Interspecies encounters with endemic health conditions: co-producing BVD and lameness with cows and sheep in the north of England

This paper focuses on the relationships between people and farmed nonhuman animals, and between these animals and the farmed environments they encounter, in the enactment of interspecies endemic disease situations. It examines how the nonhuman embodied capacities, agency and subjectivities of cows and sheep on farms in the north of England make a difference to how the endemic conditions of lameness and bovine viral diarrhoea (BVD) are encountered and responded to by farmers and advisers. The paper draws on empirical research with farmers and their advisers, and explores three key, inter-related, themes: first, the importance of intersubjective relationships between people and animals on farms; second, the nonhuman components of the 'disease situations' associated with endemic diseases, including animals' embodied characteristics and behaviours and the relationships between bodies and environments on different farms; and finally the ways in which animal agency and resistance makes a difference to on-farm interventions aiming to prevent or treat lameness and BVD. The paper concludes by arguing that animals' capacities, and nonhuman difference, should be taken further into account in future policy and practice interventions in endemic disease in farmed animals.

Simultaneous co-infection with swine influenza A and porcine reproductive and respiratory syndrome viruses potentiates adaptive immune responses

Porcine respiratory disease is multifactorial and most commonly involves pathogen co-infections. Major contributors include swine influenza A (swIAV) and porcine reproductive and respiratory syndrome (PRRSV) viruses. Experimental co-infection studies with these two viruses have shown that clinical outcomes can be exacerbated, but how innate and adaptive immune responses contribute to pathogenesis and pathogen control has not been thoroughly evaluated. We investigated immune responses following experimental simultaneous co-infection of pigs with swIAV H3N2 and PRRSV-2. Our results indicated that clinical disease was not significantly exacerbated, and swIAV H3N2 viral load was reduced in the lung of the co-infected animals. PRRSV-2/swIAV H3N2 co-infection did not impair the development of virus-specific adaptive immune responses. swIAV H3N2-specific IgG serum titers and PRRSV-2-specific CD8β⁺ T-cell responses in blood were enhanced. Higher proportions of polyfunctional CD8β⁺ T-cell subset in both blood and lung washes were found in PRRSV-2/swIAV H3N2 co-infected animals compared to the single-infected groups. Our findings provide evidence that systemic and local host immune responses are not negatively affected by simultaneous swIAV H3N2/PRRSV-2 co-infection, raising questions as to the mechanisms involved in disease modulation.

BSHI/BTS guidance on crossmatching before deceased donor kidney transplantation

All UK H&I laboratories and transplant units operate under a single national kidney offering policy, but there have been variations in approach regarding when to undertake the pre‐transplant crossmatch test. In order to minimize cold ischaemia times for deceased donor kidney transplantation we sought to find ways to be able to report a crossmatch result as early as possible in the donation process. A panel of experts in transplant surgery, nephrology, specialist nursing in organ donation and H&I (all relevant UK laboratories represented) assessed evidence and opinion concerning five factors that relate to the effectiveness of the crossmatch process, as follows: when the result should be ready for reporting; what level of donor HLA typing is needed; crossmatch sample type and availability; fairness and equity; risks and patient safety. Guidelines aimed at improving practice based on these issues are presented, and we expect that following these will allow H&I laboratories to contribute to reducing CIT in deceased donor kidney transplantation.

Micro-CT imaging of Onchocerca infection of Simulium damnosum s.l. blackflies and comparison of the peritrophic membrane thickness of forest and savannah flies

