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Torlakovic EE, Baniak N, Barnes PJ, Chancey K, Chen L, Cheung C, Clairefond S, Cutz JC, Faragalla H, Gravel DH, Dakin Hache K, Iyengar P, Komel M, Kos Z, Lacroix-Triki M, Marolt M, Mrkonjic M, Mulligan AM, Nofech-Mozes S, Park PC, Plotkin A, Raphael S, Rees H, Seno HR, Thai DV, Troxell ML, Varma S, Wang G, Wang T, Wehrli B, Bigras G. Fit-for-Purpose Ki-67 Immunohistochemistry Assays for Breast Cancer. J Transl Med 2024:102076. [PMID: 38729353 DOI: 10.1016/j.labinv.2024.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
New therapies are being developed for breast cancer and in this process some "old" biomarkers are re-utilized and given a new purpose. It is not always recognized that, by changing a biomarker's intended use, a new biomarker assay is created. The Ki-67 biomarker is typically assessed by immunohistochemistry (IHC) to provide a proliferative index in breast cancer. Canadian laboratories assessed the analytical performance and diagnostic accuracy of their Ki-67 IHC laboratory developed tests (LDTs), of relevance for the LDTs' clinical utility. Canadian clinical IHC laboratories enrolled in the Canadian Biomarker Quality Assurance (CBQA) Pilot Run for Ki-67 in breast cancer by invitation. The Dako Ki-67 IHC pharmDx assay was employed as a study reference assay. The Dako central laboratory (USA) was the reference laboratory. Participants received unstained slides of breast cancer tissue microarrays (TMAs) with 32 cases and performed their in-house Ki-67 assay. The results were assessed using QuPath, an open-source software for bio-image analysis. Positive percent agreement (PPA, sensitivity) and negative percent agreement (NPA, specificity) were calculated against the Dako Ki-67 IHC pharmDx assay for 5%, 10%, 20% and 30% cut-offs. Overall, PPA and NPA varied depending on the selected cut-off; participants were more successful with 5% and 10%, than with 20% and 30% cut-offs. Only four out of 16 laboratories had robust IHC protocols with acceptable PPA for all cut-offs. The lowest PPA for the 5% cut-off was 85%, for 10% was 63%, for 20% was 14%, and for 30% was 13%. The lowest NPA for the 5% cut-off was 50%, for 10% was 33%, for 20% was 50%, and for 30% was 57%. Despite many years of international efforts to standardize IHC testing for Ki-67 in breast cancer, our results indicate that Canadian clinical LDTs have a wide analytical sensitivity range and poor agreement for 20% and 30% cut-offs. The poor agreement was not due to the readout, but rather due to IHC protocol conditions. IKWG recommendations related to Ki-67 IHC standardization cannot take full effect without reliable fit-for-purpose reference materials that are required for the initial assay calibration, assay performance monitoring, and proficiency testing.
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Affiliation(s)
- Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, Royal University Hospital, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.
| | - Nick Baniak
- Department of Pathology and Laboratory Medicine, Saskatoon City Hospital, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.
| | - Penny J Barnes
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | | | - Liam Chen
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Carol Cheung
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Sylvie Clairefond
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon and Canadian Biomarker Quality Assurance, Saskatoon, Saskatchewan, Canada.
| | - Jean-Claude Cutz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Hala Faragalla
- Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto and Unity Health, Toronto, Ontario, Canada.
| | - Denis H Gravel
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Kelly Dakin Hache
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Pratibha Iyengar
- Laboratory Medicine and Genetics Program, Trillium Health Partners, Mississauga, Ontario, Canada.
| | - Michael Komel
- Department of Laboratory Medicine, North York General Hospital, North York, Ontario, Canada.
| | - Zuzana Kos
- Department of Pathology, BC Cancer Vancouver Centre, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - Monna Marolt
- M Health Fairview Southdale Hospital, Edina, Minnesota, USA.
| | - Miralem Mrkonjic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Anna Marie Mulligan
- Department of Laboratory Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Sharon Nofech-Mozes
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Paul C Park
- Department of Pathology, Shared Health; Department of Pathology, University of Manitoba; Cancer Care Manitoba Research Institute, Winnipeg, Manitoba, Canada.
| | - Anna Plotkin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Simon Raphael
- North York General Hospital and LMP University of Toronto, Toronto, Ontario, Canada.
| | - Henrike Rees
- Department of Pathology and Laboratory Medicine, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.
| | - H Rommel Seno
- Department of Pathology and Laboratory Medicine, Pasqua Hospital, University of Saskatchewan and Saskatchewan Health Authority, Regina, Saskatchewan, Canada.
| | - Duc-Vinh Thai
- Department of Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, Ontario, Canada.
| | - Megan L Troxell
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
| | - Sonal Varma
- Department of Pathology & Molecular Medicine, Kingston Health Science Center & Queen's University, Kingston, Ontario, Canada.
| | - Gang Wang
- Department of Pathology and Laboratory Medicine, BC Cancer Vancouver Centre, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tao Wang
- Department of Pathology & Molecular Medicine, Kingston Health Science Center & Queen's University, Kingston, Ontario, Canada.
| | - Bret Wehrli
- London Health Sciences Centre and Western University, London, Ontario, Canada.
| | - Gilbert Bigras
- Faculty of medicine, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
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2
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Torlakovic EE, Cheung CC. Immunohistochemistry: The Importance of Precision Ontology to Precision Oncology. Appl Immunohistochem Mol Morphol 2024; 32:61-63. [PMID: 38251659 DOI: 10.1097/pai.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, SK
| | - Carol C Cheung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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3
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Price P, Ganugapati U, Gatalica Z, Kakadekar A, Macpherson J, Quenneville L, Rees H, Slodkowska E, Suresh J, Yu D, Lim HJ, Torlakovic EE. Reinventing Nuclear Histo-score Utilizing Inherent Morphologic Cutoffs: Blue-brown Color H-score (BBC-HS). Appl Immunohistochem Mol Morphol 2023; 31:500-506. [PMID: 36625446 PMCID: PMC10396076 DOI: 10.1097/pai.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/07/2022] [Indexed: 01/11/2023]
Abstract
Immunohistochemistry (IHC) is a testing methodology that is widely used for large number of diagnostic, prognostic, and predictive biomarkers. Although IHC is a qualitative methodology, in addition to threshold-based stratification (positive vs. negative), the increasing levels of expression of some of these biomarkers often lead to more intense staining, which published evidence linked to specific diagnosis, prognosis, and responses to therapy. It is essential that the descriptive thresholds between positive and negative staining, as well as between frequently used graded categories of staining intensity (eg, 1+, 2+, 3+) are standardized and reproducible. Histo-score (H-score) is a frequently used scoring system that utilizes these categories. Our study introduces categorization of the cutoff points between positive and negative results and graded categories of staining intensity for nuclear IHC biomarker assays based on color interaction between hematoxylin and diaminobenzidine (DAB); the Blue-brown Color H-score (BBC-HS). Six cases of diffuse large B-cell lymphoma were stained for a nuclear marker MUM1. The staining was assessed by H-score by 12 readers. Short tutorial and illustrated instructions were provided to readers. The novel scoring system in this study uses the interaction between DAB (DAB, brown stain) and hematoxylin (blue counterstain) to set thresholds between "0" (negative nuclei), "1+" (weakly positive nuclei), "2+" (moderately positive nuclei), and "3+" (strongly positive nuclei). The readers recorded scores for 300 cells. Krippendorff alpha (K-alpha) and intraclass correlation coefficient (ICC) were calculated. We have also assessed if reliability improved when counting the first 100 cells, first 200 cells, and for the total 300 cells using K-alpha and ICC. To assess the performance of each individual reader, the mean H-score and percent positive score (PPS) for each case was calculated, and the bias was calculated between each reader's score and the mean. K-alpha was 0.86 for H-score and 0.76 for PPS. ICC was 0.96 for H-score and 0.92 for PPS. The biases for H-score ranged from -58 to 41, whereas for PPS it ranged from -27% to 33%. Overall, most readers showed very low bias. Two readers were consistently underscoring and 2 were consistently overscoring compared with the mean. For nuclear IHC biomarker assays, our newly proposed cutoffs provide highly reliable/reproducible results between readers for positive and negative results and graded categories of staining intensity using existing morphologic parameters. BBC-HS is easy to teach and is applicable to both human eye and image analysis. BBC-HS application should facilitate the development of new reliable/reproducible scoring schemes for IHC biomarkers.
