Immunohistochemical Study on Hormone Receptors and HER2 Status in Invasive Breast Carcinoma and its Therapeutic Implications (original) (raw)
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European Journal of Breast Health
Invasive breast carcinomas of no special type (IC-NST) are a group of tumours with heterogeneous clinical and biologic characteristics. To date, various biological and clinical parameters have been intensively investigated in the determination of prognosis and treatment planning. Some of these parameters are pathological stage, degree of histological differentiation, levels of estrogen receptor (ER), progesterone receptor (PR), and HER-2/neu (c-erbB2) which is a member of epidermal growth factor receptor family. HER-2/neu overexpression/ amplification is associated with unfavorable histopathological parameters and poor prognosis. Hormone receptors and HER-2/neu are investigated by immunohistocemical (IHC) methods. HER-2/neu analysis in breast carcinomas provides prognostic data. Besides, this analysis allows evaluation of indication for treatment with trastuzumab which is a monoclonal antibody developed against HER-2/neu receptor (1, 2). HER-2/neu status is evaluated by using IHC and fluorescence in situ hybridization (FISH) methods (1, 2). These methods are nowadays routinely used in many centers. In the literature, we noticed that there was the limited number of case series that HER-2/neu and hormone receptor (HR) expressions were evaluated in combination and have comparatively analyzed both in the primary tumour and metastatic axillary lymph node tissues. Our aim in this study were determined; a) to analyze the concordance between IHC and FISH results for HER-2/neu; b) to
Ibnosina Journal of Medicine and Biomedical Sciences, 2016
Background: Breast cancer has a tremendous heterogeneity in its clinical behavior. The objective of this study is to assess the positive expression of estrogen receptors (ER), progesterone receptors (PR) and HER2 overexpression in relationship to the age of patients, and certain prognostic parameters such as tumor grade, size and lymph node involvement. Patients and methods: A cross sectional case study was conducted between June 2011 and June 2014 at the pathology department of Rizgary General Hospital, Erbil, Iraq. 114 Confirmed cases of breast cancer were studied. Immunohistochemistry was used to evaluate the expression of ER, PR and HER2 status. Patients'f mean age was 48±5 (Range: 28-83) years; 57% of them were ≥50 years. Results: The expression of ER and PR was 58.8% and 49.1% respectively. HER2 overexpression (score +3) was 29.8%. Hormone receptors (ER and PR) correlated significantly with age and grade of the tumor whereas HER2 overexpression correlated significantly wit...
Cancer Cytopathology, 2012
BACKGROUND: Fine-needle aspiration cytology (FNAC) is a well-accepted procedure for the diagnosis and biological characterization of breast carcinoma. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status have a strong prognostic and predictive value in invasive breast carcinoma (IBC). Thin-Prep (TP) cytology, which uses an alcohol-based fixative, is increasingly being used for immunocytochemistry. In this study, the authors compared the immunocytochemical evaluation of hormone receptors (HR) and HER2 on TP-processed FNAC with the immunohistochemical analysis performed on the corresponding formalin-fixed paraffin-embedded (FFPE) breast tumor specimens, which are considered the gold standard. METHODS: FNACs were performed on 116 primary IBCs at the time of diagnosis and subjected to immunocytochemical evaluation of HR and HER2 using the TP method. The same markers were immunohistochemical evaluated on the corresponding FFPE tissue specimens. HER2 fluorescent in situ hybridization analysis was performed only on the equivocal immunohistochemical results. RESULTS: The HR results of the TP cytology specimens showed a very good agreement with those of the corresponding FFPE tissue samples (Cohen kappa test ¼ 0.92; concordance rate ¼ 98%) for estrogen receptor, and a good agreement (kappa ¼ 0.76; concordance rate ¼ 90.9%) for progesterone receptor. A perfect agreement (kappa ¼ 1) was observed between TP and FFPE tissue samples in evaluating HER2 status. CONCLUSIONS: Alcohol-based fixation seems not to affect the immunocytochemical evaluation of HR and HER2. Considering the high levels of agreement between the evaluation of HR and HER2, on both cytology specimens and on the corresponding FFPE tissue samples, the authors concluded that the TP technique can be routinely used for the biological characterization of IBC. Cancer (Cancer Cytopathol) 2012;120:196-205. V C 2012 American Cancer Society. KEY WORDS: breast carcinoma, hormone receptors, HER2, cytology, ThinPrep.
