchows Arch 2016; 468:417-23. [PMID: 26754674 DOI: 10.1007/s00428-016-1903-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/05/2015] [Accepted: 01/03/2016] [Indexed: 01/05/2023]
Abstract
The aim of this study is to assess the impact of changes of the 2013 ASCO/CAP guideline on the results of HER2 testing in breast cancer. A series of 916 primary invasive breast cancer cases, assessed as HER2 2+ by IHC in part using the 2007 and in part the 2013 ASCO/CAP criteria, was evaluated for HER2 amplification status by SISH and classified according to both 2007 and 2013 ASCO/CAP ISH guideline criteria. We observed a significant increase of HER2-positive cases (12.4 to 16.8%) and a decrease of HER2-equivocal cases (3.6 to 0.7%). Of the cases studied, 52.1% fulfilled both criteria of HER2/CEP17 ratio and average HER2 copy number per cell to be classified as HER2-positive. Reclassification of the cases from before the introduction of the new ASCO/CAP guideline with the 2013 ISH criteria resulted in an increase of cases with a HER2-positive status (12.4 to 14.2%) and in a decrease of HER2-equivocal cases (3.6 to 1.6%). The 2013 ASCO/CAP guideline selects more patients for anti-HER2 targeted therapy, mostly based on the modifications of criteria to evaluate ISH-HER2.
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Affiliation(s)
- António Polónia
- Department of Pathology, Ipatimup Diagnostics, Ipatimup, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dina Leitão
- Department of Pathology, Ipatimup Diagnostics, Ipatimup, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Schmitt
- Department of Pathology, Ipatimup Diagnostics, Ipatimup, Porto, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Laboratoire national de santé, 1, rue Louis Rech, L-3555, Dudelange, Luxembourg.
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Prendeville S, Feeley L, Bennett MW, O'Connell F, Browne TJ. Reflex Repeat HER2 Testing of Grade 3 Breast Carcinoma at Excision Using Immunohistochemistry and In Situ Analysis: Frequency of HER2 Discordance and Utility of Core Needle Biopsy Parameters to Refine Case Selection. Am J Clin Pathol 2016; 145:75-80. [PMID: 26712873 DOI: 10.1093/ajcp/aqv018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The updated American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines (2013) for human epidermal growth factor receptor 2 (HER2) testing in breast cancer recommend repeat testing at excision of HER2-negative grade 3 breast tumors. This study aimed to identify the rate of HER2 discordance in this cohort of cases. METHODS All HER2-negative grade 3 tumors diagnosed at a single institution over a 15-month period had reflex repeat HER2 testing at excision : HER2 testing was performed in accordance with ASCO/CAP guidelines using immunohistochemistry (IHC) and dual in situ hybridization (ISH). RESULTS One hundred cases were identified over the study period. HER2 was amplified at excision in three cases. The discordant tumors showed equivocal IHC at excision with low-level amplification on dual ISH. All discordant cases showed equivocal IHC on core needle biopsy (CNB) specimens and/or tumor upgrade at excision. CONCLUSIONS Our series demonstrated a high concordance rate (97%) for HER2 at excision in grade 3 breast tumors with a negative core biopsy result. These findings suggest that reflex repeat HER2 testing of all these cases, which has significant cost and workload implications, may not be justified. Features that may indicate HER2 heterogeneity, such as equivocal IHC on CNB specimens or tumor upgrade at excision, may help refine selection of cases for repeat testing.
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Affiliation(s)
- Susan Prendeville
- From the Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Linda Feeley
- From the Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Michael W Bennett
- From the Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Fionnuala O'Connell
- From the Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Tara Jane Browne
- From the Department of Histopathology, Cork University Hospital, Cork, Ireland.