Onchocerciasis is a neglected tropical disease (NTD) caused by Onchocerca Diesing 1841 (Spirurida: Onchocercidae) nematodes transmitted by blackflies. It is associated with poverty and imposes a significant health, welfare and economic burden on many tropical countries. Current methods to visualize infections within the vectors rely on invasive methods. However, using micro-computed tomography techniques, without interference from physical tissue manipulation, we visualized in three dimensions for the first time an L1 larva of an Onchocerca species within the thoracic musculature of a blackfly, Simulium damnosum s.l. Theobald 1903 (Diptera: Simuliidae), naturally infected in Ghana. The possibility that thicker peritrophic membranes in savannah flies could account for their lower parasite loads was not supported, but there were limits to our analysis. While there were no statistically significant differences between the mean thicknesses of the peritrophic membranes, in the anterior, dorsal and ventral regions, of forest and savannah blackflies killed 34-48 min after a blood-meal, the thickness of the peritrophic membrane in the posterior region could not be measured. Micro-computed tomography has the potential to provide novel information on many other parasite/vector systems and impactful images for public engagement in health education.

Correction: Protective porcine influenza virus-specific monoclonal antibodies recognize similar haemagglutinin epitopes as humans

[This corrects the article DOI: 10.1371/journal.ppat.1009330.].

Major differences in the larval anatomy of the digestive and excretory systems of three Oestridae species revealed by micro-CT

Oestrid flies (Diptera: Oestridae) do not feed during the adult stage, so they depend on an efficient assimilation and storage of nutrients during their parasitic larval stage. We describe the general morphology and provide volumetric data for the digestive and excretory organs of the three larval instars of the nasal bot fly Oestrus ovis L., using micro-computed tomography. The size of the digestive and excretory organs greatly increased across larval instars. In all instars, the two salivary glands were remarkably large and formed a 'glandular band' by coming together, but without lumina uniting, at their posterior ends. The distal region of the anterior Malpighian tubules was greatly enlarged and full of highly radio-opaque concretions. Moreover, the anatomy of O. ovis third-instar larva was compared to that of two species of, respectively, similar and different feeding habits: Cephenemyia stimulator (Clark) and Hypoderma actaeon Brauer. Whereas the general morphology and arrangement of the digestive and excretory systems of C. stimulator was similar to that of O. ovis, some differences were observed in H. actaeon: a swollen anterior region of the midgut, salivary glands shorter and not forming a 'band' and anterior Malpighian tubules narrowly uniform throughout their entire length.

Evaluation of the MP Rapid 2019-NCOV IgM/IgG combo POCT test vs. an established platform-based method

BACKGROUND

Accurate and rapid testing for SARS-COV-2 antibodies could improve the diagnosis and management of COVID-19. In this study, we aim to evaluate the diagnostic accuracy of a commercially available point-of-care lateral flow kit independently and in comparison to an established platform-based system.

METHOD

Samples from 144 PCR-confirmed COVID-19 cases and 130 pre-pandemic negative controls were tested in parallel by MP Rapid 2019-NCOV IgM/IgG Combo test and Roche Elecsys. Comparison of results based on serum and capillary blood testing was undertaken.

RESULTS

Sensitivity at day 15 onwards was 100% for both methods. Between days 1 and 7 post admission, the IgM/IgG Combo test and Roche Elecsys shown sensitivity of 74% (95%CI: 62%-85%) vs. 67% (95% CI: 55%-79%, P = 0.3947). Combo test specificities were 100% for IgG, 98.5% for IgM vs. Roche Elecsys specificity of 100%. Concordance analysis showed 98.5% agreement to the Roche Elecsys method (Cohen's Kappa 0.96 95% CI [0.92-0.99]). Capillary blood results showed complete agreement with serum samples using the Combo test.

CONCLUSION

In comparison to Roche Elecsys, our data show that the MP Rapid 2019-NCOV IgM/IgG Combo test provides a high-confidence assay system for the detection of previous exposure to SARS-COV-2 infection with advantage of affording near-patient testing.

