Reappraisal of HER2 Amplification in High-Grade Urothelial Carcinoma Based on 2018 ASCO/CAP Clinical Practice Guidelines

OBJECTIVES

To examine and compare human epidermal growth factor receptor 2 (HER2) amplification status in high-grade urothelial carcinoma (HGUCa), using both 2013 and 2018 HER2 reporting guidelines for breast carcinoma from the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP).

METHODS

HER2 status by fluorescence in situ hybridization (FISH) assay in 78 cases of HGUCa was compared using 2013 and 2018 HER2 reporting guidelines.

RESULTS

HER2 amplification was observed in 22 (28.2%) of 78 tumors, of which 17 were in group 1, 1 in group 2, and 2 each in groups 3 and 4 (FISH assay, 2018). The remaining 14 HER2-amplified tumors (FISH assay, 2013) became negative, falling into group 2 (FISH assay, 2018) and were either negative or equivocal on immunohistochemistry (IHC, 2018). All FISH-negative tumors (n = 37) using 2013 criteria remained negative (group 5, 2018). FISH-equivocal tumors (2013) were further categorized into HER2 amplified (n = 1) and HER2 negative (n = 4) (2018). Overall, 20 (25.6%) tumors had discordant HER2 FISH results (2018 vs 2013).

CONCLUSIONS

Implementing 2018 guidelines, HER2 amplification decreased from 36 to 22 cases. The group with a HER2/CEP17 ratio of 2 or more and average HER2 copy number less than 4 (group 2) were predominantly negative by IHC, suggesting a biologically distinct group of HGUCa that is different from HER2-amplified tumors, which may not respond to HER2-targeted therapy.

CFD-based process optimization of a dissolved air flotation system for drinking water production

Dissolved air flotation (DAF) has received more attention recently as a separation technique in both drinking water as well as wastewater treatment. However, the process as well as the preceding flocculation step is complex and not completely understood. Given the multiphase nature of the process, fluid dynamics studies are important to understand and optimize the DAF system in terms of operation and design. The present study is intended towards a comprehensive computational analysis for design optimization of the treatment plant in Kluizen, Belgium. Setting up the modelling framework involving the multiphase flow problem is briefly discussed. 3D numerical simulations on a scaled down model of the DAF design were analysed. The flow features give better confidence, but the flocs escape through the outlet still prevails which is averse to the system performance. In order to improve the performance and ease of maintenance, design modifications have been proposed by using a perforated tube for water extraction and are found to be satisfactory. The discussion is further reinforced through validating the numerical model against the experimental findings for stratified flow conditions.