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Shukla HD, Mahmood J, Vujaskovic Z. Integrated proteo-genomic approach for early diagnosis and prognosis of cancer. Cancer Lett 2015; 369:28-36. [DOI: 10.1016/j.canlet.2015.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/05/2015] [Accepted: 08/05/2015] [Indexed: 12/28/2022]
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Helin HO, Tuominen VJ, Ylinen O, Helin HJ, Isola J. Free digital image analysis software helps to resolve equivocal scores in HER2 immunohistochemistry. Virchows Arch 2015; 468:191-8. [PMID: 26493985 DOI: 10.1007/s00428-015-1868-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/22/2015] [Accepted: 10/12/2015] [Indexed: 01/29/2023]
Abstract
Evaluation of human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) is subject to interobserver variation and lack of reproducibility. Digital image analysis (DIA) has been shown to improve the consistency and accuracy of the evaluation and its use is encouraged in current testing guidelines. We studied whether digital image analysis using a free software application (ImmunoMembrane) can assist in interpreting HER2 IHC in equivocal 2+ cases. We also compared digital photomicrographs with whole-slide images (WSI) as material for ImmunoMembrane DIA. We stained 750 surgical resection specimens of invasive breast cancers immunohistochemically for HER2 and analysed staining with ImmunoMembrane. The ImmunoMembrane DIA scores were compared with the originally responsible pathologists' visual scores, a researcher's visual scores and in situ hybridisation (ISH) results. The originally responsible pathologists reported 9.1 % positive 3+ IHC scores, for the researcher this was 8.4 % and for ImmunoMembrane 9.5 %. Equivocal 2+ scores were 34 % for the pathologists, 43.7 % for the researcher and 10.1 % for ImmunoMembrane. Negative 0/1+ scores were 57.6 % for the pathologists, 46.8 % for the researcher and 80.8 % for ImmunoMembrane. There were six false positive cases, which were classified as 3+ by ImmunoMembrane and negative by ISH. Six cases were false negative defined as 0/1+ by IHC and positive by ISH. ImmunoMembrane DIA using digital photomicrographs and WSI showed almost perfect agreement. In conclusion, digital image analysis by ImmunoMembrane can help to resolve a majority of equivocal 2+ cases in HER2 IHC, which reduces the need for ISH testing.
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Affiliation(s)
- Henrik O Helin
- BioMediTech/Cancer Biology, University of Tampere, 33014, Tampere, Finland
| | - Vilppu J Tuominen
- BioMediTech/Cancer Biology, University of Tampere, 33014, Tampere, Finland
| | - Onni Ylinen
- BioMediTech/Cancer Biology, University of Tampere, 33014, Tampere, Finland
| | - Heikki J Helin
- HUSLAB, Division of Pathology and Genetics, Helsinki University Central Hospital, P.O. Box 400, 00029 HUS, Finland
| | - Jorma Isola
- BioMediTech/Cancer Biology, University of Tampere, 33014, Tampere, Finland.
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Advani PP, Crozier JA, Perez EA. HER2 testing and its predictive utility in anti-HER2 breast cancer therapy. Biomark Med 2015; 9:35-49. [PMID: 25605454 DOI: 10.2217/bmm.14.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast cancer treatment is dependent on accurate pathologic diagnosis. HER2 testing is now universally recommended as part of evaluation of invasive breast cancer. HER2 testing is available via various slide and non-slide based assays, and interpretation of results continues to evolve. Herein we review these testing modalities and their incorporation into the 2013 ASCO/CAP guidelines. Once accurate HER2 status has been established the proper treatment based on recent clinical trials can be instituted.
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Affiliation(s)
- Pooja P Advani
- Division of Hematology & Oncology, Mayo Clinic, 4500 San Pablo Road S., Jacksonville, FL 32224, USA
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Long TH, Lawce H, Durum C, Moore SR, Olson SB, Gatter K, Troxell ML. The New Equivocal: Changes to HER2 FISH Results When Applying the 2013 ASCO/CAP Guidelines. Am J Clin Pathol 2015; 144:253-62. [PMID: 26185310 DOI: 10.1309/ajcp3q9wfoqtkuvv] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Human epidermal growth factor receptor 2 (HER2, ERBB2) testing is an important prognostic/predictive marker in breast cancer management, especially in selecting HER2-targeted treatment. American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines address HER2 status and were recently revised in 2013, replacing the 2007 version. For in situ hybridization interpretation, 2013 guidelines return to the prior threshold of a HER2/CEP17 ratio of 2.0 or greater for positive and eliminate 1.8 to 2.2 as the equivocal range. Also, the HER2 signal/nucleus ratio is accounted for, with 6.0 or greater for positive and 4.0 to less than 6.0 for equivocal, even in cases with a HER2/CEP17 ratio less than 2.0. METHODS With institutional review board approval, we reviewed our 2006 to 2012 HER2 fluorescence in situ hybridization (FISH) results and classified them according to both the 2007 and 2013 guidelines as negative, positive, or equivocal. RESULTS Of 717 HER2 FISH results, 55 (7.7%) changed category when reassessed by 2013 guidelines. Nineteen of 25 results in the 2007 equivocal category were reassigned as positive (n = 13) or negative (n = 6). Thirty-five previously negative cases became equivocal in the 2013 scheme, 12 of these with 1+ immunohistochemistry. The positive category increased from 71 to 85. CONCLUSIONS The 2013 ASCO/CAP guidelines increased the number of HER2 FISH positive and equivocal results. The equivocal group is substantially different, posing a dilemma for clinical management.