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Affiliation(s)
- Phillipe Price
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
| | - Usharani Ganugapati
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon
| | - Zoran Gatalica
- Department of Pathology, Oklahoma University Medical Center, Oklahoma City, OK
| | - Archan Kakadekar
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
| | - James Macpherson
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa
| | - Louise Quenneville
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon
| | - Henrike Rees
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon
| | - Elzbieta Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Janarthanee Suresh
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
| | - Darryl Yu
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon
| | - Hyun J. Lim
- College of Medicine, University of Saskatchewan
| | - Emina E. Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon
- Canadian Biomarker Quality Assurance, University of Saskatchewan, Saskatoon, SK
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4
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Mansoor A, Kamran H, Akhter A, Seno R, Torlakovic EE, Roshan TM, Shabani-Rad MT, Elyamany G, Minoo P, Stewart D. Identification of Potential Therapeutic Targets for Plasmablastic Lymphoma Through Gene Expression Analysis: Insights into RAS and Wnt Signaling Pathways. Mod Pathol 2023; 36:100198. [PMID: 37105495 DOI: 10.1016/j.modpat.2023.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/20/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell lymphoma with overlapping characteristics with diffuse large B-cell lymphoma (DLBCL) and multiple myeloma. Hyperactive Wnt signaling derails homeostasis and promotes oncogenesis and chemoresistance in DLBCL and multiple myeloma. Evidence suggests active cross-talk between the Wnt and RAS pathways impacting metastasis in solid cancers in which combined targeted therapies show effective results. Recent genomic studies in PBL demonstrated a high frequency of mutations linked with the RAS signaling pathway. However, the role of RAS and Wnt signaling pathway molecule expression in PBL remained unknown. We examined the expression of Wnt and RAS pathway-related genes in a well-curated cohort of PBL. Because activated B cells are considered immediate precursors of plasmablasts in B cell development, we compared this data with activated B-cell type DLBCL (ABC-DLBCL) patients, employing NanoString transcriptome analysis (770 genes). Hierarchical clustering revealed distinctive differential gene expression between PBL and ABC-DLBCL. Gene set enrichment analysis labeled the RAS signaling pathway as the most enriched (37 genes) in PBL, including upregulating critical genes, such as NRAS, RAF1, SHC1, and SOS1. Wnt pathway genes were also enriched (n = 22) by gene set enrichment analysis. Molecules linked with Wnt signaling activation, such as ligands or targets (FZD3, FZD7, c-MYC, WNT5A, WNT5B, and WNT10B), were elevated in PBL. Our data also showed that, unlike ABC-DLBCL, the deranged Wnt signaling activity in PBL was not linked with hyperactive nuclear factor κB and B-cell receptor signaling. In divergence, Wnt signaling inhibitors (CXXC4, SFRP2, and DKK1) also showed overexpression in PBL. The high expression of RAS signaling molecules reported may indicate linkage with gain-in-function RAS mutations. In addition, high expression of Wnt and RAS signaling molecules may pave pathways to explore benefiting from combined targeted therapies, as reported in solid cancer, to improve prognosis in PBL patients.
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Affiliation(s)
- Adnan Mansoor
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada.
| | - Hamza Kamran
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Ariz Akhter
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Rommel Seno
- Department of Pathology & Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Emina E Torlakovic
- Department of Pathology & Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tariq Mahmood Roshan
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Meer-Taher Shabani-Rad
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Ghaleb Elyamany
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Parham Minoo
- Department of Pathology & Laboratory Medicine, University of Calgary, and Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Douglas Stewart
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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5
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Suresh J, Wu Y, Sabaratnam R, Brijlall S, Kyle B, Torlakovic EE. Dual Expression of Immunoglobulin Light Chains in Plasma Cell Myeloma: A Case Report and Literature Review. Appl Immunohistochem Mol Morphol 2023; 31:447-451. [PMID: 36314594 DOI: 10.1097/pai.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 08/19/2022] [Indexed: 11/25/2022]
Abstract
Typically, myeloma cells express a monoclonal immunoglobulin (Ig), either heavy or light chain. Here, we present a case of multiple myeloma with clonal dual expression of kappa and lambda light chain in a 74-year-old woman. Awareness of rare biphenotypic myeloma is important for proper diagnostic workup. A 74-year-old woman underwent hip replacement with an incidental finding of 20% plasma cells in the femoral head. Subsequent bone marrow biopsy also showed about 30% of plasma cells negative for CD20, CD56, and CD117. Immunohistochemistry (IHC) and in situ hybridization studies showed a mixture of kappa and lambda plasma cells. Flow cytometry showed ambiguous results for cytoplasmic Ig light chains kappa and lambda. However, cyclin D1 was highly expressed by plasma cells, and increased free kappa light chains were identified in serum. Further investigation by double IHC demonstrated co-expression of kappa and lambda light chains in the same cells. Fluoresces in situ hybridization studies were positive for t(11;14)(q13;q32) and the deletion 13q. Since its first description by Taylor and Burns in 1974, the demonstration of restricted cytoplasmic Ig light chain expression by immunohistochemistry is 1 of the basic tools for corroborating clonality of the plasma cells in tissue biopsy. IHC results in myeloma with dual expression of Ig light chains may suggest polyclonal plasma cell population, especially when plasma cells do not form sheets in the bone marrow. In an appropriate clinical setting, other investigations are needed to exclude plasma cell neoplasm, even with seemingly "polytypic" results by IHC.
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Affiliation(s)
- Janarthanee Suresh
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
| | - Yue Wu
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Saskatchewan Health Authority, Saskatoon
| | | | - Shashi Brijlall
- Department of Pathology
- Department of Orthopedic, Victoria Hospital, Prince Albert Parkland Health Region, SK, Canada
| | - Barry Kyle
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Saskatchewan Health Authority, Saskatoon
| | - Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Saskatchewan Health Authority, Saskatoon
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6
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Sompuram SR, Torlakovic EE, 't Hart NA, Vani K, Bogen SA. In Reply: Programmed Death-Ligand 1 (PD-L1) Immunohistochemistry Calibration. Mod Pathol 2023; 36:100057. [PMID: 36853795 DOI: 10.1016/j.modpat.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | - Emina E Torlakovic
- Department of Pathology & Laboratory Medicine, University of Saskatchewan and Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada; Canadian Biomarker Quality Assurance, Saskatoon, Saskatchewan, Canada
| | - Nils A 't Hart
- Department of Pathology, Isala Hospital, Zwolle, the Netherlands
| | - Kodela Vani
- Boston Cell Standards Inc, Boston, Massachusetts
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7
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Bogen SA, Dabbs DJ, Miller KD, Nielsen S, Parry SC, Szabolcs MJ, t'Hart N, Taylor CR, Torlakovic EE. A Consortium for Analytic Standardization in Immunohistochemistry. Arch Pathol Lab Med 2022; 147:584-590. [PMID: 36084252 DOI: 10.5858/arpa.2022-0031-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The authors announce the launch of the Consortium for Analytic Standardization in Immunohistochemistry, funded with a grant from the National Cancer Institute. As with other laboratory testing, analytic standards are important for many different stakeholders: commercial vendors of instruments and reagents, biopharmaceutical firms, pathologists, scientists, clinical laboratories, external quality assurance organizations, and regulatory bodies. Analytic standards are customarily central to assay development, validation, and method transfer into routine assays, and are critical quality assurance tools. OBJECTIVE.— To improve immunohistochemistry (IHC) test accuracy and reproducibility by integrating analytic standards into routine practice. To accomplish this mission, the consortium has 2 mandates: (1) to experimentally determine analytic sensitivity thresholds (lower and upper limits of detection) for selected IHC assays, and (2) to inform IHC stakeholders of what analytic standards are, why they are important, and how and for what purpose they are used. The consortium will then publish the data and offer analytic sensitivity recommendations where appropriate. These mandates will be conducted in collaboration and coordination with clinical laboratories, external quality assurance programs, and pathology organizations. DATA SOURCES.— Literature review and published external quality assurance data. CONCLUSIONS.— Integration of analytic standards is expected to (1) harmonize and standardize IHC assays; (2) improve IHC test accuracy and reproducibility, both within and between laboratories; and (3) dramatically simplify and improve methodology transfer for new IHC protocols from published literature or clinical trials to clinical IHC laboratories.