Internal morphological changes during metamorphosis in the sheep nasal bot fly, Oestrus ovis

During the larval stage, oestrid flies (Diptera: Oestridae) are obligate parasites, whereas during the adult stage they are free-living and do not feed. Like other cyclorrhaphous flies, oestrids undergo metamorphosis inside an opaque puparium, formed by the contracted and hardened cuticle of the third-instar larva. The present study documents the internal morphological changes taking place during metamorphosis of the sheep nasal bot fly, Oestrus ovis L., using non-invasive, micro-CT-based virtual histology and provides quantitative data of volumetric changes in specific organs. Virtual histological sections allowed visualisation of the progression and completion of the apolyses, which delimit the different intra-puparial stages, and the connection to the tracheal system of a large gas bubble, which plays an essential role during early metamorphosis. Overall, our results show that the sequence of morphological and volumetric changes in tissues and organs is similar to those found in other cyclorrhaphous flies, but they also reveal developmental differences that result in an adult vestigial digestive tract. Future studies could develop non-invasive, reliable methods for aging the intra-puparial forms of different oestrid species of veterinary importance, based on both qualitative and quantitative markers, thus improving our knowledge of their development and the efficiency of control strategies.

Establishment of a Pig Influenza Challenge Model for Evaluation of Monoclonal Antibody Delivery Platforms

mAbs are a possible adjunct to vaccination and drugs in treatment of influenza virus infection. However, questions remain whether small animal models accurately predict efficacy in humans. We have established the pig, a large natural host animal for influenza, with many physiological similarities to humans, as a robust model for testing mAbs. We show that a strongly neutralizing mAb (2-12C) against the hemagglutinin head administered prophylactically at 15 mg/kg reduced viral load and lung pathology after pandemic H1N1 influenza challenge. A lower dose of 1 mg/kg of 2-12C or a DNA plasmid-encoded version of 2-12C reduced pathology and viral load in the lungs but not viral shedding in nasal swabs. We propose that the pig influenza model will be useful for testing candidate mAbs and emerging delivery platforms prior to human trials.

Timelines of infection and transmission dynamics of H1N1pdm09 in swine

Influenza is a major cause of mortality and morbidity worldwide. Despite numerous studies of the pathogenesis of influenza in humans and animal models the dynamics of infection and transmission in individual hosts remain poorly characterized. In this study, we experimentally modelled transmission using the H1N1pdm09 influenza A virus in pigs, which are considered a good model for influenza infection in humans. Using an experimental design that allowed us to observe individual transmission events occurring within an 18-hr period, we quantified the relationships between infectiousness, shed virus titre and antibody titre. Transmission event was observed on 60% of occasions when virus was detected in donor pig nasal swabs and transmission was more likely when donor pigs shed more virus. This led to the true infectious period (mean 3.9 days) being slightly shorter than that predicted by detection of virus (mean 4.5 days). The generation time of infection (which determines the rate of epidemic spread) was estimated for the first time in pigs at a mean of 4.6 days. We also found that the latent period of the contact pig was longer when they had been exposed to smaller amount of shed virus. Our study provides quantitative information on the time lines of infection and the dynamics of transmission that are key parts of the evidence base needed to understand the spread of influenza viruses though animal populations and, potentially, in humans.

Influenza is a major cause of mortality and morbidity worldwide. The relationship between the time course of influenza infection and virus shedding and onward transmission of the virus remains poorly characterized. Pigs are a natural host for influenza infection with shedding patterns similar to humans. Therefore we experimentally infected pigs with the H1N1pdm09 influenza A virus using direct contact challenge and then mixed the infected pigs with a different naïve pig each day to understand when transmission occurred. Using mathematical modeling, we found that transmission events occurred on 60% of occasions when the infected pigs were shedding virus and that the risk of transmission increased with the quantity of virus shed. Also it was clear the incontact pigs started to shed virus later after exposure when the infected pigs were shedding low quantities of virus. Our study therefore provides quantitative information on the time lines of influenza virus infection and the dynamics of transmission. This is important to understand the spread of influenza viruses through animal populations and, potentially, in humans.

0696 The O2VERLAP Study: High Cpap Use Levels Found In Overlap Syndrome (OSA And COPD) Patients

Introduction

CPAP therapy is prescribed to help manage disordered breathing during sleep time periods. Most users, especially those with non-severe obstructive sleep apnea (OSA), use it only for some portion of their sleep period. Patients with Overlap Syndrome have both OSA and chronic obstructive pulmonary disease (COPD). While there has been some research on CPAP use levels in this patient population, there has been little indication that they use CPAP any differently than those with OSA only.