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Affiliation(s)
- Thomas H. Long
- Department of Pathology, Oregon Health & Science University, Portland
| | - Helen Lawce
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Connie Durum
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Stephen R. Moore
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland
- Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland
| | - Susan B. Olson
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland
- Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland
| | - Ken Gatter
- Department of Pathology, Oregon Health & Science University, Portland
| | - Megan L. Troxell
- Department of Pathology, Oregon Health & Science University, Portland
- Knight Cancer Institute, Oregon Health & Science University, Portland
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Bethune GC, Veldhuijzen van Zanten D, MacIntosh RF, Rayson D, Younis T, Thompson K, Barnes PJ. Impact of the 2013 American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 (HER2) testing of invasive breast carcinoma: a focus on tumours assessed as ‘equivocal’ for HE. Histopathology 2015; 67:880-7. [PMID: 25913507 DOI: 10.1111/his.12723] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/22/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Gillian C Bethune
- Department of Pathology and Laboratory Medicine; Capital District Health Authority and Dalhousie University; Halifax NS Canada
| | - Daniel Veldhuijzen van Zanten
- Department of Pathology and Laboratory Medicine; Capital District Health Authority and Dalhousie University; Halifax NS Canada
| | - Rebecca F MacIntosh
- Department of Pathology and Laboratory Medicine; Capital District Health Authority and Dalhousie University; Halifax NS Canada
| | - Daniel Rayson
- Division of Medical Oncology; Capital District Health Authority and Dalhousie University; Halifax NS Canada
| | - Tallal Younis
- Division of Medical Oncology; Capital District Health Authority and Dalhousie University; Halifax NS Canada
| | - Kara Thompson
- Department of Medicine; Research Methods Unit; Capital District Health Authority and Dalhousie University; Halifax NS Canada
| | - Penny J Barnes
- Department of Pathology and Laboratory Medicine; Capital District Health Authority and Dalhousie University; Halifax NS Canada
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Semi-comprehensive analysis of gene amplification in gastric cancers using multiplex ligation-dependent probe amplification and fluorescence in situ hybridization. Mod Pathol 2015; 28:861-71. [PMID: 25743022 DOI: 10.1038/modpathol.2015.33] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/13/2014] [Accepted: 12/15/2014] [Indexed: 12/17/2022]
Abstract
The prognosis of patients with gastric carcinomas at an advanced stage still remains dismal, and therefore novel therapeutic modalities are urgently needed. Since the successful targeting of amplified ERBB2 with a humanized monoclonal antibody, the amplified genes of other receptor tyrosine kinases such as EGFR, FGFR2, and MET, as well as those of other cell regulator genes, are being considered as candidate targets of molecular therapy. The aim of the present study was to determine the amplification status of 26 genes, which are frequently amplified in solid cancers, in advanced gastric cancers. A total of 93 formalin-fixed and paraffin-embedded advanced gastric cancer tissues were examined by multiple ligation-dependent probe amplification, and 32 cases with 'gain' or 'amplified' status of 16 genes were further examined for the respective gene amplification by fluorescence in situ hybridization (FISH) and for the respective protein overexpression by immunohistochemistry. The frequencies of gene amplifications in advanced gastric cancers were as follows: ERBB2 (13 cases, 14%), FGFR2 (7 cases, 8%), MYC (7 cases, 8%), TOP2A (7 cases, 8%), MET (4 cases, 4%), MDM2 (4 cases, 4%), CCND1 (3 cases, 3%), FGF10 (2 cases, 3%), and EGFR (1 case, 1%). Amplification of the receptor tyrosine kinases genes occurred in a mutually exclusive manner except for one tumor in which ERBB2 and FGFR2 were both amplified but in different cancer cells. Co-amplification of ERBB2 and MYC, and EGFR and CCND1, in single nuclei but on different amplicons, was confirmed in one case each. Attempts at correlating the FISH status with the immunohistochemical staining pattern showed variable results from complete concordance to no correlation. In conclusion, combination of multiple ligation-dependent probe amplification and FISH analysis is a feasible approach for obtaining the semi-comprehensive genetic information that is necessary for personalized molecular targeted therapy.