International Journal of Clinical and Diagnostic Pathology, 2021
Background: Prognosis of breast cancer and success of therapeutic interventions largely rely on clinico-pathologic and biological characteristics of tumor and vary due to the heterogenous nature of breast cancers. This study was intended to find correlation between the expression of Estrogen receptor (ER), Progesterone receptor (PR) and Human Epidermal Growth Factor Receptor-2 (HER-2/neu) with histological grade in case of carcinoma of breast. Material and Method: This study was conducted on 56 histologically confirmed specimens of breast carcinoma in Department of Pathology, Surat Municipal Institute of Medical Education and Research. Results: Maximum number of cases of breast carcinoma were found in 41-50 years aged females. Invasive ductal carcinoma-not otherwise specified (IDC-NOS) (82.14%) was most common histological type. Most of the carcinoma showed grade II (62.5%). ER, PR and HER-2/neu positivity was 50%, 42.86% and 42.86% respectively. Conclusion: Evaluation of ER, PR and HER-2/neu status and tumor grade should be incorporated routinely as a part of histopathological reports in all cases of breast carcinoma as they not only help in histopathologic assessment of prognosis, but also help in deciding the management thereby improving overall survival.
Evaluation of Immunohistochemistry (Ihc) Marker HER2 in Breast Cancer
ICTACT Journal on Image and Video Processing, 2016
The paper discusses a novel approach involving algorithm implementation and hardware Devkit processing for estimating the extent of cancer in a breast tissue sample. The process aims at providing a reliable, repeatable, and fast method that could replace the traditional method of manual examination and estimation. Immunohistochemistry (IHC) and Fluorescence in situ Hybridization (FISH) are the two main methods used to detect the marker status in clinical practice. FISH is though more reliable than IHC, but IHC is widely used as it is cheaper, convenient to operate and conserve, the morphology is clear. The IHC markers are Estrogen receptor (ER, Progesterone receptor (PR), Human Epidermal Growth Factor (HER2) that give clear indications of the presence of cancer cells in the tissue sample. HER2 remains the most reliable marker for the detection of breast cancer. The Human Epidermal Growth Factor Receptor (HER2) markers are discussed in the paper, as it gives clear indications of the presence of cancer cells in the tissue sample. HER2 is identified based on the color and intensity of the cell membrane staining. The color and intensity is obviously based on the thresholding for classifying the cancerous cells into severity levels in terms of score to estimate the extent of spread of cancer in breast tissue. For HER2 evaluation, the percentage of staining is calculated in terms of ratio of stain pixel count to the total pixel count. The evaluation of HER2 is obtained through simulation software (MATLAB) using intensity based algorithm and same is run on embedded processor evaluation board Devkit 8500. The results are validated with doctors.
Archives of Medical Science, 2013
I In nt tr ro od du uc ct ti io on n: : Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression are crucial in the biology of breast carcinoma. HER-2/neu gene is amplified and overexpressed in 15-30% of invasive breast cancers. HER-2-positive breast cancers have worse prognosis than HER-2 negative tumors and possess distinctive clinical features. The aim of this study was to assess the expression of HER2 in cancer tissue of patients with invasive breast cancer in correlation with tumor type, histological grade, tumor size, lymph node status, and expression of estrogen receptor and progesterone receptor. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Formalin-fixed, paraffin-embedded tissues from 40 patients with invasive HER-2-positive breast cancer and from 191 patients with HER-2-negative breast cancer were used in this study. HER2 expression was determined using the test HerceptTest TM DAKO. R Re es su ul lt ts s: : Among 231 cases of breast cancer, 18 invasive lobular carcinomas and 213 invasive ductal carcinomas were diagnosed. Sixty percent of HER-2positive breast cancers were ER-positive compared with 77% in the HER-2negative group (p = 0.002). The expression of PR was observed in 43% of HER-2-positive breast cancers and in 72% of HER2-negative tumors (p = 0.003). Excessive expression of HER2 protein was detected in 60% of patients positive for estrogen receptors, which may worsen prognosis in these patients. C Co on nc cl lu us si io on ns s: : Determination of HER2 overexpression in breast cancer patients, allows for a determination of a group of patients with a worse prognosis. K Ke ey y w wo or rd ds s: : invasive ductal carcinoma, invasive lobular carcinoma, human epidermal growth factor receptor 2, estrogen receptor, progesterone receptor. C Co or rr re es sp po on nd di in ng g a au ut th ho or r: :
Turkish Journal of Pathology, 2016
iNTRoDuCTioN estrogen (eR) and progesterone receptors (PR) are considered to be predictive markers for the patient response to hormonal therapy in breast cancer (1). In addition to its prognostic value, human epidermal growth factor receptor (heR2) is an important predictive marker to predict the patient's response to Trastuzumab in mammary carcinomas. Trastuzumab is a humanized monoclonal antibody used, in combination with other drugs, in the treatment of heR2 positive breast carcinomas (2, 3). The american Society of Clinical Oncology (aSCO) and the College of american Pathologists (CaP) outlined guidelines for testing of heR2, eR and PR with continuous review and updates (1, 4, 5). Currently these guidelines require heR2 testing on metastatic and recurrent breast carcinomas (6, 7). It has been published that approximately 20% of breast cancers are heR2 positive for gene amplification or show protein overexpression by immunohistochemistry (IhC) (8, 9). Therefore, determination of heR2 status is critical for patient care and for prediction of response to Trastuzumab. IhC and Fluorescence in situ hybridization (FISh) are the most commonly used methods for testing the heR2 status (5). FISh analysis may be considered by some superior to that of IhC in predicting response to trastuzumab in patients with mammary carcinoma. This may be related to the strict criteria used as cut off in FISh analysis compared to the subjective analysis with personal variations in evaluating IhC results (10). however, others have reported that IhC is as effective as FISh in predicting the response to treatment (11). The concordance has been found to be high among IhC and FISh in negative (0 and 1+) and positive (3+) cases. Steroid hormone receptors (eR and PR) are prognostic markers that determine to great extent the response to adjuvant hormonal therapy. It is the standard of care to test eR and PR in all cases of invasive breast carcinomas and to test eR in ductal carcinoma in situ (DCIS) (5, 12).
