Immunohistochemical detection of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression in breast carcinomas

Abstract

BACKGROUND: Fine‐needle aspiration (FNA) is a rapid and accurate procedure for the detection of breast carcinomas. The evaluation of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression by immunohistochemistry (IHC) is performed routinely on formalin‐fixed, paraffin‐embedded needle‐core (NC) or excision tissue block (TB) preparations, according to the American Society of Clinical Oncology/College of American Pathologist guidelines. In this retrospective study, the authors compared expression levels of ER, PR, and HER2 in ethanol‐fixed BC FNA cell block (CB) samples with expression levels in formalin‐fixed NC and TB samples. METHODS: Forty‐one breast carcinoma CB samples with concurrent or subsequent NC and TB samples were identified. Patients who had received neoadjuvant or adjuvant chemotherapy were excluded. CB samples initially were fixed in 50% ethanol (4‐12 hours), and this was followed by formalin fixation (minimum, 6 hours). NC samples were placed promptly in formalin for a minimum of 6 hours. Within 4 to 8 hours, TB samples were fixed in formalin for 6 to 48 hours. Fluorescence in situ hybridization (FISH) results were also compared. RESULTS: IHC for ER on alcohol‐fixed CB samples had good correlation with NC and TB samples. PR results on TB samples had excellent agreement with NC samples. A higher discordance rate wais observed when PR results were compared between CB samples and NC samples. HER2 detection on ethanol‐fixed CB samples resulted in a higher rate of positive and equivocal staining than NC or TB samples. HER2 IHC on TB samples demonstrated better correlation with FISH results than CB or NC samples. CONCLUSIONS: Alcohol fixation did not affect ER results in breast carcinoma, but it may alter tumor cell PR antigenicity. The authors concluded that CB samples could be used to triage patients for tamoxifen therapy, but they are not reliable for the assessment of HER2 status; therefore, CB results should be correlated with results from NC or TB samples. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

Immunohistochemistry Practices of Cytopathology Laboratories: A Survey of Participants in the College of American Pathologists Nongynecologic Cytopathology Education Program

“…1 Many reports specified that the same (or ''virtually'' the same) staining protocol was used for FFPE specimens as for non-FFPE cytology specimens. [5][6][7]9,10,12,14 In their survey of 28 laboratories (primarily European laboratories), Schmitt et al 18 found that IHC conditions were identical for more than 50% of laboratories for cytology specimens compared with surgical specimens, even though cell blocks were used by only 20% of laboratories. 18 Cytology IHC shares with surgical pathology the same potential sources of error in the analytic and postanalytic aspects of IHC, and there is clear evidence that major variability in IHC results can be attributed to analytic or postanalytic factors.…”

“…There are many reports of successful IHC staining on cytology specimens using a variety of preanalytic ''platforms,'' including direct smears 5 ; various monolayer preparations, such as ThinPrep (Hologic Inc, Marlborough, Massachusetts) 6,7 ; SurePath (BD Diagnostics, Franklin Lakes, New Jersey) 8 ; cytospin preparations 1,9 ; and cells removed from a stained, cover-slipped smear and transferred to another slide 10,11 ; or paraffin-embedded cell blocks prepared with or without formalin. 9,[12][13][14][15] There are no data on the number of laboratories using these different preanalytic IHC platforms in the United States.…”

MTDH expression in invasive micropapillary carcinoma of the breast

“…10% of tumor cells [16] . The scoring of HER2 was as follows [17] : Strong, circumferential membrane staining demonstrated in more than 30% of the invasive carcinoma cells was scored as 3+; moderate, circumferential membrane staining demonstrated in 10% or more of the invasive tumor cells or 3+ staining in 30% or less of the invasive tumor cells was scored as 2+ staining; weak and incomplete membrane staining presented in the invasive tumor cells was scored as 1+; and no staining shown in the tumor invasive cells was scored as 0. In the IMPC group, only the staining of the IMPC component was evaluated.…”

Cell-block in EUS Guided FNA-Best method in a Resource Constraint Setting?

“…However the newer techniques utilize methanol-based fixation, which interfere with immunohistochemical analysis especially for ER, PR, MIB 1 and Her 2 neu [9][10][11]. However this issue may be overcome by formalin pre-fixation prior to Cellient [7].…”