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Current HER2 Testing Recommendations and Clinical Relevance as a Predictor of Response to Targeted Therapy. Clin Breast Cancer 2015; 15:171-80. [DOI: 10.1016/j.clbc.2014.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 11/18/2022]
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Liu FF, Shi W, Done SJ, Miller N, Pintilie M, Voduc D, Nielsen TO, Nofech-Mozes S, Chang MC, Whelan TJ, Weir LM, Olivotto IA, McCready DR, Fyles AW. Identification of a Low-Risk Luminal A Breast Cancer Cohort That May Not Benefit From Breast Radiotherapy. J Clin Oncol 2015; 33:2035-40. [PMID: 25964246 DOI: 10.1200/jco.2014.57.7999] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the prognostic and predictive value of intrinsic subtyping by using immunohistochemical (IHC) biomarkers for ipsilateral breast relapse (IBR) in participants in an early breast cancer randomized trial of tamoxifen with or without breast radiotherapy (RT). PATIENTS AND METHODS IHC analysis of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), cytokeratin 5/6, epidermal growth factor receptor, and Ki-67 was conducted on 501 of 769 available blocks. Patients were classified as luminal A (n = 265), luminal B (n = 165), or high-risk subtype (luminal HER2, n = 22; HER2 enriched, n = 13; basal like, n = 30; or triple-negative nonbasal, n = 6). Median follow-up was 10 years. RESULTS Classification by subtype was prognostic for IBR (10-year estimates: luminal A, 5.2%; luminal B, 10.5%; high-risk subtypes, 21.3%; P < .001). Luminal subtypes seemed to derive less benefit from RT (luminal A hazard ratio [HR], 0.40; luminal B HR, 0.51) than high-risk subtypes (HR, 0.13); however, the overall subtype-treatment interaction term was not significant (P = .26). In an exploratory analysis of women with clinical low-risk (age older than 60 years, T1, grade 1 or 2) luminal A tumors (n = 151), 10-year IBR was 3.1% versus 11.8% for the high-risk cohort (n = 341; P = .0063). Clinical low-risk luminal A patients had a 10-year IBR of 1.3% with tamoxifen versus 5.0% with tamoxifen plus RT (P = .42). Multivariable analysis showed that RT (HR, 0.31; P < .001), clinical risk group (HR, 2.2; P = .025), and luminal A subtype (HR, 0.25; P < .001) were significantly associated with IBR. CONCLUSION IHC subtyping was prognostic for IBR but was not predictive of benefit from RT. Further studies may validate the exploratory finding of a low-risk luminal A group who may be spared breast RT.
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Affiliation(s)
- Fei-Fei Liu
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Wei Shi
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Susan J Done
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Naomi Miller
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Melania Pintilie
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - David Voduc
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Torsten O Nielsen
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Sharon Nofech-Mozes
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Martin C Chang
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Timothy J Whelan
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Lorna M Weir
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Ivo A Olivotto
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - David R McCready
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Anthony W Fyles
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada.