Evaluation of Hormone Receptors Status in Breast Carcinoma
Journal of Shaheed Suhrawardy Medical College, 2019
Background & objective: The importance of establishing hormone receptor status of tumors for the treatment of women with hormone receptor-positive breast cancer is often emphasized. It is critical to evaluate hormone receptor status when considering response to endocrine therapy. The present study was intended to evaluate the usefulness of hormone receptor status in breast carcinoma. Materials & Methods: The present study was conducted in the Department of Pathology, Dhaka Medical College, Dhaka over a period 12 months from July 2009 to June 2010. A total of 30 histopathologically diagnosed cases of breast tumors who were also subjected to immunohistochemical (IHC) test for ER, PR status and HER-2/neu were consecutively included in the study. Patients who have already been treated for malignancy or who had a history of receiving radiotherapy were excluded. Result: Age distributions shows that 40% of the patients were early middle-aged (30-40 years), 30% middle-aged and the rest were either < 30 years or >50 years old. Left breast was involved more often (56.7%) than the right breast (43.3%). The predominant location was upper outer quadrant (43.3%), followed by upper inner quadrant (20%), lower outer quadrant (20%), lower inner quadrant (10%) and central (6.7%). Over half (53.3%) of the tumors were < 5 cm and the rest 5 cm or more. Nearly half (46.7%) of the tumors were moderately differentiated, 36.6% well-differentiated and 16.7% poorly differentiated. In majority (83.3%) of the cases lymph-nodes (axillary lymph nodes) were involved. Based on estrogen and progesterone receptor status, over half (53.3%) of the tumors were ER and PR positive and 40% were Her2/neu overexpressed. Conclusion: The study concluded that half of the Bangladeshi breast cancer patients are ER and PR positive and two in every five cases are Her2/neu overexpressed.
Folia Histochemica et Cytobiologica, 2010
Her-2/neu is overexpressed in 20-30% of breast cancer patients and is associated with a more aggressive disease. Identification of Her-2/c-erbB-2-neu overexpression is based on immunohistochemical [ihc] detection of protein and/or gene amplification in fluorescence in situ hybridization test (FISH). Also Estrogen receptors [ER] and Progesterone receptors [PR] are the prognostic and predictive biomarkers, recently analysed by ihc methods. Subjective, manual scoring of the ihc Her-2/neu expression and expression of the ER/PR reported as the percentage of immunopositive cells are the most common mode of interpretation among pathologists. Automated microscopy and computerised processing have provided increased accuracy in quantification and standardisation. The aims of our study were: to evaluate the scoring reproducibility of Her-2 /neu ihc expression tested by two automated systems: ACIS (Dako) and ScanScope (Aperio); to estimate the ER/PR expression in ihc staining methods with different anti-ER/anti-PR antibodies (the monoclonal and the ER/PR phar-mDx TM Kit ) by the ACIS system. Her-2/neu ihc expression was measured in 114 primary invasive breast carcinomas by the manual and the automated scoring (ACIS and Aperio system). 106 slides stained ihc with two types of anti-ER/anti-PR antibodies entered the quantisation. The results of our investigations showed very high reproducibility of Her-2/neu scores in intra-and interobserver analysis by ACIS evaluation. The major concordance was present in strong 3+ ihc cases; very small discordance was shown by cases with low expression of Her-2/neu. The accuracy of scoring by the Aperio was little lower in comparison to ACIS but it might result from the smaller and variable series of samples analysed by Aperio. The concordance in scoring of two automated systems was 86.5% (p<0.0001; γ=0.887); the discordance was referred only to the lower expression of Her-2/neu. The concordance in manual scoring performed by the single observer and the panel was 84.2% (p<0.0001, γ = 0.99); the discordance comprised a few cases with strong expression (2+ vs 3+). Very high intra-and interobserver reproducibility of the ER/PR ihc measurements was present in the readers results (referred to the percentage of immunoreactive carcinomatous cell population in the breast carcinomas acc. to the ACIS algorithm). No differences were disclosed in the percentage of ER-immunoreactive and PR-immunoreactive carcinomatous cell populations when used 2 different type of antibodies, in the ACIS automated method.