[Histonet] Uneven ER/PR

[Greg Dobbin]

Joanne,
I do not think you should expect to get perfectly uniform IHC staining in
breast core biopsies every time. At our hospital, we prefer to avoid doing
hormone receptor stains on breast cores because they are not as "robust" as
a lumpectomy or mastectomy specimen.

The unevenness could be due to pre-analytic causes beyond your control
(such as: are they placed in directly and immediately into formalin by the
radiologist? Is your processing schedule optimized for small biopsies or is
it a "one-size fits all" schedule for large and small specimens, etc).
Occasionally, we will agree to an Oncology request to stain them but this
is usually only done when they feel it is not going to be clinically
beneficial to put the patient through a more invasive procedure (ie
lumpectomy).

Another disadvantage of looking at cores vs lump specimens is that you
cannot see the "bigger picture". Perhaps there is heterogeneity in the
intensity of the ER/PR expression throughout the tumor; something that is
easier to discern when you can see the staining pattern across the entire
cross-section of the tumor.

I too use the Bond platform. If you are placing appropriate tissue controls
on the same slide as the patient and these have the expected staining
pattern and intensity, you may be fairly certain that the issue was (or is)
pre-analytic in nature. If this is not your practice, then try re-staining
new sections of the same case. If it is corrected, contact Leica Tech
support to try to figure out what went wrong the first time. If it is not
corrected, then you are back to suspecting a pre-analytic issue (assuming
you are not seeing this uneven-ness in other IHC specimens). I strongly
encourage use of tissue controls on every patient slide.

Cheers,
Greg

-- 
*Greg Dobbin*
1205 Pleasant Grove Rd
RR#2 York,
PE      C0A 1P0


*Everything in moderation...even moderation itself**!*