Methods

The O2VERLAP Study was a large comparative effectiveness trial enrolling people with COPD and OSA and using two different methods of providing information and support to current users of CPAP therapy. The study utilized an electronic national recruitment strategy and 332 participants were enrolled. CPAP data from the 12-week study period was analyzed. The Pittsburgh Sleep Quality Index was used to determine both estimated total sleep period (TSP) and total sleep time (TST). Because participants were all current users of CPAP, data from the total sample was combined and used. The percentage of TST and TSP that CPAP was used was calculated as CPAP use divided by either TST or TSP.

Results

The mean TST was 6.8 hours, TSP was 8.1 hours, and CPAP use was 6.7 hours. CPAP was used during 98.5% of the TST and during 82.7% of the TSP. Over 35% of the sample used CPAP at a level that was equal to or greater than their total sleep period.

Conclusion

Most OSA study populations use CPAP for some fraction of their night’s sleep. This COPD/OSA study population used CPAP to a markedly high level, including over one-third of the sample (n=~100) who used CPAP more than their self-reported sleep period. Further research on the extent and reasons for non-sleep period (i.e., daytime) CPAP use in COPD patients is warranted.

Support

PPRND #1507-31666.

Immunogenicity and Protective Efficacy of Seasonal Human Live Attenuated Cold-Adapted Influenza Virus Vaccine in Pigs

Influenza A virus infection is a global health threat to livestock and humans, causing substantial mortality and morbidity. As both pigs and humans are readily infected with influenza viruses of similar subtype, the pig is a robust and appropriate model for investigating swine and human disease. We evaluated the efficacy of the human cold-adapted 2017–2018 quadrivalent seasonal LAIV in pigs against H1N1pdm09 challenge. LAIV immunized animals showed significantly reduced viral load in nasal swabs. There was limited replication of the H1N1 component of the vaccine in the nose, a limited response to H1N1 in the lung lymph nodes and a low H1N1 serum neutralizing titer. In contrast there was better replication of the H3N2 component of the LAIV, accompanied by a stronger response to H3N2 in the tracheobronchial lymph nodes (TBLN). Our data demonstrates that a single administration of human quadrivalent LAIV shows limited replication in the nose and induces detectable responses to the H1N1 and H3N2 components. These data suggest that pigs may be a useful model for assessing LAIV against influenza A viruses.

Food fraud and the perceived integrity of European food imports into China

Background/Aims

Persistent incidents of food fraud in China have resulted in low levels of consumer trust in the authenticity and safety of food that is domestically produced. We examined the relationship between the concerns of Chinese consumers regarding food fraud, and the role that demonstrating authenticity may play in relieving those concerns.

Methods

A two-stage mixed method design research design was adopted. First, qualitative research (focus groups n = 7) was conducted in three Chinese cities, Beijing, Guangzhou and Chengdu to explore concerns held by Chinese consumers in relation to food fraud. A subsequent quantitative survey (n = 850) tested hypotheses derived from the qualitative research and theoretical literature regarding the relationship between attitudinal measures (including risk perceptions, social trust, and perceptions of benefit associated with demonstrating authenticity), and behavioral intention to purchase “authentic” European products using structural equation modelling.

Results

Chinese consumers perceive food fraud to be a hazard that represents a food safety risk. Food hazard concern was identified to be geographically influenced. Consumers in Chengdu (tier 2 city) possessed higher levels of hazard concern compared to consumers in Beijing and Guangzhou (tier 1). Structural trust (i.e. trust in actors and the governance of the food supply chain) was not a significant predictor of attitude and intention to purchase authenticated food products. Consumers were shown to have developed ‘risk-relieving’ strategies to compensate for the lack of trust in Chinese food and the dissonance experienced as a consequence of food fraud. Indexical and iconic authenticity cues provided by food manufacturers and regulators were important elements of product evaluations, although geographical differences in their perceived importance were observed.

