To evaluate if ultrasound gel or water-based media affects ER/PR staining patterns on breast core biopsy specimens

Abstract

Introduction/Objective IHC staining for biomarkers ER, PR and HER-2 (CerB2) forms an essential component of breast cancer management and prognostication. Staining for these biomarkers is dependent on optimal fixation of the specimen in formalin. Scoring systems employed for ER and PR grade the intensity of the nuclear staining along with the percentage of the cells stained. This study aims to determine if ultrasound gel used during core biopsy as opposed to water affects immunohistochemical staining of biomarkers ER and PR in breast cancer specimens, following an observation that ultrasound gel assisted core biopsies may affect ER/PR nuclear staining scores through excess cytoplasmic staining. Methods/Case Report We included a total of 50 cases of invasive breast carcinoma diagnosed on core biopsy from KK Women’s and Children’s Hospital from February 2019 to July 2020. These included 25 cases with gel and 25 cases with water applied to the breast prior to the procedure. All biopsies were optimally fixed in formalin as per recommended latest ASCO/CAP guidelines. The control group included 25 resection cases of invasive breast carcinoma which had neither gel nor water and had been optimally fixed in formalin. Cytoplasmic staining for ER and PR was graded as being present or absent and was compared against the excision specimens (control group) to determine if using the gel was significant in producing cytoplasmic staining. The data was analyzed on SPSS using multiple logistic regression. Results (if a Case Study enter NA) Using the gel appeared to be statistically significant in producing cytoplasmic staining for ER (p=0.042) as opposed to using water (p=0.274). For PR staining, both gel-based (p=0.250) and water-based media (p=0.286) were not statistically significant in causing cytoplasmic staining. Conclusion The preliminary findings of this small retrospective case-control study gives an insight that gel-based media may have a role in causing cytoplasmic staining for oestrogen receptor in breast cancer biopsy specimens which may interfere with accurate scoring and impact results of external quality assurance schemes to which laboratories subscribe to. However the study is limited by the small sample size and exclusion of any other pre- analytical factors like needle bore or number of cores taken which may have had an impact on the staining.

[Retracted] Correlation Analysis of Ultrasound Elastography Score with Invasive Breast Cancer and Biological Prognostic Factors

“…At the end, the nuclei were counterstained with hematoxylin and mounted with DAB. Interpretation criteria [14,15] tumor cell nuclei with brownish-yellow granules accounted for ≥10% were recorded as a positive expression of P receptor and E receptor; positive staining cells accounted for ≥14% were recorded as high expression of Ki67 antigen, otherwise, it was recorded as low expression of Ki67 antigen; cell membrane molecules stained at a different level were recorded as 0, +, ++ and +++, among which 0 and<puncsp> </puncsp>+<puncsp> </puncsp>are recorded as HER factor 2 negative, +++ is recorded as HER factor 2 positive, ++ requires, respectively further in situ hybridization gene amplification verification. 3 shows that the AUC of the UES is used for evaluating the expression of P receptor, HER factor 2 and Ki67 were 0.704 (95% CI:0.600-0.795), 0.763 (95% CI:0.663-0.845) and 0.820 (95% CI:0.726-0.893), respectively, as shown in Table 3 and Figure 2.…”