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Affiliation(s)
- Steven A Bogen
- From Boston Cell Standards Inc, Boston, Massachusetts (Bogen)
| | | | - Keith D Miller
- The Research Department of Pathology, University College London, London, United Kingdom (Miller)
| | | | | | - Matthias J Szabolcs
- The Department of Pathology & Laboratory Medicine, New York Presbyterian/Columbia University Irving Medical Center, New York, New York (Szabolcs)
| | - Nils t'Hart
- The Department of Pathology, Isala, Zwolle, Netherlands (t'Hart)
| | - Clive R Taylor
- The Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles (Taylor)
| | - Emina E Torlakovic
- The Department of Pathology, University of Saskatchewan and Saskatoon Health Authority, Saskatoon, Canada (Torlakovic).,Canadian Biomarker Quality Assurance, Saskatoon, Saskatchewan, Canada (Torlakovic)
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8
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Sompuram SR, Torlakovic EE, ‘t Hart NA, Vani K, Bogen SA. Quantitative comparison of PD-L1 IHC assays against NIST standard reference material 1934. Mod Pathol 2022; 35:326-332. [PMID: 34389791 PMCID: PMC8840973 DOI: 10.1038/s41379-021-00884-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022]
Abstract
Companion diagnostic immunohistochemistry (IHC) tests are developed and performed without incorporating the tools and principles of laboratory metrology. Basic analytic assay parameters such as lower limit of detection (LOD) and dynamic range are unknown to both assay developers and end users. We solved this problem by developing completely new tools for IHC-calibrators with units of measure traceable to National Institute of Standards & Technology (NIST) Standard Reference Material (SRM) 1934. In this study, we demonstrate the clinical impact and opportunity for incorporating these changes into PD-L1 testing. Forty-one laboratories in North America and Europe were surveyed with newly-developed PD-L1 calibrators. The survey sampled a broad representation of commercial and laboratory-developed tests (LDTs). Using the PD-L1 calibrators, we quantified analytic test parameters that were previously only inferred indirectly after large clinical studies. The data show that the four FDA-cleared PD-L1 assays represent three different levels of analytic sensitivity. The new analytic sensitivity data explain why some patients' tissue samples were positive by one assay and negative by another. The outcome depends on the assay's lower LOD. Also, why previous attempts to harmonize certain PD-L1 assays were unsuccessful; the assays' dynamic ranges were too disparate and did not overlap. PD-L1 assay calibration also clarifies the exact performance characteristics of LDTs relative to FDA-cleared commercial assays. Some LDTs' analytic response curves are indistinguishable from their predicate FDA-cleared assay. IHC assay calibration represents an important transition for companion diagnostic testing. The new tools will improve patient treatment stratification, test harmonization, and foster accuracy as tests transition from clinical trials to broad clinical use.
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Affiliation(s)
| | - Emina E. Torlakovic
- University of Saskatchewan and Saskatoon Health Authority, Saskatoon, SK, Canada,Canadian Biomarker Quality Assurance (CBQA, Saskatoon, SK, Canada)
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9
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Gonzalez RS, Streutker CJ, Torlakovic EE. Proficiency Testing to Improve Interobserver Agreement for Mismatch Repair Deficiency Immunohistochemistry: An Invitation to Join CBQA Readout. Appl Immunohistochem Mol Morphol 2022; 30:79-82. [PMID: 35175237 DOI: 10.1097/pai.0000000000000995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Raul S Gonzalez
- From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Catherine J Streutker
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON
| | - Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatchewan, SK, Canada
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10
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Sompuram SR, Torlakovic EE, 't Hart NA, Vani K, Bogen SA. Correction to: Quantitative comparison of PD-L1 IHC assays against NIST standard reference material 1934. Mod Pathol 2021; 34:2242. [PMID: 34493826 DOI: 10.1038/s41379-021-00898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Emina E Torlakovic
- University of Saskatchewan and Saskatoon Health Authority, Saskatoon, SK, Canada.,Canadian Biomarker Quality Assurance CBQA, Saskatoon, SK, Canada
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11
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Cheung CC, Smith AC, Albadine R, Bigras G, Bojarski A, Couture C, Cutz JC, Huang WY, Ionescu D, Itani D, Izevbaye I, Karsan A, Kelly MM, Knoll J, Kwan K, Nasr MR, Qing G, Rashid-Kolvear F, Sekhon HS, Spatz A, Stockley T, Tran-Thanh D, Tucker T, Waghray R, Wang H, Xu Z, Yatabe Y, Torlakovic EE, Tsao MS. Canadian ROS proto-oncogene 1 study (CROS) for multi-institutional implementation of ROS1 testing in non-small cell lung cancer. Lung Cancer 2021; 160:127-135. [PMID: 34509095 DOI: 10.1016/j.lungcan.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Patients with non-small cell lung cancer (NSCLC) harboring ROS proto-oncogene 1 (ROS1) gene rearrangements show dramatic response to the tyrosine kinase inhibitor (TKI) crizotinib. Current best practice guidelines recommend that all advanced stage non-squamous NSCLC patients be also tested for ROS1 gene rearrangements. Several studies have suggested that ROS1 immunohistochemistry (IHC) using the D4D6 antibody may be used to screen for ROS1 fusion positive lung cancers, with assays showing high sensitivity but moderate to high specificity. A break apart fluorescence in situ hybridization (FISH) test is then used to confirm the presence of ROS1 gene rearrangement. The goal of Canadian ROS1 (CROS) study was to harmonize ROS1 laboratory developed testing (LDT) by using IHC and FISH assays to detect ROS1 rearranged lung cancers across Canadian pathology laboratories. Cell lines expressing different levels of ROS1 (high, low, none) were used to calibrate IHC protocols after which participating laboratories ran the calibrated protocols on a reference set of 24 NSCLC cases (9 ROS1 rearranged tumors and 15 ROS1 non-rearranged tumors as determined by FISH). Results were compared using a centralized readout. The stained slides were evaluated for the cellular localization of staining, intensity of staining, the presence of staining in non-tumor cells, the presence of non-specific staining (e.g. necrosis, extracellular mater, other) and the percent positive cells. H-score was also determined for each tumor. Analytical sensitivity and specificity harmonization was achieved by using low limit of detection (LOD) as either any positivity in the U118 cell line or H-score of 200 with the HCC78 cell line. An overall diagnostic sensitivity and specificity of up to 100% and 99% respectively was achieved for ROS1 IHC testing (relative to FISH) using an adjusted H-score readout on the reference cases. This study confirms that LDT ROS1 IHC assays can be highly sensitive and specific for detection of ROS1 rearrangements in NSCLC. As NSCLC can demonstrate ROS1 IHC positivity in FISH-negative cases, the degree of the specificity of the IHC assay, especially in highly sensitive protocols, is mostly dependent on the readout cut-off threshold. As ROS1 IHC is a screening assay for a rare rearrangements in NSCLC, we recommend adjustment of the readout threshold in order to balance specificity, rather than decreasing the overall analytical and diagnostic sensitivity of the protocols.