Conclusions

Targeted communication of authenticity assurance measures, including; regulations; enforcement; product testing; and actions taken by industry may improve Chinese consumer trust in the domestic food supply chain and reduce consumer concerns regarding the food safety risks associated with food fraud. To support product differentiation and retain prestige, European food manufactures operating within the Chinese market should recognise regional disparities in consumer risk perceptions regarding food fraud and the importance of personal risk mitigation strategies adopted by Chinese consumers to support the identification of authentic products.

The effect of pelvic osteotomy plate type on axial rotation of the acetabular segment in the triple pelvic osteotomy

Objective: The purpose of this study is to evaluate the changes in structural anatomy of cadaver pelves, with specific emphasis on axial rotation, resulting from the application of TPO plates differing by type, angle and orientation. Sample population: Nine cadaver pelves procedure: The degree of axial rotation was determined for three different pelvic osteotomy plate types, four different plate angles and two different orientations of the same plate. Results: The observed degree of axial rotation was significantly different than the degree of axial rotation predicted by the plate angle for each group except the Rooks pelvic osteotomy plate. Conclusions/ clinical relevance: In the triple pelvic osteotomy the final degree of axial rotation may be significantly different than the predetermined plate angle.

Abstract P6-09-14: Prognostic significance of a modified residual disease in breast and nodes (mRDBN) algorithm after neoadjuvant therapy for breast cancer

Background: Patients achieving pathologic complete response to neoadjuvant chemotherapy have excellent disease free and overall survival. For patients with residual disease, the residual disease in breast and lymph node (RDBN) method provides useful prognostic information. RDBN is calculated as follows: 0.2*tumor size (in cm)+lymph node status (0-3) + tumor grade (1-3). pCR, low, intermediate and high risk of recurrence categories correspond to RDBN index of 0, 0.1 to 2.9, 3 to <4.4, and ≥ 4.4, respectively. We hypothesized that the prognostic accuracy of RDBN may be improved by also taking into account the residual tumor cellularity.

Methods: Retrospective review of 614 consecutive patients who underwent neoadjuvant therapy for breast cancer was performed. At our institution, tumor size/volume reduction in the breast is determined using the equation:

Estimated % tumor size reduction = [(pre-therapy clinical size – “revised” pathology tumor size)/pre-therapy clinical size]*100.

“Revised” pathology tumor size is calculated by multiplying the largest dimension of the gross tumor bed by the invasive tumor cellularity of the tumor bed (in comparison to the pre-therapy core biopsy sample). For example, if a 3 cm tumor bed has only 50% cellularity for invasive cancer (in comparison to pre-therapy core biopsy), the revised tumor size is 1.5 cm. Hence, we were able to use the “revised tumor size” for calculating the modified RDBN index (mRDBN). We also used gross tumor bed size for gross RDBN (gRDBN) to compare with mRDBN. mRDBN and gRDBN could be calculated on 459 of the 514 cases. Chi-Square statistical analysis was performed.

Results: Mean follow up was 33.1 months (median 31, range 4-70).

The results are shown in Table 1 & 2.

Table 1. Overall Recurrence and MortalityRDBN Score Category Overall Recurrence Mortality  nn (%)RR95% CI; pn (%)RR95% CI; pmRDBN (n=459)High5829 (50.0)19.63[7.22, 53.40]; p=<0.000118 (31.0)16.24[4.97, 53.10]; p=<0.0001Intermed16433 (20.1)7.9[2.86, 21.78]; p=<0.000115 (9.1)4.79[1.41, 16.21]; p=0.006Low803 (3.8)1.47[0.34, 6.42]; p=0.694 (5.0)2.62[0.60, 11.41]; p=0.23pCR1574 (2.5)REF 3 (1.9)REF gRDBN (n=459)High8131 (38.3)15.02[5.49, 41.09]; p=<0.000119 (23.5)12.28[3.74, 40.26]; p=<0.0001Intermed14932 (21.5)8.43[3.05, 23.26]; p=<0.000116 (10.7)5.62[1.67, 18.89]; p=0.003Low722 (2.8)1.09[0.20, 5.82]; p=12 (2.8)1.45[0.25, 8.51]; p=1pCR1574 (2.5)REF 3 (1.9)REF 

