[Histonet] HER-2

[Mark Tarango]

Many pathologists, if they have any doubt about the score will just say
that it is 2+ so that its gets HER2 by FISH which is considered the best
method for determining HER2 status.  Even if by the scoring criteria it is
a 1+ but the intensity is a little stronger than normal (but maybe
basolateral or not complete staining) they just go with 2+.  Sometimes its
high grade 1+ and it doesn't quite meet the 2+ staining criteria and they
call it 2+ too.  If these things are happening enough it could mean calling
more 2+ cases.  They don't always follow the scoring criteria to the letter.

We use digital image analysis for HER2 IHC scoring and the computer is
pretty right on (matches with FISH), but sometimes the pathologist will
change the score in the report to 2+ even though it's a 1+ by the computer.
 There is one pathologist in particular who doesn't believe in the computer
reading the HER2 score and is trying very hard to find cases that are
positive by FISH but that the computer is calling the IHC 1+.  He also
requests FISH on some 3+ cases to try and find any over-calling by the
computer.  The thought of a woman getting a toxic drug needlessly really
bothers him.

So without Wilson posting more info there's not much help that I think
anyone can offer.  This is stain that has to be validated
more extensively than others, so the protocol shouldn't just be tweaked.
 How do the controls look?  Was there any lot to lot variation?  Lots of
questions..

Mark

On Tue, Feb 5, 2013 at 12:49 PM, Rene J Buesa <rjbuesa <@t> yahoo.com> wrote:

> Yes, that is sometimes a common occurrence amongst pathologists, BUT those
> differences have to be solved in conference before issuing the report.
> Difficult cases (at least at my hospital) are reviewed in conference,
> I agree with you: your protocol (specially if it is based on DAKO'sprotocol) should remain as is.
> The diagnosis differences should not determine a change.
> René J.
>
>   *From:* Mark Tarango <marktarango <@t> gmail.com>
> *To:* Wilson A <wilson6848 <@t> yahoo.com>
> *Cc:* "histonet <@t> lists.utsouthwestern.edu" <
> histonet <@t> lists.utsouthwestern.edu>
> *Sent:* Tuesday, February 5, 2013 2:24 PM
> *Subject:* Re: [Histonet] HER-2
>
> I'd be interested to know if all your pathologists agree that the 2+ cases
> are 2+.  Is it possible that one of the pathologists is calling more cases
> as 2+ than the rest?  I would have a lot of questions before modifying the
> staining protocol.  It would be helpful you posted more info.
>
> Mark T.
>
> On Fri, Feb 1, 2013 at 6:52 PM, Wilson A <wilson6848 <@t> yahoo.com> wrote:
>
> >
> >    Hi,
> >      Our pathologists are concerned we may be reporting too many 2+
> > HER2’s.  Can someone  help with this?
> >
> >      Thanks,
> >    Wilson
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