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Stålhammar G, Farrajota P, Olsson A, Silva C, Hartman J, Elmberger G. Gene protein detection platform--a comparison of a new human epidermal growth factor receptor 2 assay with conventional immunohistochemistry and fluorescence in situ hybridization platforms. Ann Diagn Pathol 2015; 19:203-10. [PMID: 25921313 DOI: 10.1016/j.anndiagpath.2015.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) are widely used semiquantitative assays for selecting breast cancer patients for HER2 antibody therapy. However, both techniques have been shown to have disadvantages. Our aim was to test a recent automated technique of combined IHC and brightfield dual in situ hybridization-gene protein detection platform (GPDP)-in breast cancer HER2 protein, gene, and chromosome 17 centromere status evaluations, comparing the results in accordance to the American Society of Clinical Oncology/College of American Pathologists recommendations for HER2 testing in breast cancer from both 2007 and 2013. The GPDP technique performance was evaluated on 52 consecutive whole slide invasive breast cancer cases with HER2 IHC 2/3+ scoring results. Applying in turns the American Society of Clinical Oncology/College of American Pathologists recommendations for HER2 testing in breast cancer from 2007 and 2013 to both FISH and GPDP DISH assays, the HER2 gene amplification results showed 100% concordance among amplified/nonamplified cases, but there was a shift in 4 cases toward positive from equivocal results and toward equivocal from negative results. This might be related to the emphasis on the average HER2 copy number in the 2013 criteria. HER2 expression by IVD market IHC kit (Pathway®) has a strong correlation with GPDP HER2 protein, including a full concordance for all cases scored as 3+ and a reduction from 2+ to 1+ in 7 cases corresponding to nonamplified cases. Gene protein detection platform HER2 protein "solo" could have spared the need for 7 FISH studies. In addition, the platform offered advantages on interpretation reassurance including selecting areas for counting gene signals paralleled with protein IHC expression, on heterogeneity detection, interpretation time, technical time, and tissue expense.
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Affiliation(s)
- Gustav Stålhammar
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; St Erik Eye Hospital, Stockholm, Sweden.
| | - Pedro Farrajota
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Olsson
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
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Martin V, Cappuzzo F, Mazzucchelli L, Frattini M. HER2 in solid tumors: more than 10 years under the microscope; where are we now? Future Oncol 2015; 10:1469-86. [PMID: 25052756 DOI: 10.2217/fon.14.19] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HER2 is a well-recognized mediator of the cancerogenic process. It is dysregulated in a wide range of solid tumors, mainly via protein overexpression and/or gene amplification, thus making HER2 an attractive target for tailored treatment. The anti-HER2 therapy trastuzumab was approved for the treatment of HER2-positive metastatic breast cancer patients more than 10 years ago. Since then, trastuzumab and other HER2-inhibitors have been entered into clinical practice for the treatment of breast cancer and, more recently, have been approved to treat HER2-positive metastatic gastric cancers. Currently, HER2-targeted therapies are under evaluation in other tumor types. Due to the relevance of proper patient selection, the accurate assessment of HER2 status is fundamental. This review will discuss the established knowledge and novel insights into the HER2 story, mainly focusing on breast, gastric and colorectal cancers, as well as providing a brief overview of salivary gland, bladder, ovarian and lung tumors.
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Affiliation(s)
- Vittoria Martin
- Institute of Pathology, Via in Selva 24, 6600 Locarno, Switzerland
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Assessing the HER2 status in mucinous epithelial ovarian cancer on the basis of the 2013 ASCO/CAP guideline update. Am J Surg Pathol 2014; 38:1227-34. [PMID: 25133707 DOI: 10.1097/pas.0000000000000268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Her2 gene amplification and protein overexpression are important factors in predicting clinical sensitivity to anti-HER2 monoclonal antibody therapy in breast, gastric, or gastro-esophageal junction cancer patients. The purpose of this study was to evaluate the HER2 status in the mucinous epithelial ovarian cancer (EOC). Adopting the 2013 American Society for Clinical Oncology and the College of American Pathologists guideline update for HER2 testing, 49 tissue microarray samples of mucinous EOC were analyzed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) tests. The prevalence of HER2 positivity in Asian mucinous EOC was 9 of 49 Asian women (18.37%). The overall concordance was 100% between IHC and FISH results. Her2 gene copies before chromosome-17 correction increased significantly in a stepwise order through the negative, equivocal, and positive IHC result categories (P<0.001), as did the Her2 gene copies after chromosome-17 correction (P<0.001). Of the Taiwanese cohort (n=21), HER2 heterogeneity was 4.76% (1/21) in all but 14.26% (1/7) in HER2-positive cancer. In conclusion, we demonstrated that the prevalence of HER2 positivity in both Asian and white women was comparable; complete HER2 concordance existed between IHC and FISH tests for the Her2 gene copies per tumor cell either before or after correction of chromosome-17, and this can be applied as a potentially valuable tool to analyze the HER2 status. Polysomy-17 was absent under the CEP17 cutoff ≥3. The existence of HER2 heterogeneity can be discerned in certain HER2-expressed primary mucinous EOC in Taiwanese women.
