[Histonet] RE: Breast IHC testing

Fri Feb 3 10:56:59 CST 2012

This abstract is in the January 2012 edition of CAP Today. 

Effect of prolonged fixation on evaluation of ER, PR, and HER2 expression in breast cancer 

Expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 is important in predicting a response to targeted therapies in breast cancer. Therefore, immunohistochemical assays to determine hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status must be accurate and reproducible. Tissue fixation has been shown to play a crucial role in determining consistency in quality. Although guidelines impose upper limits for the fixation period, the data on which these limits are based are scant. The authors conducted a study to prospectively examine the effect of fixation of longer than 72 hours on these assays. In 101 invasive breast cancer samples, HR and HER2 status were compared between tumor blocks undergoing a short fixation period and those undergoing a period of prolonged fixation. Discordances were classified as an incremental change between categories of (i) a single order of magnitude-that is, a difference in the status of low positive (Allred score, 3) compared with positive (Allred score, 4 to 8) or negative (Allred score, 0 or 2) and vice versa for HRs and a difference in HER2 status of equivocal compared with negative or positive and vice versa or (ii) greater than a single order of magnitude-that is, a difference in the status of positive compared with negative or vice versa. The median fixation time for the short fixation group was 13 hours and 18 minutes (mean, 13 hours and 17 minutes; range, 10 hours and 33 minutes to 17 hours and 45 minutes) and for the prolonged fixation group was 79 hours and 22 minutes (mean, 79 hours and 35 minutes; range, 73 hours and 33 minutes to 102 hours and 30 minutes). Eight cases showed discordances, all of which were of a single order of magnitude, including one for ER, five for PR, and two for HER2. In six of these, a higher score was seen in the prolonged fixation group. The authors concluded that fixation for limited periods beyond 72 hours does not reduce assay sensitivity in determining ER, PR, or HER2 immunohistochemical status. 

Tong LC, Nelson N, Tsourigiannis J, et al. The effect of prolonged fixation on the immunohistochemical evaluation of estrogen receptor, progesterone receptor, and HER2 expression in invasive breast cancer: a prospective study. Am J Surg Pathol. 2011;35:545-552.

Correspondence: Anna Marie Mulligan at mulligana <@t> smh.ca
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Tom Podawiltz HT (ASCP)
Histology Section Head/Laboratory Safety Officer. 
LRGHealthcare
Laconia, NH 03246
603-524-3211 ext: 3220

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Anatomic pathology abstracts editors: Michael Cibull, MD, professor and vice chair, Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, assistant professor of pathology and laboratory medicine, University of Kentucky College of Medicine; and Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.    

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Morken, Timothy
Sent: Friday, February 03, 2012 11:14 AM
To: 'Gale Limron'; histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] RE: Breast IHC testing

Remember that you can validate your testing for longer fixation. Run parallel  ER/PR/Her2 testing with tissue fixed for various lengths of  times and look at the staining correlation between groups. Most likely your longer fixation won't be a problem.  If you do see a drop off with longer times you can probably adjust antigen retrieval time to alleviate that.

Tim Morken
Supervisor, Histology, IPOX
UCSF Medical Center
San Francisco, CA, USA
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Gale Limron
Sent: Friday, February 03, 2012 7:24 AM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Breast IHC testing

I would like to know what other hospitals are doing with breast specimens that are resected on Friday and are in formalin longer than the maximum number of hours that CAP allows for ER/PR  and HER2/neu testing. We are running into this problem since we don't currently work Saturday hours.
Thank you!
Gale Limron CT,HT (ASCP)
Histology Supervisor
Union Hospital
659 Boulevard
Dover, Ohio 44622
330-343-3311 ext 2562

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