Estrogen and progesterone hormone receptor status in breast carcinoma: Comparison of immunocytochemistry and immunohistochemistry

Abstract

We evaluated the correlation between histologic and cytologic specimens in the determination of estrogen receptor (ER) and progesterone receptor (PR) status in breast carcinoma and investigated the causes of clinically significant discrepancies. We analyzed 70 immunoassays for ER and 60 for PR from 71 patients with breast carcinoma. Concordance between cytology and histology was 89% for ER and 63% for PR using scores from pathology reports. Concordance between cytology and histology was 98% for ER and 91% for PR using consensus scores (obtained after reevaluation by the team of pathologists). Thirty of 130 (23%) tests had clinically relevant discrepancies, 53% of which were caused by wrong interpretation of cytologic findings, 10% by wrong interpretation of histologic findings, 17% by sampling error and 20% were not available for reevaluation. Wrong interpretation of the results for ER and PR status in cytology was a far more frequent cause of clinically relevant discrepancies than sampling errors. The use of strict criteria is recommended.

Optimal fixation conditions for immunocytochemical analysis of estrogen receptor in cytologic specimens of breast carcinoma

“…Air-drying has been advocated by some for better retention of cells in the cytologic specimen, 12,15,31 but others found air-drying to be a major cause of loss of ER antigenicity in addition to poor cellular morphology. 11,16,26,32 In the current study, the ER detection rate was better when smears were fixed immediately rather than airdried, thereby attesting to the necessity of prompt fixation to reduce the risk of false-negative results.…”

“…16,19,33 However, in view of the ER scores of the 2 cases by IHC (90% and 50%, respectively), tissue heterogeneity appears to be an unlikely factor contributing to the negative results in smears. The exact cause of the false-negative staining is difficult to determine and may be due to unknown preanalytic factors rather than tissue heterogeneity.…”

“…11,26 In contrast, other reports showed that microwave-stimulated epitope retrieval can be applied successfully on smears fixed in alcohol, formalin, or processed by ThinPrep. 15,16,27,28 The low ER immunoreactivity in our initial smears, however, prompted us to try heat-induced epitope retrieval on all negatively staining smears that had been fixed in 10% formalin, followed by repeat ER staining. A negative-to-positive conversion was observed in 18 of 20 smears with an increased nuclear staining intensity.…”

“…In addition to the Abbott method, 8 which was originally introduced with a first-generation ER antibody (i.e., H222) and required fixing samples in a formalin-methanolacetone sequence at Ϫ20°C, a variety of other fixatives have been used along with subsequently developed antibodies. These included the use of periodatelysineparaformaldehyde at room temperature (RT), a formalin-acetone sequence at Ϫ10°C, 11 95% alcohol, [12][13][14] 10% buffered formalin at RT, 15 acetone/formalin fixative, 16 and cytospin collection fluid, a mixture of ethanol, isopropanol, and polyoxyethylene. 17 These methods, however, have produced conflicting results.…”

Comparison of Breast Carcinoma Prognostic/Predictive Biomarkers on Cell Blocks Obtained by Various Methods: Cellient, Formalin and Thrombin

“…Many studies have compared the results of IHC staining for breast carcinoma biomarkers performed on cytologic smears and liquid-based preparations to those performed on tissue samples [6,7,8,9,10,11,12]. Numerous studies have investigated the effects of different fixation methods on both cytologic and histologic samples of breast carcinoma [13,14,15,16,17,18,19,20].…”