[Histonet] Her 2 Control

Wed Nov 22 13:21:55 CST 2017

Hey Scott - Our interpretation of CAP requirements for IHC Controls is the same as yours.  Our Her2 control is a microarray with  3+ case and a piece of normal skin to serve as our negative tissue control.
If you have normal breast tissue adjacent to your tumor control, that can also serve as a negative tissue control, but your procedure has to state it as such.  Our control tissue are 5mm punches of solid tumor, so we just add a punch of normal skin. 
I hope this helps, but sometimes, it's just not worth the argument.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Message: 2
Date: Tue, 21 Nov 2017 21:05:51 +0000
From: "Lindrud, Scott" <Scott.Lindrud at rice.willmar.mn.us>
Subject: [Histonet] Negative IHC Control for Her2
Hi All,
We are having an internal debate regarding Her2 IHC control tissue in our lab.  We run a MTA (multi tissue array) consisting of 0+, 1+, 2+, and 3+ Her2 staining tissue taken from lumpectomy/resection cases.  I'm in the process of searching for more tissue to use in future control blocks and it can be difficult to find tissue that is 0+ and 3+.
I've discussed this with our pathologist in charge of Histology and he says that we don't need to run all 4 of the cores as controls.  He says all we need to run is a positive control and a negative control.  He says the positive control could be a 2+ or 3+ and the negative control could be either a 0+ OR a 1+.
I respectfully disagreed with him and said the negative control is not meant for accessing staining interpretation but to verify the sensitivity and specificity of the actual antibody-antigen reaction.  I said a 1+ is still staining the tissue where there is no staining in a 0+ reaction.  The 1+ is not a negative staining reaction, but a negative interpretation.   The pathologist says I'm wrong.
The CAP in its checklist says "It is also important to assess the specificity of each antibody by a negative tissue control, which must show no staining of tissues known to lack the antigen".    To me, a 1+ Her2 staining reaction shows that that tissue has antigen and should not be used as a negative control.
So, after saying all that, can/should  1+ Her2 breast tissue be used as a negative tissue control?  Seems pretty straight forward to me, but I'm just a Cytotechnologist/Histotech.
Thanks for any input!
Scott
Scott A. Lindrud, MLS(ASCP)CM CTCM
Histopathology Technical Specialist/Cytotechnologist Rice Memorial Hospital
301 Becker Ave SW
Willmar, MN 56201
WP(320)231-4406
Fax(320)231-4861
scott.lindrud at rice.willmar.mn.us

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Message: 3
Date: Wed, 22 Nov 2017 16:02:21 +0000 (UTC)
From: Rene J Buesa <rjbuesa at yahoo.com>
To: "Lindrud, Scott" <Scott.Lindrud at rice.willmar.mn.us>,
        "histonet at lists.utsouthwestern.edu"
        <histonet at lists.utsouthwestern.edu>
Subject: Re: [Histonet] Negative IHC Control for Her2
Message-ID: <800857894.1231622.1511366541476 at mail.yahoo.com>
Content-Type: text/plain; charset=UTF-8

You are right but, your point is?Regardless, the pathologist is the responsible for his/her diagnosis/interpretation and the liability is his/hers.Remember that for us histotechs, our "client" is the pathologist (always remembering the patient behind the whole process) and our essential duty is to provide the pathologist what s/he needs to being able to make the best and more accurate diagnosis.Follow his/her instructions and your life will be much simpler and less stressful.Ren?

    On Tuesday, November 21, 2017 4:21 PM, "Lindrud, Scott via Histonet" <histonet at lists.utsouthwestern.edu> wrote:

 Hi All,

We are having an internal debate regarding Her2 IHC control tissue in our lab.? We run a MTA (multi tissue array) consisting of 0+, 1+, 2+, and 3+ Her2 staining tissue taken from lumpectomy/resection cases.? I'm in the process of searching for more tissue to use in future control blocks and it can be difficult to find tissue that is 0+ and 3+.

I've discussed this with our pathologist in charge of Histology and he says that we don't need to run all 4 of the cores as controls.? He says all we need to run is a positive control and a negative control.? He says the positive control could be a 2+ or 3+ and the negative control could be either a 0+ OR a 1+.

I respectfully disagreed with him and said the negative control is not meant for accessing staining interpretation but to verify the sensitivity and specificity of the actual antibody-antigen reaction.? I said a 1+ is still staining the tissue where there is no staining in a 0+ reaction.? The 1+ is not a negative staining reaction, but a negative interpretation.? The pathologist says I'm wrong.

The CAP in its checklist says "It is also important to assess the specificity of each antibody by a negative tissue control, which must show no staining of tissues known to lack the antigen".? ? To me, a 1+ Her2 staining reaction shows that that tissue has antigen and should not be used as a negative control.

So, after saying all that, can/should? 1+ Her2 breast tissue be used as a negative tissue control?? Seems pretty straight forward to me, but I'm just a Cytotechnologist/Histotech.

Thanks for any input!

Scott

Scott A. Lindrud, MLS(ASCP)CM CTCM
Histopathology Technical Specialist/Cytotechnologist Rice Memorial Hospital
301 Becker Ave SW
Willmar, MN 56201
WP(320)231-4406
Fax(320)231-4861
scott.lindrud at rice.willmar.mn.us

________________________________

"This e-mail transmission is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution violates confidentiality and privacy laws and is prohibited. If you are not the intended recipient, please notify the sender immediately and delete all copies of the message. Thank you."
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