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Affiliation(s)
- Carol C Cheung
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adam C Smith
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roula Albadine
- Department of Pathology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gilbert Bigras
- Laboratory Medicine Department, University of Alberta, Edmonton, AB, Canada
| | - Anna Bojarski
- Department of Pathology and Laboratory Medicine, Health Sciences North, Sudbury, ON, Canada
| | - Christian Couture
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Jean-Claude Cutz
- Department of Pathology and Molecular Medicine, McMaster University Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Weei-Yuan Huang
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Science Center, ON, Canada
| | - Diana Ionescu
- Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, BC, Canada
| | - Doha Itani
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iyare Izevbaye
- Laboratory Medicine Department, University of Alberta, Edmonton, AB, Canada
| | - Aly Karsan
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Margaret M Kelly
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joan Knoll
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michel R Nasr
- Department of Pathology, Shared Health Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pathology SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gefei Qing
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada, and Calgary Laboratory Services, Calgary, AB, Canada
| | - Fariboz Rashid-Kolvear
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada, and Calgary Laboratory Services, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Johns Hopkins Medicine, Johns Hopkins All Children's Hospital, Baltimore, MD, USA
| | - Harmanjatinder S Sekhon
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and ORLA, University of Ottawa, Ottawa, ON, Canada
| | - Alan Spatz
- Divisions of Pathology and Molecular Genetics, McGill University Health Center and McGill University, Montreal, QC, Canada
| | - Tracy Stockley
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Danh Tran-Thanh
- Department of Pathology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Tracy Tucker
- Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, BC, Canada
| | - Ranjit Waghray
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hangjun Wang
- Divisions of Pathology and Molecular Genetics, McGill University Health Center and McGill University, Montreal, QC, Canada
| | - Zhaolin Xu
- Dept. of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center, Tokyo, Japan
| | - Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, SK, Canada.
| | - Ming-Sound Tsao
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Torlakovic EE, Sompuram S, Vani K, Bogen S. Abstract LB034: Analysis of PD-L1 IHC tests using NIST SRM 1934-traceable reference materials: A new paradigm for development of predictive IHC biomarkers. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-lb034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND. The challenges in accurate patient stratification for immune checkpoint inhibitors have been compounded by the fact that the FDA-cleared PD-L1 IHC tests are analytic ‘black boxes'. Relatively basic analytic parameters such as lower limit of detection and analytic dynamic range are unknown to both developers of assays as well as end users. The recent development of standardized PD-L1 immunohistochemistry (IHC) reference materials enables quantitative test characterizations that were not previously possible.
METHODS. We surveyed 41 PD-L1 testing laboratories in North America and Europe, quantitatively defining each of the PD-L1 tests' analytic performance in terms of lower limit of detection and dynamic range. All four commercial PD-L1 kits were assessed by multiple laboratories. A variety of laboratory-developed tests (LDTs) we also assessed. The reference materials incorporated defined concentrations of PD-L1 peptide (intracellular domain) or recombinant extracellular domain protein, traceable to NIST Standard Reference Material 1934. Each laboratory received a slide with 10 separate PD-L1 calibrator concentrations: 2,200 - 600,000 molecules of PD-L1 extracellular domain or 34,000 - 2,200,000 molecules of PD-L1 intracellular domain. The calibrator concentrations ranged from those that are below the lower limit of detection to others that yield maximal staining.
RESULTS. The data obtained with the four PD-L1 kits (VENTANA PD-L1 (SP263) Assay, VENTANA PD-L1 (SP142) Assay, DAKO PD-L1 IHC 28-8 pharmDx and DAKO PD-L1 IHC 22C3 pharmDx assays) revealed that the lower limits of detection (PD-L1 molecules per cell equivalent) are approximately: 50,000 - 180,000 (SP263), 800,000 - 1,200,000 (SP142), 220,000 - 360,000 (28-8), and 200,000 - 400,000 (22C3). The dynamic ranges for all of these tests are generally narrow, spanning less than a log concentration of PD-L1. The SP263 and SP142 assays showed no overlap of their analytic response curves. This means that a maximal stain intensity with SP263 kit can be associated with zero staining with the SP142 kit. Consequently, it is not possible to compensate for the variability in analytic sensitivity between these two tests by adjusting the percent positive cell cutoff. The 28-8 was more sensitive than, but statistically indistinguishable from the 22C3 assay. Laboratory-developed tests (LDTs) using these and other primary antibodies have their own unique analytic performance characteristics.
CONCLUSIONS. The PD-L1 reference materials enable precise definitions of analytic test performance and linking them with clinical management thresholds. Therefore, this tool finds its most important implementation at the stage of development of new IHC predictive biomarkers in clinical trials as well as at the stage of methodology transfer to clinical IHC laboratories. Furthermore, our results also help define more precisely the possibility for assay interchangeability and to what degree the assays may be harmonized.
Citation Format: Emina E. Torlakovic, Seshi Sompuram, Kodela Vani, Steve Bogen. Analysis of PD-L1 IHC tests using NIST SRM 1934-traceable reference materials: A new paradigm for development of predictive IHC biomarkers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB034.
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Affiliation(s)
- Emina E. Torlakovic
- 1University of Saskatchewan and Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada
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Torlakovic EE, Sompuram SR, Vani K, Wang L, Schaedle AK, DeRose PC, Bogen SA. Development and Validation of Measurement Traceability for In Situ Immunoassays. Clin Chem 2021; 67:763-771. [PMID: 33585916 PMCID: PMC8085580 DOI: 10.1093/clinchem/hvab008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/21/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Immunoassays for protein analytes measured in situ support a $2 billion laboratory testing industry that suffers from significant interlaboratory disparities, affecting patient treatment. The root cause is that immunohistochemical testing lacks the generally accepted tools for analytic standardization, including reference standards and traceable units of measure. Until now, the creation of these tools has represented an insoluble technical hurdle. METHODS We address the need with a new concept in metrology-that is, linked traceability. Rather than calculating analyte concentration directly, which has proven too variable, we calculate concentration by measuring an attached fluorescein, traceable to NIST Standard Reference Material 1934, a fluorescein standard. RESULTS For validation, newly developed estrogen receptor (ER) calibrators were deployed in tandem with an array of 80 breast cancer tissue sections in a national external quality assessment program. Laboratory performance was assessed using both the ER standards and the tissue array. Similar to previous studies, the tissue array revealed substantial discrepancies in ER test results among the participating laboratories. The new ER calibrators revealed a broad range of analytic sensitivity, with the lower limits of detection ranging from 7310 to 74 790 molecules of ER. The data demonstrate, for the first time, that the variable test results correlate with analytic sensitivity, which can now be measured quantitatively. CONCLUSIONS The reference standard enables precise interlaboratory alignment of immunohistochemistry test sensitivity for measuring cellular proteins in situ. The introduction of a reference standard and traceable units of measure for protein expression marks an important milestone.
