激素受体和 HER2 在乳腺癌骨转移中的评估：细针抽吸细胞块与脱钙芯针活检的比较。

Hormone receptor and HER2 assessment in breast carcinoma metastatic to bone: A comparison between FNA cell blocks and decalcified core needle biopsies.

机构信息

Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.

Department of Biomedicine, University of Basel, Basel, Switzerland.

出版信息

Cancer Cytopathol. 2020 Feb;128(2):133-145. doi: 10.1002/cncy.22226. Epub 2019 Dec 28.

DOI:10.1002/cncy.22226

PMID:31883437

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7027380/

Abstract

BACKGROUND

Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) guide the clinical management of breast cancer metastases. Decalcification of bone core needle biopsies (CNBs) can affect IHC. In the current study, the authors sought to define whether fine-needle aspiration (FNA) would be a better alternative to CNB for reliable IHC.

METHODS

Patients with breast cancer metastases to bone that were sampled by both CNB and FNA were selected. ER, PR, and HER2 were performed in FNA cell blocks (FNA-CBs) and concurrent decalcified CNBs. Discrepancies were classified as minor when there was a difference of up to 30% nuclear staining in IHC for ER and PR between paired samples and as major when a clinically relevant change was observed (ie, positive vs negative). Quantitative reverse transcriptase-polymerase chain reaction of ESR1 messenger RNA levels was performed on FNA/CNB pairs with discrepancies for ER IHC. IHC status of the primary breast carcinoma was recorded.

RESULTS

Concordance rates for ER, PR, and HER2 were 89%, 67%, and 93%, respectively, between FNA-CB and CNB pairs from 27 patients. Major discrepancies were noted in approximately 11% of FNA/CNB pairs for ER IHC and in 33% of FNA/CNB pairs for PR. ESR1 messenger RNA levels of FNA/CNB matched samples were similar and did not explain the differences in ER IHC expression in the majority of cases. Two of 27 FNA/CNB pairs had different results for HER2 IHC that changed from negative on CNB to equivocal (2+) on FNA-CB. Both cases had prior HER2 amplification by fluorescence in situ hybridization.

CONCLUSIONS

FNA-CB and CNB appear to constitute acceptable methods for the assessment of ER, PR, and HER2 for clinical decision making.

摘要

背景

雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体 2（HER2）免疫组织化学（IHC）指导乳腺癌转移的临床管理。骨芯针活检（CNB）的脱钙会影响 IHC。在本研究中，作者试图确定细针抽吸（FNA）是否是 CNB 的更好替代方法，以获得可靠的 IHC。

方法

选择同时接受 CNB 和 FNA 取样的乳腺癌骨转移患者。在 FNA 细胞块（FNA-CB）和同时进行脱钙的 CNB 中进行 ER、PR 和 HER2 检测。当配对样本中 ER 和 PR 的 IHC 核染色差异不超过 30%时，将差异归类为次要差异，当观察到临床相关变化（即阳性与阴性）时，将差异归类为主要差异。对 ER IHC 存在差异的 FNA/CNB 对进行 ESR1 信使 RNA 水平的定量逆转录-聚合酶链反应。记录原发性乳腺癌的 IHC 状态。

结果

27 例患者的 FNA-CB 与 CNB 配对的 ER、PR 和 HER2 一致性率分别为 89%、67%和 93%。FNA/CNB 配对的 ER IHC 中约有 11%存在主要差异，PR 中约有 33%存在主要差异。FNA/CNB 匹配样本的 ESR1 信使 RNA 水平相似，不能解释大多数 ER IHC 表达差异的原因。27 例 FNA/CNB 对中有 2 对 HER2 IHC 结果不同，从 CNB 上的阴性变为 FNA-CB 上的不确定（2+）。这两种情况均通过荧光原位杂交检测到先前存在 HER2 扩增。