Table 2; Reclassification of gRDBN categoriesgRDBN mRDBN ReclassificationClassificationnLow (%)Intermed (%)High (%)Low7272 (100)0 (0)0 (0)Intermed1498 (5.4)140 (93.9)1 (0.7)High810 (0)24 (29.6)57 (70.4)

Conclusions: Both mRDBN and gRDBN provide prognostic information; however, separation of categories is improved with mRDBN (Table 1). mRDBN reclassified 30% of the high risk-gRDBN patients into intermediate risk category with a recurrence rate of 20%, leaving the 'true' high risk subgroup with a revised recurrence rate of 50% (Table 2). RDBN index also identified a group of low risk patients who have prognosis similar to patients with pCR.

Citation Format: Farrugia DJ, Landmann A, McAuliffe PF, Diego EJ, Johnson R, Bonaventura M, Soran A, Dabbs DJ, Clark B, Lembersky BC, Puhalla SL, Brufsky A, Jankowitz R, Davidson NE, Ahrendt GM, Bhargava R. Prognostic significance of a modified residual disease in breast and nodes (mRDBN) algorithm after neoadjuvant therapy for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-14.

Abstract P3-05-14: A neoadjuvant window trial of endocrine response in women with invasive lobular carcinoma

Background:

Patients with invasive lobular carcinoma (ILC) would be expected to have favorable outcomes compared to patients with invasive ductal carcinoma (IDC) given that ILC is more often hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)-negative, of lower grade, and displays decreased proliferation markers. Based on our preclinical studies showing differential hormone response in HR+ ILC vs. IDC and on recent studies suggesting differences in endocrine treatment response between patients with ILC vs. IDC, we designed a biomarker-driven, neoadjuvant window trial for newly diagnosed women with HR+, HER2-negative ILC. We hypothesize that Ki67 will be reduced by 85% in the fulvestrant arm compared with 60% and 75% reduction in the tamoxifen and anastrozole arms, respectively, and that Ki67 reduction will correlate with alterations in expression of ER and ER-regulated genes. Differential Ki67 effect will serve as a surrogate for outcome of patients with ILC on endocrine therapy.

Trial Design: This multicenter study (NCT02206984) will enroll 150 women with HR+ and HER2-negative ILC. A mandatory research breast tumor biopsy will be performed at baseline. Fifty patients will be randomized to each of three open-label treatment arms for 21 days: fulvestrant (two 250 mg IM injections on both day 1 and day 14), anastrozole (1mg orally daily), or tamoxifen (20 mg orally daily). Biomarkers of response will be assessed on baseline and post-treatment tumor tissue. Patients will proceed to definitive surgery on day 21 after study drug exposure, or they will undergo a second research breast core biopsy if further neoadjuvant treatment is planned.

Eligibility Criteria: Eligible patients include postmenopausal women with newly diagnosed, HR+, HER2-negative ILC (excluding pleomorphic subtype) measuring ≥ 1cm, with adequate organ function, ECOG PS ≥ 2, and agreeable to baseline research breast tumor biopsy.

Specific Aims: The primary endpoint is percent change from baseline to post-treatment Ki67 values in ILC tissue after 21 days of endocrine treatment. Comparisons across study arms will be made using a general linear model adjusting for institutional effect, with 80% power estimated for pairwise comparisons of log2(% staining) between treatment arms, allowing for 10% attrition. Secondary endpoints include post-therapy Ki67, and change in ER and PR protein expression by IHC. Finally, planned correlative studies include evaluation of gene expression, epigenetic markers, and DNA sequence variants in ILC tissues in an effort to identify biomarkers of endocrine response and putative drivers of endocrine resistance in ILC.

