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- Title
Well-differentiated invasive breast cancers with equivocal HER2 immunohistochemistry: what is the yield of routine reflex in-situ hybridization testing?
- Authors
Bethune, Gillian C; Pettit, Alexandra S L; Veldhuijzen van Zanten, Daniel; Barnes, Penelope J
- Abstract
Aims The 2013 American Society of Clinical Oncology and the College of American Pathologists ( ASCO/ CAP) HER2 guidelines recommend testing all invasive breast cancers for HER2, typically with immunohistochemistry ( IHC) followed by in-situ hybridization ( ISH) when IHC is equivocal. As well-differentiated breast cancers are rarely HER2-positive, we assessed the value of routine reflex HER2 ISH testing for this subset of breast cancers. Methods and results We collected HER2 IHC 2+ cases and fluorescence in-situ hybridization ( FISH) data from primary breast cancers with well-differentiated tumour types (grade 1 ductal carcinomas, classic lobular carcinomas, tubular, cribriform and pure mucinous carcinomas) at our centre from 2010 to 2015. Haematoxylin and eosin (H&E) and IHC slides were reviewed to confirm tumour type, grade and IHC score based on ASCO/ CAP 2013 guidelines and their recent revisions. Of 4633 invasive carcinomas, 1133 had a well-differentiated tumour type; 177 of these were HER2 IHC equivocal, three of which were low-level amplified by FISH (0.3% of all well-differentiated tumours). One amplified case was classic invasive lobular carcinoma and two were invasive ductal carcinomas, grade 1. One amplified case had chromosome 17 monosomy, and one was rescored as HER2 IHC 1+ upon review. 'Basolateral' staining was noted in one amplified case and in 65 of 174 (37.4%) non-amplified cases. This incomplete membranous staining pattern was observed in the majority of invasive ductal carcinomas that were rescored as 1+ according to the revised 2013 guidelines. Conclusions The rate of HER2 amplification among well-differentiated breast cancers is very low. Basolateral staining in well-differentiated tumours may be overinterpreted as HER2 IHC 2+, but is rarely associated with HER2 amplification.
- Subjects
BREAST cancer; CANCER invasiveness; IMMUNOHISTOCHEMISTRY; AMERICAN Society of Clinical Oncology; COLLEGE of American Pathologists
- Publication
Histopathology, 2017, Vol 70, Issue 6, p966
- ISSN
0309-0167
- Publication type
Article
- DOI
10.1111/his.13160