El-Sibai Mohammad F, Cohen Cynthia, Nassar Aziza, Bryant Sandra C, Siddiqui Momin T
Int J Physiol Pathophysiol Pharmacol. 2009 Feb 15;1(1):57-63.
High levels of HER2 expression identify those patients who might benefit from treatments that target HER2. Among women with metastatic breast cancer, the predictive markers may be different from the primary tumor. We compared predictive markers: Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2 of primary breast carcinomas with those of lymph node (LN) and blood spread metastases (BM). ER, PR and HER2 status were compared between the primary breast tumor and the LN metastasis and blood spread metastasis. ER, PR and HER2 were performed on primary tumor core biopsies and available FNA cell blocks and on metastatic lesions using FDA approved antibodies and HercepTest (Dako). ER and PR were positive when >/=10%. Her2 was positive (amplified/expressed) when 3+ >30% by immunostain or >2.2 by FISH. Sixty four metastatic breast cancer patients were included in this analysis. Forty-eight patients had LN metastases (35 [73 %] diagnosed by FNA) and twenty seven patients had BM (16 [60 %] diagnosed by FNA). P value was determined comparing primary breast with BM and LN for ER, PR and HER2. ER p values when compared for primary breast with BM and LN were 0.45 and 0.57 respectively, and for PR were 0.31 and 0.06 and for HER2 were 0.45 and 0.07. All three predictive markers are similar in the primary and two metastatic sites (lymph node, bloodspread). Only in primary versus lymph node metastases is there a tendency for PR and HER2 (P values 0.06, 0.07) to be different. For HER2, the majority of lymph node metastases are in cell blocks (FNA), fixed in ethanol rather than formalin, which may have caused false positive HER2 expression.
高水平的HER2表达可识别出那些可能从针对HER2的治疗中获益的患者。在转移性乳腺癌女性患者中，预测标志物可能与原发性肿瘤不同。我们比较了原发性乳腺癌与淋巴结（LN）及血行转移灶（BM）的预测标志物：雌激素受体（ER）、孕激素受体（PR）和HER2。比较了原发性乳腺肿瘤与LN转移灶及血行转移灶之间的ER、PR和HER2状态。使用FDA批准的抗体和HercepTest（达科公司）对原发性肿瘤核心活检组织、可用的细针穿刺（FNA）细胞块以及转移病灶进行ER、PR和HER2检测。当ER和PR≥10%时为阳性。通过免疫染色Her2为3+且＞30%或通过荧光原位杂交（FISH）检测＞2.2时为阳性（扩增/表达）。本分析纳入了64例转移性乳腺癌患者。48例患者有LN转移（35例[73%]通过FNA诊断），27例患者有BM转移（16例[60%]通过FNA诊断）。通过比较原发性乳腺与BM及LN的ER、PR和HER2来确定P值。原发性乳腺与BM及LN比较时，ER的P值分别为0.45和0.57，PR的P值分别为0.31和0.06，HER2的P值分别为0.45和0.07。所有这三种预测标志物在原发性肿瘤及两个转移部位（淋巴结、血行转移）中相似。仅在原发性肿瘤与LN转移灶之间，PR和HER2有不同的趋势（P值分别为0.06、0.07）。对于HER2，大多数LN转移灶存在于细胞块（FNA）中，固定于乙醇而非福尔马林中，这可能导致HER2表达出现假阳性。