Target Accrual: This study will be open to enrollment by August 2015 at the University of Pittsburgh. Additional sites will be opened through the Translational Breast Cancer Research Consortium (TBCRC). We anticipate an accrual rate of 8 patients per month.

(Funding from Susan G. Komen® and AstraZeneca).

Citation Format: Jankowitz RC, McAuliffe PF, Sikora MJ, Butler L, Ahrendt G, Johnson R, Diego E, Bonaventura M, Puhalla S, Lembersky B, Clark B, Brufsky A, Kurland BF, Davidson NE, Dabbs DJ, Oesterreich S. A neoadjuvant window trial of endocrine response in women with invasive lobular carcinoma. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-05-14.

Abstract P1-01-15: Breast cancer biomarkers: Global tumor biomarker quality assurance study of intratumor heterogeneity

Introduction

Biomarkers (BM) are often performed on core biopsies(CB) of breast tumors for treatment purposes, yet comprehensive information on BM heterogeneity is lacking. This quality assurance study is to survey BM intra-tumor heterogeneity (ITH) by comparing BM from CB and the examination of entire breast tumors from surgical excisions (SE). This interim report supplies data on 45/100 collected cases to date.

Methods:

Whole tumor cases, 3.0cm or less were collected in years 2013-2014, excluding neoadjuvant cases and were examined with CB by two pathologists. All tissues were processed using 2013 ASCO/CAP guidelines. Immunohistochemistry (IHC) for ER/PR/Her2/Ki67 was performed on breast core biopsies and each block of a tumor surgical excision (1-13 blocks per case). IHC was performed using the Ultra Ventana-Roche device with FDA IVD clones ER (SP1), PR(1E2) Her2(4B5) Ki67(30-9). Whole slides were semi-quantitated for ER/PR using HScore (0-300), Her2 was interpreted with 2013 ASCO/CAP guidelines and Ki67 proliferation index (PI) as estimated whole slide percent of tumor cell nuclear stain. Mean HScores and PI were calculated for all BM on SE, and CB deviations from the SE mean were calculated for ER/PR/Ki67. ITH of BM was assessed by comparing results among all tissue blocks for each case. Her2 results were descriptive. Eight cases lacked CB Ki67 PI.

Results

There were no cases in which categorical hormone receptors results (positive/negative) differed between CB and SE.

2/45 (4%) cases were Her2 positive, and 13/45(28%) were equivocal by IHC with one case amplified by in situ hybridization.

Comparing ER between CB/SE , 3/45 differed in HScores by 30% or more. 10/45 SE ER had ITH of 25% or more among different tissue blocks. 14/45 cases had CB/SE PR difference in HScore of 30% or more. 18/45 cases had SE PR with ITH HScore of 25% or more between tissue blocks.

Ki67 PI differed between CB/SE by more than 25% in 18/37 cases, with ITH among tissue blocks of more than 25% in 23/37 cases. The variability of CB-SE results and ITH among tissue blocks are summarized in table 1.

Table 1 Summary of ResultsCB-SE ERITH ERCB-SE PRITH PRCB- SE PIITH PI>30%>25%>30%>25%>25%>25%3/4510/45 (22%)14/45 (31%)18/45 (40%)18/37(49%)23/37(62%)CB-SE: core biopsy vs surgical excision; ER PR as H Score

Conclusions

In this interim report of 45/100 cases, (1) ITH of 25% or more occurred for ER content in 22 % of cases (2) similar ITH exists for PR content in 40% of cases. (3) Ki67 PI tissue block ITH was expressed with variation of 25% or more in 23/37 cases.

(4) While this degree of variability of BM may not affect treatment decisions, the tissues show sufficient BM variability that should stimulate concern for accuracy of results of prognostic gene expression profiles and genomic testing of breast tumors.

Citation Format: Dabbs DJ, Clark B. Breast cancer biomarkers: Global tumor biomarker quality assurance study of intratumor heterogeneity. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-15.