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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

A case where the local result was determined as ER-positive, while this staining was not reproduced on the TMA core and whole-slide testing. A. The local slide which showed both nuclear and smudgy, weaker cytoplasmic staining in the tumor cells as well as associated fibroblasts. A nearby duct is strongly positive. B. The TMA test showing no staining in tumor cells. C. Whole-slide test which verified the ER-negative staining of the TMA, while the normal duct shows an appropriate positive control
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Fig2: A case where the local result was determined as ER-positive, while this staining was not reproduced on the TMA core and whole-slide testing. A. The local slide which showed both nuclear and smudgy, weaker cytoplasmic staining in the tumor cells as well as associated fibroblasts. A nearby duct is strongly positive. B. The TMA test showing no staining in tumor cells. C. Whole-slide test which verified the ER-negative staining of the TMA, while the normal duct shows an appropriate positive control

Mentions: The next step was to investigate whether the discordant results were due to observer inaccuracy or inaccurate IHC procedures. To assess the possibility of observer error, the original slides were revised when available (N = 15). In 12 tumors, discordance between the local observer and the revision panel was present, which can be considered to be observer inaccuracy. Three discordant cases were due to inaccurate IHC procedures. Two showed ER-positive staining in the local testing center (which was also verified with slide revision), while no positive test result was obtained if the staining was repeated (example shown in Fig. 2). The opposite was true for the third discordant case. The reason for the discordant result could not be ascertained for the sole remaining tumor, since the unavailability of the original slide leaves it impossible to determine whether the discordance was due to inaccurate scoring or IHC procedure (Table 1).Fig. 2


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)

A case where the local result was determined as ER-positive, while this staining was not reproduced on the TMA core and whole-slide testing. A. The local slide which showed both nuclear and smudgy, weaker cytoplasmic staining in the tumor cells as well as associated fibroblasts. A nearby duct is strongly positive. B. The TMA test showing no staining in tumor cells. C. Whole-slide test which verified the ER-negative staining of the TMA, while the normal duct shows an appropriate positive control
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: A case where the local result was determined as ER-positive, while this staining was not reproduced on the TMA core and whole-slide testing. A. The local slide which showed both nuclear and smudgy, weaker cytoplasmic staining in the tumor cells as well as associated fibroblasts. A nearby duct is strongly positive. B. The TMA test showing no staining in tumor cells. C. Whole-slide test which verified the ER-negative staining of the TMA, while the normal duct shows an appropriate positive control
Mentions: The next step was to investigate whether the discordant results were due to observer inaccuracy or inaccurate IHC procedures. To assess the possibility of observer error, the original slides were revised when available (N = 15). In 12 tumors, discordance between the local observer and the revision panel was present, which can be considered to be observer inaccuracy. Three discordant cases were due to inaccurate IHC procedures. Two showed ER-positive staining in the local testing center (which was also verified with slide revision), while no positive test result was obtained if the staining was repeated (example shown in Fig. 2). The opposite was true for the third discordant case. The reason for the discordant result could not be ascertained for the sole remaining tumor, since the unavailability of the original slide leaves it impossible to determine whether the discordance was due to inaccurate scoring or IHC procedure (Table 1).Fig. 2

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