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Affiliation(s)
- Emina E Torlakovic
- Canadian Biomarker Quality Assurance, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada
| | | | | | - Lili Wang
- Biosystems and Biomaterials Division, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | | | - Paul C DeRose
- Biosystems and Biomaterials Division, National Institute of Standards and Technology, Gaithersburg, MD, USA
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Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL, Hayes DF, Lakhani SR, Chavez-MacGregor M, Perlmutter J, Perou CM, Regan MM, Rimm DL, Symmans WF, Torlakovic EE, Varella L, Viale G, Weisberg TF, McShane LM, Wolff AC. Estrogen and Progesterone Receptor Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update. Arch Pathol Lab Med 2020; 144:545-563. [PMID: 31928354 DOI: 10.5858/arpa.2019-0904-sa] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE.— To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS.— A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS.— The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
| | | | | | | | | | | | | | - Sunil R Lakhani
- University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | | | - Meredith M Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Emina E Torlakovic
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Giuseppe Viale
- IEO, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- University of Milan, Milan, Italy
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Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL, Hayes DF, Lakhani SR, Chavez-MacGregor M, Perlmutter J, Perou CM, Regan MM, Rimm DL, Symmans WF, Torlakovic EE, Varella L, Viale G, Weisberg TF, McShane LM, Wolff AC. Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update. J Clin Oncol 2020; 38:1346-1366. [PMID: 31928404 DOI: 10.1200/jco.19.02309] [Citation(s) in RCA: 584] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Sunil R Lakhani
- University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | | | - Meredith M Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Emina E Torlakovic
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Giuseppe Viale
- IEO, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- University of Milan, Milan, Italy
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Ulndreaj A, Tzekou A, Mothe AJ, Siddiqui AM, Dragas R, Tator CH, Torlakovic EE, Fehlings MG. Characterization of the Antibody Response after Cervical Spinal Cord Injury. J Neurotrauma 2016; 34:1209-1226. [PMID: 27775474 DOI: 10.1089/neu.2016.4498] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The immune system plays a critical and complex role in the pathobiology of spinal cord injury (SCI), exerting both beneficial and detrimental effects. Increasing evidence suggests that there are injury level-dependent differences in the immune response to SCI. Patients with traumatic SCI have elevated levels of circulating autoantibodies against components of the central nervous system, but the role of these antibodies in SCI outcomes remains unknown. In rodent models of mid-thoracic SCI, antibody-mediated autoimmunity appears to be detrimental to recovery. However, whether autoantibodies against the spinal cord are generated following cervical SCI (cSCI), the most common level of injury in humans, remains undetermined. To address this knowledge gap, we investigated the antibody responses following cSCI in a rat model of injury. We found increased immunoglobulin G (IgG) and IgM antibodies in the spinal cord in the subacute phase of injury (2 weeks), but not in more chronic phases (10 and 20 weeks). At 2 weeks post-cSCI, antibodies were detected at the injury epicenter and co-localized with the astroglial scar and neurons of the ventral horn. These increased levels of antibodies corresponded with enhanced activation of immune responses in the spleen. Higher counts of antibody-secreting cells were observed in the spleen of injured rats. Further, increased levels of secreted IgG antibodies and enhanced proliferation of T-cells in splenocyte cultures from injured rats were found. These findings suggest the potential development of autoantibody responses following cSCI in the rat. The impact of the post-traumatic antibody responses on functional outcomes of cSCI is a critical topic that requires further investigation.
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Affiliation(s)
- Antigona Ulndreaj
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada .,2 Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Apostolia Tzekou
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada
| | - Andrea J Mothe
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada
| | - Ahad M Siddiqui
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada
| | - Rachel Dragas
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada .,2 Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Charles H Tator
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada .,2 Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,3 Department of Surgery, University of Toronto , Toronto, Ontario, Canada .,4 University of Toronto Spine Program, University of Toronto , Toronto, Ontario, Canada
| | - Emina E Torlakovic
- 5 Department of Laboratory Hematology, University of Toronto , Toronto, Ontario, Canada
| | - Michael G Fehlings
- 1 Division of Genetics and Development, Toronto Western Research Institute and University of Toronto Spinal Program, Krembil Neuroscience Center, University Health Network , Toronto, Ontario, Canada .,2 Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,3 Department of Surgery, University of Toronto , Toronto, Ontario, Canada .,4 University of Toronto Spine Program, University of Toronto , Toronto, Ontario, Canada
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Cheung CC, Banerjee D, Barnes PJ, Berendt RC, Butany J, Canil S, Clarke BA, El-Zimaity H, Garratt J, Geldenhuys L, Gilks CB, Manning L, Mengel M, Perez-Ordonez B, Pilavdzic D, Riddell R, Swanson PE, Torlakovic EE. Canadian Association of Pathologists-Association canadienne des pathologistes National Standards Committee for High Complexity Testing/Immunohistochemistry: guidelines for the preparation, release, and storage of unstained archived diagnostic tissue sections for immunohistochemistry. Am J Clin Pathol 2014; 142:629-33. [PMID: 25319977 DOI: 10.1309/ajcp77gxyveqxmxt] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Formalin-fixed, paraffin-embedded unstained archived diagnostic tissue sections are frequently exchanged between clinical laboratories for immunohistochemical staining. The manner in which such sections are prepared represents a type of preanalytical variable that must be taken into account given the growing importance of immunohistochemical assays, especially predictive and prognostic tests, in personalized medicine. METHODS Recommendations were derived from review of the literature and expert consensus of the Canadian Association of Pathologists-Association canadienne des pathologists National Standards Committee for High Complexity Testing/Immunohistochemistry. RESULTS Relevant considerations include the type of glass slide on which to mount the unstained sections; the thickness of the tissue sections; the time from slide preparation to testing; the environment, particularly the temperature at which the unstained sections will be maintained prior to testing; the inclusion of on-slide positive control tissue where possible; and whether patient identifier(s) should be included on slide labels. CONCLUSIONS Clear communication between requesting and releasing laboratories will facilitate the proper preparation of unstained sections and also ensure that applicable privacy considerations are addressed.
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Affiliation(s)
- Carol C. Cheung
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - Diponkar Banerjee
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Penny J. Barnes
- Department of Pathology, Dalhousie University and Capital District Health Authority, Halifax, Canada
| | - Richard C. Berendt
- Department of Laboratory Medicine, University of Alberta, Cross Cancer Institute, Edmonton, Canada
| | - Jagdish Butany
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - Sarah Canil
- Department of Laboratory Medicine, University of Alberta, Cross Cancer Institute, Edmonton, Canada
| | - Blaise A. Clarke
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - Hala El-Zimaity
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - John Garratt
- Department of Pathology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Laurette Geldenhuys
- Department of Pathology, Dalhousie University and Capital District Health Authority, Halifax, Canada
| | - C. Blake Gilks
- Department of Pathology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Lisa Manning
- Diagnostic Services of Manitoba, Health Sciences Centre, Winnipeg, Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Bayardo Perez-Ordonez
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | | | - Robert Riddell
- Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Emina E. Torlakovic
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
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Sheffield BS, Garratt J, Kalloger SE, Li-Chang HH, Torlakovic EE, Gilks CB, Schaeffer DF. HER2/neu Testing in Gastric Cancer by Immunohistochemistry: Assessment of Interlaboratory Variation. Arch Pathol Lab Med 2014; 138:1495-502. [DOI: 10.5858/arpa.2013-0604-oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Baron JA, Erichsen R, Hamilton-Dutoit SJ, Snover DC, Torlakovic EE, Frøslev T, Pedersen L, Vyberg M, Hamilton SR, Sørensen HT. Abstract 2201: Long-term risk of colorectal cancer in patients with sessile serrated adenomas, traditional serrated adenomas, and hyperplastic polyps. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Evidence for the recently recognized serrated pathway to colorectal cancer (CRCa) is based largely on the similarity of genetic changes in CpG island methylator phenotype positive (CIMP+) cancers and serrated lesions such as the sessile serrated adenoma (SSA). There is limited evidence regarding the future cancer risks in patients diagnosed with these lesions.
Methods: We used Danish medical databases to select subjects for a population-based case-control study of CRCa within the population of 272,342 individuals who underwent colonoscopy during 1977 - 2009. 2,045 CRCa cases were diagnosed during 1977-2006. We used risk set sampling to select 8,105 controls matched by gender and year of birth to the cases. After accessing records of colorectal polyps identified in the subjects, we requested histopathological blocks for the first lesions diagnosed as hyperplastic polyps (HPs) at or after the first colonoscopy during the study period, and obtained them for 895 (97%) of the affected subjects. Four expert pathologists used current criteria to review these lesions and reclassify them as SSAs, traditional serrated adenomas (TSAs) or hyperplastic polyps (HPs). Lesions initially diagnosed as conventional adenomas (CADs) were not reviewed, nor were later polyps. We used conditional logistic regression to compute odds ratios (ORs) and 95% confidence limits (CIs) for CRCa associated with polyp types at the first examination recorded with HPs, using patients with no polyp history during the study period as the referent group and adjusting for age and year at first colonoscopy.
