Haines G Kenneth, Wiley Elizabeth, Susnik Barbara, Apple Sophia K, Frkovic-Grazio Snjezana, Reyes Carolina, Goldstein Lynn C, Dadmanesh Farnaz, Gown Allen M, Nadji Mehrdad, Bracko Matej, Tavassoli Fattaneh A
Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA.
Breast Cancer Res Treat. 2008 Dec;112(3):551-6. doi: 10.1007/s10549-008-9893-8. Epub 2008 Jan 18.
In addition to providing a timely and accurate diagnosis, pathologists routinely provide prognostic and predictive information to assist in the treatment of patients with invasive breast cancer. As our understanding of breast cancer at the molecular and genetic level improves, sophisticated new treatment options have become available to patients. The demonstrated improvements in disease-free and overall survival with the use of trastuzumab (Herceptin) has made HER2 testing a standard of care in the evaluation of patients with breast cancer. Specialized breast centers have accumulated sufficient experience to recognize that HER2 positive tumors tend to be of higher grade and to be estrogen receptor negative, whereas well-differentiated breast cancers rarely are HER2 positive.
To determine whether HER2 testing is necessary in well-differentiated breast cancer, we analyzed the frequency of HER2 positivity among 1,162 cases from 7 major breast centers or commercial laboratories in the United States and Europe.
Well-differentiated breast cancers, defined by either nuclear grading or the Scarff-Bloom-Richardson system, rarely are HER2 positive (mean 1.6%, range 0-2.8%).
Given the low rate of well differentiated HER2 positive tumors, falling within the range reported for false negative IHC tests for HER2, and the absence of published data demonstrating a beneficial effect of trastuzumab therapy in this subset of patients, HER2 testing should not be considered a standard of care for all patients with well-differentiated breast cancer.
除了提供及时准确的诊断外，病理学家通常还会提供预后和预测信息，以协助浸润性乳腺癌患者的治疗。随着我们对乳腺癌在分子和基因水平上的认识不断提高，患者有了更先进的新治疗选择。使用曲妥珠单抗（赫赛汀）已证明能改善无病生存期和总生存期，这使得HER2检测成为评估乳腺癌患者的一项标准治疗手段。专业的乳腺中心积累了足够的经验，认识到HER2阳性肿瘤往往分级较高且雌激素受体阴性，而高分化乳腺癌很少为HER2阳性。
为了确定高分化乳腺癌是否有必要进行HER2检测，我们分析了来自美国和欧洲7个主要乳腺中心或商业实验室的1162例病例中HER2阳性的频率。
通过核分级或斯卡夫-布卢姆-理查森系统定义的高分化乳腺癌很少为HER2阳性（平均1.6%，范围0 - 2.8%）。
鉴于高分化HER2阳性肿瘤的发生率较低，处于报道的HER2免疫组化假阴性检测范围内，且缺乏已发表的数据证明曲妥珠单抗治疗对该亚组患者有有益效果，HER2检测不应被视为所有高分化乳腺癌患者的标准治疗手段。