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Gomez-Martín C, Lopez-Rios F, Aparicio J, Barriuso J, García-Carbonero R, Pazo R, Rivera F, Salgado M, Salud A, Vázquez-Sequeiros E, Lordick F. A critical review of HER2-positive gastric cancer evaluation and treatment: from trastuzumab, and beyond. Cancer Lett 2014; 351:30-40. [PMID: 24943493 DOI: 10.1016/j.canlet.2014.05.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/03/2014] [Accepted: 05/16/2014] [Indexed: 12/22/2022]
Abstract
Identification of the importance of human epidermal growth factor receptor-2 (HER2) status, biomarker testing and the development of anti-HER2 treatments have changed the prognosis of breast and gastric cancers. The addition of trastuzumab to chemotherapy has improved outcomes for patients with HER2-positive metastatic adenocarcinoma of the stomach and gastroesophageal junction, but some relevant issues remain to be elucidated or will emerge with new drugs. This article reviews the current state of HER2 in gastric cancer focusing on diagnostic and anti-HER2 targeted treatment issues and the role of trastuzumab in localized disease, and its combination or integration with new therapies.
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Affiliation(s)
- Carlos Gomez-Martín
- Gastrointestinal Cancer Unit and Early Drug Development Unit, Medical Oncology Division, "12 de Octubre" University Hospital, Madrid, Spain; Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Facultad de Medicina, Universidad San Pablo CEU, Madrid, Spain.
| | - Fernando Lopez-Rios
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Facultad de Medicina, Universidad San Pablo CEU, Madrid, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jorge Barriuso
- Upper GI Unit, Oncology Department, La Paz University Hospital-IdIPAZ, Madrid, Spain
| | - Rocio García-Carbonero
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, CSIC, HUVR, Sevilla, Spain
| | - Roberto Pazo
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fernando Rivera
- Medical Oncology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Mercedes Salgado
- Medical Oncology Department, Complejo Hospitalario de Ourense, Ourense, Spain
| | - Antonieta Salud
- Medical Oncology Department, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | | | - Florian Lordick
- University Cancer Center Leipzig, University Clinic Leipzig, Germany
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Impact of HER2 copy number in IHC2+/FISH-amplified breast cancer on outcome of adjuvant trastuzumab treatment in a large UK cancer network. Br J Cancer 2014; 110:2139-43. [PMID: 24691421 PMCID: PMC3992505 DOI: 10.1038/bjc.2014.147] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 01/18/2023] Open
Abstract
Background: Adjuvant trastuzumab with chemotherapy is standard treatment for HER2-positive breast cancer, defined as either HER2 IHC3+ or IHC2+ and FISH amplified. The aim of this study was to investigate the degree to which HER2 amplification in terms of HER2 gene copy numbers in HER2+IHC2+ cancers affected the outcome in a community setting. Methods: Case records of 311 consecutive patients with early breast cancer presenting between 1st January 2005 and 31st December 2008 were reviewed. Progression-free survival and overall survival were calculated with the Kaplan–Meier method using STATA 13. Results: Among 3+ cases (n=230) 163 received T vs 67 no-T. Among 2+ cases (n=81) 59 received T vs 22 no-T. Among 59 IHC2+-treated cases n=28 had an average of >12, n=13 had >6 to <12, and n=18 had >2 to <6 HER2 gene copies, respectively. The time of progression and overall survival of high and low copy number patients was similar and better than the intermediate copy number and the untreated cohorts. Conclusions: High HER2 copy number (>12) appears to be associated with consistently better response compared with patients with intermediate HER2 copy numbers (6–12). In light of emerging data of patients showing insensivity to trastuzumab therapy, we propose that the HER2 gene copy number value should be included as an additional indicator for stratifying both the management and the follow-up of breast cancer patients.