Results: After review, 48 (2.3%) cases and 81 (1.0%) controls had SSAs but no CADs or TSAs (OR for CRCa = 3.34, 95% CI: 2.31-4.83). TSAs conferred a similarly high CRCa risk (OR = 3.35, 95%CI: 1.39-8.07), but HPs did not (OR = 1.30, 95% CI: 0.96-1.77). The OR for CADs without SSA or TSA was 2.49 (95% CI: 2.23-2.79); subjects with both SSAs and CADs had an OR intermediate between those for CADs alone and SSAs alone. Women with SSAs and no CADs had a higher OR (4.92; 95% CI: 2.96-8.18) than men (OR = 2.18, 95% CI: 1.24-3.82). Proximal SSAs were associated with a particularly high OR (12.39, 95% CI: 4.87-31.51). Consideration of reported metachronous lesions changed most of these ORs only modestly.
Conclusions: We found that SSAs and TSAs are associated with a substantial increase in the risk of CRCa. These data provide further evidence for the serrated pathway to CRCa, with SSAs and TSAs as cancer precursors.
Citation Format: John A. Baron, Rune Erichsen, Stephen J. Hamilton-Dutoit, Dale C. Snover, Emina E. Torlakovic, Trine Frøslev, Lars Pedersen, Mogens Vyberg, Stanley R. Hamilton, Henrik T. Sørensen. Long-term risk of colorectal cancer in patients with sessile serrated adenomas, traditional serrated adenomas, and hyperplastic polyps. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2201. doi:10.1158/1538-7445.AM2014-2201
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Yohe SL, Chenault CB, Torlakovic EE, Asplund SL, McKenna RW. Langerhans cell histiocytosis in acute leukemias of ambiguous or myeloid lineage in adult patients: support for a possible clonal relationship. Mod Pathol 2014; 27:651-6. [PMID: 24186134 DOI: 10.1038/modpathol.2013.181] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 08/09/2013] [Accepted: 08/20/2013] [Indexed: 11/09/2022]
Abstract
Four patients presented with acute leukemia of ambiguous or myeloid lineage in association with Langerhans cell histiocytosis and provide evidence suggesting a common origin of the two neoplasms. One patient had a non-constitutional trisomy 21 in both the leukemic blasts and the Langerhans cells indicative of a clonal relationship. A second case expressed CD2, CD13, and CD117 on both the Langerhans cells and the blasts suggesting a possible clonal relationship. All four cases exhibited geographic intermingling of the Langerhans cell histiocytosis and acute leukemia and shared unique features including extramedullary leukemia involving lymph nodes in all cases with Langerhans cell histiocytosis only present in sites involved by acute leukemia. T-cell antigen expression was present in all cases with one meeting criteria for mixed phenotype acute leukemia, T/myeloid, not otherwise specified. These findings support the concept that coexistent Langerhans cell histiocytosis and acute leukemia is clonally related in some cases. Furthermore, these cases of acute myeloid or acute leukemia of ambiguous lineage with Langerhans cell histiocytosis share some unique features suggesting a common underlying neoplastic hematopoietic stem cell.
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Affiliation(s)
- Sophia L Yohe
- Special Hematology Laboratory, Division of Hematopathology, University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA
| | | | - Emina E Torlakovic
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Sheryl L Asplund
- Division of Hematopathology, Miraca Life Sciences, Phoenix, AZ, USA
| | - Robert W McKenna
- Special Hematology Laboratory, Division of Hematopathology, University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA
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Schwock J, Hyjek EM, Torlakovic EE, Geddie WR. Enteropathy-associated intestinal T-cell lymphoma in cavitating mesenteric lymph node syndrome: Fine-needle aspiration contributes to the diagnosis. Diagn Cytopathol 2014; 43:125-30. [DOI: 10.1002/dc.23144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/05/2014] [Accepted: 02/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Joerg Schwock
- Laboratory Medicine Program, University Health Network, Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
| | - Elizabeth M. Hyjek
- Laboratory Medicine Program, University Health Network, Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
| | - Emina E. Torlakovic
- Laboratory Medicine Program, University Health Network, Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
| | - William R. Geddie
- Laboratory Medicine Program, University Health Network, Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
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Abstract
There are two broad classes (or categories) of excised human tissue: diagnostic tissue (DT) and research tissue (RT). Classification of excised human tissue does not define its ultimate use and ultimate use of excised human tissue does not define its classification. While both DT and RT can be used for research, DT has specific requirements with respect to how it must be handled if and when being accessed for research. We highlight distinguishing features of DT: (1) it is a clinical record, (2) it must be identifiable to a specific individual, (3) it is stewarded by pathology departments/clinical laboratories and (4) it has a mandatory retention period. We discuss how the further sub-classification of DT into archived DT (aDT) and excess DT (eDT) impacts the nature of its role in research. We examine the concept of DT as a clinical record and emphasize the impact of mandatory retention as it applies to how DT may be accessed for research purposes. We explain the role of post-retention eDT as a source of RT as well as procedures for access to in-retention aDT for research. Clarity of such issues will facilitate responsible access to DT for research.
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Chen ZW, Neufeld H, Copete MA, Garratt J, Gilks CB, Torlakovic EE. Academic and nonacademic laboratories perform equally on CIQC immunohistochemistry proficiency testing. Am J Clin Pathol 2013; 140:55-60. [PMID: 23765534 DOI: 10.1309/ajcphbl59mwbvyrd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To test whether academic centers (ACs) are more successful than nonacademic centers (NACs) in immunohistochemistry (IHC) external quality assessment challenges in the Canadian Immunohistochemistry Quality Control (CIQC) program. METHODS Results of 9 CIQC challenges for breast cancer marker (BM) and various non-breast cancer marker (NBM) tests were examined. Success rates were compared between AC/NAC laboratories and those located in small or large cities. Performance was also correlated with annual IHC case volumes. RESULTS There was no statistically significant difference in performance in any of the comparisons. However, overall performance on BM was significantly better (P < .0001, t test) than on NBM tests regardless of AC/NAC nature or city size. The mean failure rate on NBM was approximately twice that of BM tests. CONCLUSION Our results suggest that recent emphasis on breast hormone IHC quality assurance has led to improved test quality.
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Affiliation(s)
- Zhongchuan Will Chen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Heather Neufeld
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Maria A. Copete
- Department of Oral Pathology, College of Dentistry, University of Saskatchewan, Saskatoon, Canada
| | - John Garratt
- Department of Pathology, Lions Gate Hospital, Vancouver, Canada
| | - C. Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Emina E. Torlakovic
- Department of Laboratory Hematology, University Health Network, University of Toronto, Toronto, Canada
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Downes MR, Torlakovic EE, Aldaoud N, Zlotta AR, Evans AJ, van der Kwast TH. Diagnostic utility of androgen receptor expression in discriminating poorly differentiated urothelial and prostate carcinoma. J Clin Pathol 2013; 66:779-86. [PMID: 23775437 DOI: 10.1136/jclinpath-2013-201586] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS Pathological separation of poorly differentiated urothelial and prostate carcinoma is difficult, but imperative because of the impact on patient management. Tumour morphology, in conjunction with a panel of immunohistochemistry (IHC), such as prostate-specific antigen (PSA), prostatic acid phosphatase (PSAP), CK7, CK20, p63 and high molecular weight keratins (HMWKs) are usually employed to resolve this issue. Androgen receptor (AR) expression is maintained in high-grade, undifferentiated prostate carcinoma, and thus, could be considered as a potentially useful adjunct to the conventional panel of markers. METHODS We performed an institutional review of all cases from 2006 to 2012 in which AR IHC had been performed to determine its diagnostic utility in discriminating between poorly differentiated urothelial and prostate carcinoma. Of the eligible cases (n=40), there were 9 high-grade urothelial carcinomas, 27 prostate carcinomas and 4 with both prostate and bladder tumours. All diagnoses were made by integrating the clinical, radiological, morphological and IHC results. RESULTS In all the prostate carcinomas, there was diffuse, intense nuclear staining for AR. The urothelial tumours were either negative, had cytoplasmic staining or showed occasionally weak nuclear staining. The difference was highly significant with p<0.0001 (Mann-Whitney U test). CONCLUSIONS We conclude that AR is an important marker as it is best able to distinguish between poorly differentiated urothelial and prostate carcinoma. AR appears superior to PSA and PSAP, which are not consistently expressed in high-grade prostate carcinoma. Also, high-grade urothelial carcinoma may be negative for CK20, p63/HMWK and occasionally CK7. We advocate the inclusion of AR in the panel of markers to differentiate these tumours.
