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Quality assessment of estrogen receptor and progesterone receptor testing in breast cancer using a tissue microarray-based approach.

Dekker TJ, ter Borg S, Hooijer GK, Meijer SL, Wesseling J, Boers JE, Schuuring E, Bart J, van Gorp J, Bult P, Riemersma SA, van Deurzen CH, Sleddens HF, Mesker WE, Kroep JR, Smit VT, van de Vijver MJ - Breast Cancer Res. Treat. (2015)

Bottom Line: When a discordant result was found between the local and TMA result, the original testing slide was revised and staining was repeated on a whole-tissue block.Out of 96 discordant cases, 36 cases would have been concordant if the recommended cut-off value of 1% instead of 10% was followed.Overall sensitivity and specificity of estrogen and progesterone receptor testing were high among participating laboratories.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands, T.J.A.Dekker@lumc.nl.

ABSTRACT
Assessing hormone receptor status is an essential part of the breast cancer diagnosis, as this biomarker greatly predicts response to hormonal treatment strategies. As such, hormone receptor testing laboratories are strongly encouraged to participate in external quality control schemes to achieve optimization of their immunohistochemical assays. Nine Dutch pathology departments provided tissue blocks containing invasive breast cancers which were all previously tested for estrogen receptor and/or progesterone receptor expression during routine practice. From these tissue blocks, tissue microarrays were constructed and tested for hormone receptor expression. When a discordant result was found between the local and TMA result, the original testing slide was revised and staining was repeated on a whole-tissue block. Sensitivity and specificity of individual laboratories for testing estrogen receptor expression were high, with an overall sensitivity and specificity [corrected] of 99.7 and 95.4%, respectively. Overall sensitivity and specificity of progesterone receptor testing were 94.8 and 92.6%, respectively. Out of 96 discordant cases, 36 cases would have been concordant if the recommended cut-off value of 1% instead of 10% was followed. Overall sensitivity and specificity of estrogen and progesterone receptor testing were high among participating laboratories. Continued enrollment of laboratories into quality control schemes is essential for achieving and maintaining the highest standard of care for breast cancer patients.

No MeSH data available.


Related in: MedlinePlus

Concordance for ER testing results
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Fig1: Concordance for ER testing results

Mentions: A number of 1736 invasive breast carcinomas that were tested for ER in nine different pathology laboratories were included in this study. Of these, 163 tumors were omitted from the analysis when the original ER result could not be retrieved, when TMA cores were lost during the staining procedure, or due to the absence of invasive breast cancer on the TMA cores. A further four tumors were excluded because material was not available for subsequent retesting after an initial discordant result was found between the TMA and the original testing result. The subsequent analysis was performed on the remaining cohort of 1569 breast tumors (Fig. 1). When comparing the local testing result with the TMA result, 52 tumors were considered to be discordant. For these tumors, the whole-sized sections were stained for ER in order to assess the reason for discordance. If the whole-slide result was concordant with the original ER testing result, the discordance was decided to be due to sampling error due to use of a TMA and the final results were thus concordant (N = 36). If the discordance remained, this was considered a true discordant result (N = 16). Of the 16 discordant cases, 12 were false positive and 4 were false negative (Fig. 1; Table 1). Overall concordance was 99.0 %, and the sensitivity and specificity for all ER tests performed by the combined nine centers showed a sensitivity of 99.7 % (range 98.7–100.0 %) and specificity of 95.4 % (range 83.3–100.0 %). Positive predictive value (PPV) and negative predictive value (NPV) for all centers combined were 99.1 % (range 97.4–100.0 %) and 98.4 % (range 90.9–100 %), respectively.Fig. 1


Quality assessment of estrogen receptor and progesterone receptor testing in breast cancer using a tissue microarray-based approach.

Dekker TJ, ter Borg S, Hooijer GK, Meijer SL, Wesseling J, Boers JE, Schuuring E, Bart J, van Gorp J, Bult P, Riemersma SA, van Deurzen CH, Sleddens HF, Mesker WE, Kroep JR, Smit VT, van de Vijver MJ - Breast Cancer Res. Treat. (2015)

Concordance for ER testing results
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4491103&req=5

Fig1: Concordance for ER testing results
Mentions: A number of 1736 invasive breast carcinomas that were tested for ER in nine different pathology laboratories were included in this study. Of these, 163 tumors were omitted from the analysis when the original ER result could not be retrieved, when TMA cores were lost during the staining procedure, or due to the absence of invasive breast cancer on the TMA cores. A further four tumors were excluded because material was not available for subsequent retesting after an initial discordant result was found between the TMA and the original testing result. The subsequent analysis was performed on the remaining cohort of 1569 breast tumors (Fig. 1). When comparing the local testing result with the TMA result, 52 tumors were considered to be discordant. For these tumors, the whole-sized sections were stained for ER in order to assess the reason for discordance. If the whole-slide result was concordant with the original ER testing result, the discordance was decided to be due to sampling error due to use of a TMA and the final results were thus concordant (N = 36). If the discordance remained, this was considered a true discordant result (N = 16). Of the 16 discordant cases, 12 were false positive and 4 were false negative (Fig. 1; Table 1). Overall concordance was 99.0 %, and the sensitivity and specificity for all ER tests performed by the combined nine centers showed a sensitivity of 99.7 % (range 98.7–100.0 %) and specificity of 95.4 % (range 83.3–100.0 %). Positive predictive value (PPV) and negative predictive value (NPV) for all centers combined were 99.1 % (range 97.4–100.0 %) and 98.4 % (range 90.9–100 %), respectively.Fig. 1

Bottom Line: When a discordant result was found between the local and TMA result, the original testing slide was revised and staining was repeated on a whole-tissue block.Out of 96 discordant cases, 36 cases would have been concordant if the recommended cut-off value of 1% instead of 10% was followed.Overall sensitivity and specificity of estrogen and progesterone receptor testing were high among participating laboratories.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands, T.J.A.Dekker@lumc.nl.

ABSTRACT
Assessing hormone receptor status is an essential part of the breast cancer diagnosis, as this biomarker greatly predicts response to hormonal treatment strategies. As such, hormone receptor testing laboratories are strongly encouraged to participate in external quality control schemes to achieve optimization of their immunohistochemical assays. Nine Dutch pathology departments provided tissue blocks containing invasive breast cancers which were all previously tested for estrogen receptor and/or progesterone receptor expression during routine practice. From these tissue blocks, tissue microarrays were constructed and tested for hormone receptor expression. When a discordant result was found between the local and TMA result, the original testing slide was revised and staining was repeated on a whole-tissue block. Sensitivity and specificity of individual laboratories for testing estrogen receptor expression were high, with an overall sensitivity and specificity [corrected] of 99.7 and 95.4%, respectively. Overall sensitivity and specificity of progesterone receptor testing were 94.8 and 92.6%, respectively. Out of 96 discordant cases, 36 cases would have been concordant if the recommended cut-off value of 1% instead of 10% was followed. Overall sensitivity and specificity of estrogen and progesterone receptor testing were high among participating laboratories. Continued enrollment of laboratories into quality control schemes is essential for achieving and maintaining the highest standard of care for breast cancer patients.

No MeSH data available.


Related in: MedlinePlus