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Quintayo MA, Starczynski J, Yan FJ, Wedad H, Nofech-Mozes S, Rakovitch E, Bartlett JMS. Virtual tissue microarrays: a novel and viable approach to optimizing tissue microarrays for biomarker research applied to ductal carcinoma in situ. Histopathology 2014; 65:2-8. [PMID: 24267587 DOI: 10.1111/his.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/21/2013] [Indexed: 12/15/2022]
Abstract
AIMS Tissue microarrays (TMAs) are effective tools for performing high-throughput standardization analyses of biomarkers, but evidence indicating the core number required to be representative of the whole tumour is lacking. Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer. The number and size of cores that can best represent a DCIS lesion are unknown. Rather than performing extensive experiments using several variants of physical TMAs, the aim of this study was to develop a 'virtual TMA' approach that is effective at optimizing biomarker discovery and validation. METHODS AND RESULTS Whole DCIS sections from 95 patients were evaluated by immunohistochemistry for oestrogen receptor (ER), progesterone receptor (PgR), HER2, and Ki67. Histoscores were generated manually for ER, PgR, and HER2, as well as percentage positivity for Ki67. Slides were scanned using the FDA-approved Ariol SL50 Image Analysis system, and the virtual array (V-Array) module was used. Virtual cores created virtual TMAs, and our validated scoring classifiers were applied. Automated histoscores and percentage positivity were determined, and compared against increasing numbers of cores. The optimal number of cores was based on concordant results between virtual TMAs and corresponding whole sections. CONCLUSIONS We have shown that virtual arrays constitute an important tool in digital pathology in both research and clinical settings.
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Perez EA, Cortés J, Gonzalez-Angulo AM, Bartlett JM. HER2 testing: Current status and future directions. Cancer Treat Rev 2014; 40:276-84. [DOI: 10.1016/j.ctrv.2013.09.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/19/2013] [Accepted: 09/02/2013] [Indexed: 11/30/2022]
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Wolff AC, Hammond MEH, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, Bartlett JMS, Bilous M, Fitzgibbons P, Hanna W, Jenkins RB, Mangu PB, Paik S, Perez EA, Press MF, Spears PA, Vance GH, Viale G, Hayes DF. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med 2014; 138:241-56. [PMID: 24099077 PMCID: PMC4086638 DOI: 10.5858/arpa.2013-0953-sa] [Citation(s) in RCA: 813] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To update the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guideline recommendations for human epidermal growth factor receptor 2 (HER2) testing in breast cancer to improve the accuracy of HER2 testing and its utility as a predictive marker in invasive breast cancer. METHODS ASCO/CAP convened an Update Committee that included coauthors of the 2007 guideline to conduct a systematic literature review and update recommendations for optimal HER2 testing. RESULTS The Update Committee identified criteria and areas requiring clarification to improve the accuracy of HER2 testing by immunohistochemistry (IHC) or in situ hybridization (ISH). The guideline was reviewed and approved by both organizations. RECOMMENDATIONS The Update Committee recommends that HER2 status (HER2 negative or positive) be determined in all patients with invasive (early stage or recurrence) breast cancer on the basis of one or more HER2 test results (negative, equivocal, or positive). Testing criteria define HER2-positive status when (on observing within an area of tumor that amounts to >10% of contiguous and homogeneous tumor cells) there is evidence of protein overexpression (IHC) or gene amplification (HER2 copy number or HER2/CEP17 ratio by ISH based on counting at least 20 cells within the area). If results are equivocal (revised criteria), reflex testing should be performed using an alternative assay (IHC or ISH). Repeat testing should be considered if results seem discordant with other histopathologic findings. Laboratories should demonstrate high concordance with a validated HER2 test on a sufficiently large and representative set of specimens. Testing must be performed in a laboratory accredited by CAP or another accrediting entity. The Update Committee urges providers and health systems to cooperate to ensure the highest quality testing.
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Affiliation(s)
- Antonio C Wolff
- Antonio C. Wolff, Johns Hopkins Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth H. Hammond, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Mitch Dowsett, Royal Marsden Hospital, London, United Kingdom; Kimberly H. Allison, Stanford University Medical Center, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Donald C. Allred, Washington University School of Medicine, St Louis, MO; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Michael Bilous, University of Western Sydney and Healthscope Pathology, Sydney, New South Wales, Australia; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Soonmyung Paik, National Surgical Adjuvant Breast and Bowel Project, Pitsburgh, PA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Patricia A. Spears, North Carolina State University, Raleigh, NC; Gail H. Vance, Indiana University Medical Center, Indianapolis, IN; Giuseppe Viale, University of Milan, European Institute of Oncology, Milan, Italy; and Daniel F. Hayes, University of Michigan Comprehensive Cancer Care Center, Ann Arbor, MI
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