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Affiliation(s)
- Michelle R Downes
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada.
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Torlakovic EE, Porwit A, Butany J. Bone marrow disorders: recent advances, Part II. Introduction. Semin Diagn Pathol 2012; 29:1. [PMID: 22372200 DOI: 10.1053/j.semdp.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Torlakovic EE, Hyjek E, Butany J. Bone marrow disorders: recent advances, part I. Introduction. Semin Diagn Pathol 2011; 28:257. [PMID: 22195403 DOI: 10.1053/j.semdp.2011.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Makretsov N, Gilks CB, Alaghehbandan R, Garratt J, Quenneville L, Mercer J, Palavdzic D, Torlakovic EE. Development of an evidence-based approach to external quality assurance for breast cancer hormone receptor immunohistochemistry: comparison of reference values. Arch Pathol Lab Med 2011; 135:874-81. [PMID: 21732777 DOI: 10.5858/2010-0380-oar1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT External quality assurance and proficiency testing programs for breast cancer predictive biomarkers are based largely on traditional ad hoc design; at present there is no universal consensus on definition of a standard reference value for samples used in external quality assurance programs. OBJECTIVE To explore reference values for estrogen receptor and progesterone receptor immunohistochemistry in order to develop an evidence-based analytic platform for external quality assurance. DESIGN There were 31 participating laboratories, 4 of which were previously designated as "expert" laboratories. Each participant tested a tissue microarray slide with 44 breast carcinomas for estrogen receptor and progesterone receptor and submitted it to the Canadian Immunohistochemistry Quality Control Program for analysis. Nuclear staining in 1% or more of the tumor cells was a positive score. Five methods for determining reference values were compared. RESULTS All reference values showed 100% agreement for estrogen receptor and progesterone receptor scores, when indeterminate results were excluded. Individual laboratory performance (agreement rates, test sensitivity, test specificity, positive predictive value, negative predictive value, and κ value) was very similar for all reference values. Identification of suboptimal performance by all methods was identical for 30 of 31 laboratories. Estrogen receptor assessment of 1 laboratory was discordant: agreement was less than 90% for 3 of 5 reference values and greater than 90% with the use of 2 other reference values. CONCLUSIONS Various reference values provide equivalent laboratory rating. In addition to descriptive feedback, our approach allows calculation of technical test sensitivity and specificity, positive and negative predictive values, agreement rates, and κ values to guide corrective actions.
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Affiliation(s)
- Nikita Makretsov
- Department of Pathology, Memorial University of Newfoundland, St John's, Canada
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Cheung CC, Neufeld H, Lining LA, Pilavdzic D, Copete M, Garratt J, Gilks B, Torlakovic EE. The laboratory score/reference method score ratio (LSRSR) is a novel tool for monitoring laboratory performance in immunohistochemistry proficiency testing of hormone receptors in breast cancer: the CIQC experience. Am J Clin Pathol 2011; 136:67-73. [PMID: 21685033 DOI: 10.1309/ajcpq6i9ghjmcbev] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Canadian Immunohistochemistry Quality Control (CIQC) operates an academic proficiency testing (PT) program using a traditional expert panel-based qualitative assessment system. The image analysis approach is increasingly considered for use in PT to follow demand for precision in immunohistochemical test calibration. CIQC introduces and explores the usefulness of a novel image analysis-based tool, the laboratory score/reference method score ratio (LSRSR) for PT. Two CIQC runs with 33 and 57 participants, respectively, were analyzed for interlaboratory concordance for estrogen receptor results using expert panel-based and LSRSR systems. Samples included tissue microarrays with 40 tissue cores each. The LSRSR was calculated from participants' and reference laboratory H scores measured by image analysis. We found lower concordance with reference method results for participating laboratories by LSRSR than those reported by the expert panel; although the expert panel observed those differences, it was not able to measure them without LSRSR. LSRSR may be useful in monitoring laboratory performance for quantitative immunohistochemical testing.
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Copete M, Garratt J, Gilks B, Pilavdzic D, Berendt R, Bigras G, Mitchell S, Lining LA, Cheung C, Torlakovic EE. Inappropriate calibration and optimisation of pan-keratin (pan-CK) and low molecular weight keratin (LMWCK) immunohistochemistry tests: Canadian Immunohistochemistry Quality Control (CIQC) experience. J Clin Pathol 2011; 64:220-5. [DOI: 10.1136/jcp.2010.085258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AimsPan-cytokeratin (pan-CK) and low molecular weight cytokeratin (LMWCK) tests are the most common immunohistochemistry (IHC) tests used to support evidence of epithelial differentiation. Canadian Immunohistochemistry Quality Control (CIQC), a new provider of proficiency testing for Canadian clinical IHC laboratories, has evaluated the performance of Canadian IHC laboratories in two proficiency testing challenges for both pan-CK and LMWCK.MethodsCIQC has designed a 70-sample tissue microarray (TMA) for challenge 1 and a 30-sample TMA for challenge 2. There were 13 participants in challenge 1, and 62 in challenge 2. All results were evaluated and scored by CIQC assessors and compared with reference laboratory results.ResultsParticipating laboratories often produced false-negative results that ranged from 20% to 80%. False-positive results were also detected. About half of participating clinical laboratories have inappropriately calibrated IHC tests for pan-CK and LMWCK, which are the most commonly used markers for demonstration of epithelial differentiation. The great majority of laboratories were not aware of the problem with calibration of pan-CK and LMWCK tests because of inappropriate selection of external positive controls and samples for optimisation of these tests. Benign liver and kidney are the most important tissues to include as positive controls for both pan-CK and LMWCK.ConclusionsParticipation in external quality assurance is important for peer comparison and proper calibration of IHC tests, which is also helpful for appropriate selection of positive control material and material for optimisation of the tests.
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Torlakovic EE, Naresh K, Kremer M, van der Walt J, Hyjek E, Porwit A. Call for a European programme in external quality assurance for bone marrow immunohistochemistry; report of a European Bone Marrow Working Group pilot study. J Clin Pathol 2009; 62:547-51. [DOI: 10.1136/jcp.2008.063446] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Torlakovic EE, Slipicevic A, Flørenes VA, Chibbar R, DeCoteau JF, Bilalovic N. Fli-1 expression in malignant melanoma. Histol Histopathol 2008; 23:1309-14. [PMID: 18785112 DOI: 10.14670/hh-23.1309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Friend leukemia integration site 1 (Fli-1) has been reported as the first nuclear marker of endothelial differentiation; it is expressed in leukocytes and recently demonstrated in melanomas. Formalin-fixed, paraffin-embedded tissue sections from 97 melanomas including 69 cases of primary and 28 metastatic melanomas were evaluated by immunohistochemistry. Five melanoma cell lines were evaluated by Western blot and immunocytochemistry. Fli-1 expression was observed in all cell lines. Fli-1 expression was higher in metastatic than in primary tumors (r=0.208, p=0.041, Spearman correlation), it positively correlated with Ki-67 expression (r=0.233, p=0.022, Spearman correlation), and the presence of an ulcer in the primary tumor (r=0.267, p=0.030, Spearman correlation). Therefore, the expression of Fli-1 in malignant melanoma appears to be associated with biologically more aggressive tumors.
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Affiliation(s)
- Emina E Torlakovic
- Department of Pathology, Royal University Hospital, Saskatoon, SK, Canada.
