Hariri Nosaibah, Hasteh Farnaz, Walavalkar Vighnesh, Roma Andres A, Fadare Oluwole
Department of Pathology, University of California San Diego, San Diego, CA.
Appl Immunohistochem Mol Morphol. 2019 Jan;27(1):1-7. doi: 10.1097/PAI.0000000000000525.
At some tertiary breast care centers, where many patients are referred from other institutions, it is routine to repeat testing for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2/neu) in excision specimens if these tests were performed on the preceding biopsy at the referring facility. The goal of this study is to assess the value of this practice. We documented results from ER, PR, and HER2 testing in 541 consecutive invasive breast cancers excised over a 2.5-year period and analyzed the subset (n=153) for which testing was performed on the excision specimen solely due to the fact that testing on the preceding biopsy was performed at an outside institution. The rates and directions of biopsy-to-excision change were as follows: ER [1.3% (2/153), 100% from (+) to (-)]; PR [4% (6/153), 83% from (+) to (-)]; HER2/neu assessed by immunohistochemistry [21% (29/137)]; HER2/neu assessed by fluorescence in situ hybridization [3.3% (2/61); 50% from amplified to nonamplified and 50% vice versa]. There were no ER(-) and PR(-) biopsy cases that became ER and/or PR(+) in the excision. By coordinate analysis for the hormone receptors [ie, ER and/or PR(+) being indicative of "hormone receptor" (HR) positivity], there were no cases that changed from HR(+) in the biopsy to HR(-) in the excision (or vice versa), which suggests that repeat testing for ER and PR in this setting is of limited value. In an analysis that incorporated both immunohistochemistry and in situ fluorescence hybridization results, there were 2 cases with a clinically significant biopsy-to-excision change in HER2/neu status in which that change was detected primarily because the excision was retested. These findings provide baseline data for formulating policies on whether repeat testing should routinely be performed in the described scenario.
在一些三级乳腺护理中心，许多患者是从其他机构转诊而来的。如果在转诊机构之前的活检中已对雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2/neu）进行了检测，那么在切除标本中重复检测这些指标已成为常规操作。本研究的目的是评估这种做法的价值。我们记录了在2.5年期间连续切除的541例浸润性乳腺癌中ER、PR和HER2检测的结果，并分析了其中仅因之前的活检是在外部机构进行而在切除标本上进行检测的子集（n = 153）。活检到切除的变化率和变化方向如下：ER [1.3%（2/153），100%从（+）变为（-）]；PR [4%（6/153），83%从（+）变为（-）]；通过免疫组织化学评估的HER2/neu [21%（29/137）]；通过荧光原位杂交评估的HER2/neu [3.3%（2/61）；50%从扩增变为非扩增，50%反之亦然]。活检时ER（-）和PR（-）的病例在切除时没有变为ER和/或PR（+）。通过对激素受体进行坐标分析[即ER和/或PR（+）表示“激素受体”（HR）阳性]，没有病例从活检时的HR（+）变为切除时的HR（-）（反之亦然），这表明在这种情况下重复检测ER和PR的价值有限。在一项结合了免疫组织化学和原位荧光杂交结果的分析中，有2例HER2/neu状态在活检到切除时有临床显著变化的病例，这种变化主要是因为对切除标本进行了重新检测才被发现。这些发现为制定在所描述的情况下是否应常规进行重复检测的政策提供了基线数据。
