Department of Pathology, Singapore General Hospital, Singapore.
J Clin Pathol. 2013 Jun;66(6):478-84. doi: 10.1136/jclinpath-2012-201148. Epub 2013 Mar 22.
Hormone receptor expression is a critical part of the pathological evaluation of breast cancer. Underpinning not only therapeutic decisions and prognosis, oestrogen receptor (ER) and progesterone receptor (PR) have been a consistent thread in the expanding knowledge of breast cancer. Accurate laboratory testing requires care and precision in preanalytical, analytical and postanalytical processes. In this report, postanalytical issues of pathologist interpretation of ER and PR status in breast cancer are discussed. Apart from key elements of the actual pathological assessment, it is important to realise that there are additional factors that can impact on sensitivity, specificity and dynamic range of hormone receptor expression as rendered on pathology. These include tumour characteristics and heterogeneity, biological changes of tumour progression and interacting molecules, all of which can influence the degree of hormone responsiveness in a particular individual with hormone receptor-positive breast cancer. There is a need to ensure participation in quality assurance programmes and slide exchanges, as well as to constantly keep abreast of emerging data on clinical trials and outcomes of hormone receptor-positive breast cancer.
激素受体表达是乳腺癌病理评估的关键部分。雌激素受体 (ER) 和孕激素受体 (PR) 不仅为治疗决策和预后提供了依据，也是乳腺癌不断扩展的知识体系中的一个重要线索。准确的实验室检测需要在分析前、分析中和分析后过程中精心操作和精准控制。在本报告中，我们讨论了病理学家在乳腺癌中解读 ER 和 PR 状态的分析后问题。除了实际病理评估的关键要素外，还需要认识到，还有其他因素会影响激素受体表达的敏感性、特异性和动态范围，而这些因素是通过病理学呈现的。这些因素包括肿瘤特征和异质性、肿瘤进展的生物学变化以及相互作用的分子，所有这些因素都会影响特定激素受体阳性乳腺癌患者的激素反应程度。有必要确保参与质量保证计划和幻灯片交换，并不断了解激素受体阳性乳腺癌的临床试验和结果的最新数据。