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Torlakovic EE. Authors' reply. J Pathol 2006. [DOI: 10.1002/path.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Very few prognostic factors are known in follicular lymphoma (FL), a common malignancy of germinal centre (GC) B-cells. The Follicular Lymphoma International Prognostic Index (FLIPI) thus far appears to be the most important predictor of clinical outcome. This study explores the predictive power of the degree of GC differentiation for outcome in FL. Samples from 73 patients with FL were evaluated by immunohistochemistry for expression of GC markers. Strong PU.1, CD20, and CD75 expression were significantly associated with longer progression-free survival (PFS) and overall survival (OS). Results for PFS were independent of the International Prognostic Index or the Italian Lymphoma Intergroup prognostic index for CD75 and PU.1, but only PU.1 expression was independent of FLIPI for PFS and OS. Oct-2 was weakly expressed overall, but more strongly in higher grades of FL; it had a trend for negative linear association with PU.1 and strong positive linear association with CD27, which possibly reflects its role in terminal B-cell differentiation. We show that the level of GC differentiation, as determined by the levels of PU.1, CD75, CD20, Bcl-6, and CD10 expression, has an association with outcome in patients with FL. While this is determined qualitatively in most studies of diffuse large B-cell lymphoma, in FL there is a quantitative positive association between a high level of expression of GC antigens and longer OS and PFS even when data are stratified by the FLIPI score.
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Affiliation(s)
- E E Torlakovic
- Department of Pathology, Royal University Hospital Saskatoon, Canada.
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Torlakovic EE, Aamot HV, Heim S. A marginal zone phenotype in follicular lymphoma with t(14;18) is associated with secondary cytogenetic aberrations typical of marginal zone lymphoma. J Pathol 2006; 209:258-64. [PMID: 16583359 DOI: 10.1002/path.1981] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Marginal zone differentiation of follicular lymphomas (FL), sometimes referred to as monocytoid B-cell differentiation, is a relatively uncommon phenomenon. Recently, this type of differentiation was also linked to secondary cytogenetic aberrations of chromosome 3 in a small number of patients. We have analysed 131 primary nodal FL with t(14;18)(q32;q21) for secondary cytogenetic aberrations previously described as recurrent in marginal zone lymphomas (MZL) to identify their frequency and possible association with morphological evidence of marginal zone differentiation. We searched for trisomy of chromosomes 3, 12, and 18, gains of chromosome arm 3q, deletions of chromosome arm 7p, structural anomalies with break-points in 1q21 and 1p34, as well as the t(1;2)(p22;p12), t(1;14)(p22;q32), t(3;14)(q27;q32), t(6;14)(p21;q32), and t(11;18)(q21;q21) translocations. At least focal morphological evidence of marginal zone differentiation occurred in 35/131 (27%) FL with t(14;18)(q32;q21) as the primary chromosomal abnormality. None of the recurrent balanced translocations characteristic of extranodal MZL were seen secondarily in the nodal FLs with t(14;18)(q32;q21). However, 43/131 (33%) cases had at least one of the above secondary cytogenetic aberrations previously reported as recurrent aberrations in MZL and, when combined, these were significantly more frequent in FL with morphological evidence of marginal zone differentiation (p<0.0001, two-sided Fisher's exact test). Aberrations of chromosome 3 and, in particular, trisomy 3 occurred frequently in FL with marginal zone differentiation (p=0.002 and p<0.0001, respectively, two-sided Fisher's exact test), while chromosome 21, 22, and X chromosome aberrations, which have not been described previously as recurrent in MZL, were also significantly associated with marginal zone differentiation in FL (p=0.002, p=0.037, p=0.039, respectively, two-sided Fisher's exact test).
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MESH Headings
- Cell Differentiation/genetics
- Chromosome Aberrations
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 7/genetics
- Cytogenetic Analysis/methods
- Humans
- Immunophenotyping/methods
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Phenotype
- Translocation, Genetic/genetics
- Trisomy/genetics
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Affiliation(s)
- E E Torlakovic
- Department of Pathology, College of Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada.
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Torlakovic EE, Bilalovic N, Nesland JM, Torlakovic G, Flørenes VA. Ets-1 transcription factor is widely expressed in benign and malignant melanocytes and its expression has no significant association with prognosis. Mod Pathol 2004; 17:1400-6. [PMID: 15205685 DOI: 10.1038/modpathol.3800206] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ets-1 transcription factor has been associated with tumor progression in various carcinomas, but its expression in malignant melanoma was only recently described. The study was conducted in two steps: exploratory and confirmatory. In the first step, we studied 69 primary melanomas, 28 metastatic melanomas, 10 usual intradermal nevi and 13 various melanocytic skin lesions. In the second step, an additional group of 98 patients with follow-up of up to 200 months was also evaluated. Immunohistochemical analysis of formalin-fixed/paraffin-embedded tissues was performed using 1G11 antibody and polymer conjugate for visualization. While Ets-1 was variably expressed in 83% primary melanomas in exploratory and 69% in the confirmatory group, the expression of Ets-1 was also found in normal benign melanocytes and all nevi. Analysis of the exploratory group revealed lower expression of Ets-1 in primary melanomas than in common nevi (P=0.048, Mann-Whitney U-test) and metastatic melanomas expressed significantly less Ets-1 than primary melanomas (P=0.015, Mann-Whitney U-test). There was a negative correlation between Ets-1 expression and the largest dimension of the primary tumors (r=0.23, P=0.034, Spearman's correlation rank test), but no correlation with the depth of tumor invasion (Breslow thickness) or the presence of ulceration was found. Analyses of the confirmatory group revealed no association between Ets-1 expression with disease-specific survival or time to treatment failure. However, a statistical trend was found for worse outcome for those primary melanomas that had strong expression (H-score >100) of Ets-1 (P=0.054). Ets-1 is expressed in benign melanocytes probably due to their neural crest origin. We conclude that Ets-1 expression cannot be used to differentiate between benign and malignant melanocytic lesions and it has no definite association with clinical outcome. At the same time, its role in tumor progression in some cases of malignant melanoma cannot be entirely excluded.
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Affiliation(s)
- Emina E Torlakovic
- Department of Pathology, The Norwegian Radium Hospital University of Oslo, Oslo, Norway.
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Bilalovic N, Sandstad B, Golouh R, Nesland JM, Selak I, Torlakovic EE. CD10 protein expression in tumor and stromal cells of malignant melanoma is associated with tumor progression. Mod Pathol 2004; 17:1251-8. [PMID: 15205682 DOI: 10.1038/modpathol.3800174] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CD10 antigen is a 100-kDa-cell surface zinc metalloendopeptidase expressed in a variety of normal and neoplastic lymphoid and nonlymphoid tissues including melanomas. It was recently shown that metastatic melanomas express more CD10 than primary tumors. We evaluated CD10 expression in tumor and stromal cells in 70 biopsies with primary and 28 with metastatic malignant melanomas. Ki-67, Bcl-2, and Bax were also examined to investigate whether CD10 expression is associated with tumor proliferation index or factors of apoptosis. Formalin-fixed/paraffin-embedded tissues were studied by immunohistochemistry. More advanced primary tumors had higher CD10 expression in the tumor cells (r = 0.27, P = 0.03 for Clark levels and r = 0.29, P = 0.02 for Breslow) and higher Ki-67 proliferation fraction (r = 0.32, P = 0.007 for Clark levels and r = 0.32, P = 0.001 for Breslow). Similarly, CD10 expression in the intratumoral stromal cells was also higher in primary tumors with higher Clark level (P = 0.04, linear-by-linear association) and tumor thickness according to Breslow (r = 0.33, P = 0.01). The presence of CD10+ peritumoral stromal cell cuffs was also positively associated with tumor thickness according to Breslow (r = 0.27, P = 0.05). Also, expression of CD10 and Ki-67 were significantly higher in metastatic than in primary tumors (P = 0.01 and 0.02 respectively), but Bcl-2 expression was higher in primary melanomas (P = 0.02). We conclude that CD10 expression in malignant melanoma is associated with tumor progression.
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Affiliation(s)
- Nurija Bilalovic
- Department of Pathology, University Hospital Sarajevo, Bosnia and Herzegovina
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