Template:Immunohistochemistry evaluation of invasive breast cancer - Revision history

Mikael Häggström: Colors

2026-04-28T17:15:25Z

Colors

← Older revision		Revision as of 13:15, 28 April 2026
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	! rowspan="2" \| Average HER2 copy number per cell		! rowspan="2" \| Average HER2 copy number per cell
	! ≥4.0		! ≥4.0
	\| HER2 positive		\| style="background:Pink" \| HER2 positive
	\| Additional work-up required<ref name=HER2fish group=note>If additional work-up is required by FISH study, see source article for detailed algorithms:<br>{{cite journal\| author=Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS \| display-authors=etal\| title=Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. \| journal=J Clin Oncol \| year= 2018 \| volume= 36 \| issue= 20 \| pages= 2105-2122 \| pmid=29846122 \| doi=10.1200/JCO.2018.77.8738 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29846122 }}</ref>		\| style="background:LemonChiffon" \| Additional work-up required<ref name=HER2fish group=note>If additional work-up is required by FISH study, see source article for detailed algorithms:<br>{{cite journal\| author=Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS \| display-authors=etal\| title=Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. \| journal=J Clin Oncol \| year= 2018 \| volume= 36 \| issue= 20 \| pages= 2105-2122 \| pmid=29846122 \| doi=10.1200/JCO.2018.77.8738 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29846122 }}</ref>
	\|-		\|-
	! <4.0		! <4.0
	\| Additional work-up required<ref name=HER2fish group=note/>		\| style="background:LemonChiffon" \| Additional work-up required<ref name=HER2fish group=note/>
	\| HER2 negative		\| style="background:LightGreen" \| HER2 negative
	\|}		\|}
	If the initial HER2 result is negative for a needle biopsy of a primary breast cancer, a new HER2 test may be performed on the subsequent breast excision.<ref name=HER2fish group=note/>		If the initial HER2 result is negative for a needle biopsy of a primary breast cancer, a new HER2 test may be performed on the subsequent breast excision.<ref name=HER2fish group=note/>

Mikael Häggström: /* HER2 immunohistochemistry */ How

2024-01-19T19:15:06Z

HER2 immunohistochemistry: How

← Older revision		Revision as of 15:15, 19 January 2024
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	======HER2 immunohistochemistry======		======HER2 immunohistochemistry======
			Look at different parts of the tumor, and evaluate the area(s) with most staining. When negative of faint staining is seen, evaluate at high magnification.
	{\|class="wikitable" align="center"		{\|class="wikitable" align="center"
	\|+Immunohistochemistry		\|+Immunohistochemistry

Mikael Häggström: /* Immunohistochemistry */ '''

2023-05-15T03:00:18Z

Immunohistochemistry: '''

← Older revision		Revision as of 23:00, 14 May 2023
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	===Immunohistochemistry===		===Immunohistochemistry===
	Look at local protocols for what immunohistochemistry tests and other biomarker test need to be tested for each case of invasive breast cancer, or what needs to be retested for subsequent excisions at the primary site or at metastatic sites.<ref group=note>If the previous biopsy was negative for ER and PR receptors, and the patient has undergone '''neoadjuvant chemotherapy''' before excision, then generally retest ER/PR on the excision. Retesting ER/PR on any excision with previously negative ER/PR on biopsy on a patient having received neoadjuvant therapy has no scientific support nor opposition.<br>- {{cite web\|url=https://www.uptodate.com/contents/general-principles-of-neoadjuvant-management-of-breast-cancer#H4238568521\|title=General principles of neoadjuvant management of breast cancer\|author=William M Sikov, MD, FACP, FNCBCJudy C Boughey, MD, FACSZahraa Al-Hilli, MD, FACS, FRCSI\|website=UpToDate}}		Look at '''local protocols''' for what immunohistochemistry tests and other biomarker test need to be tested for each case of invasive breast cancer, or what needs to be retested for subsequent excisions at the primary site or at metastatic sites.<ref group=note>If the previous biopsy was negative for ER and PR receptors, and the patient has undergone '''neoadjuvant chemotherapy''' before excision, then generally retest ER/PR on the excision. Retesting ER/PR on any excision with previously negative ER/PR on biopsy on a patient having received neoadjuvant therapy has no scientific support nor opposition.<br>- {{cite web\|url=https://www.uptodate.com/contents/general-principles-of-neoadjuvant-management-of-breast-cancer#H4238568521\|title=General principles of neoadjuvant management of breast cancer\|author=William M Sikov, MD, FACP, FNCBCJudy C Boughey, MD, FACSZahraa Al-Hilli, MD, FACS, FRCSI\|website=UpToDate}}

	In breast cancer '''metastases''', generally retest estrogen and progesterone receptors, and HER2 in the following circumstances:		In breast cancer '''metastases''', generally retest estrogen and progesterone receptors, and HER2 in the following circumstances:

Mikael Häggström: /* Immunohistochemistry */ ref

2023-05-15T02:59:05Z

Immunohistochemistry: ref

← Older revision		Revision as of 22:59, 14 May 2023
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	===Immunohistochemistry===		===Immunohistochemistry===
	Look at local protocols for what immunohistochemistry tests and other biomarker test need to be tested for each case of invasive breast cancer, or what needs to be retested for subsequent excisions at the primary site or at metastatic sites.<ref group=note>If the previous biopsy was negative for ER and PR receptors, and the patient has undergone '''neoadjuvant chemotherapy''' before excision, then generally retest ER/PR on the excision. Retesting ER/PR on any excision with previously negative ER/PR on biopsy on a patient having received neoadjuvant therapy has no scientific support nor opposition.<br>- {{cite web\|url=https://www.uptodate.com/contents/general-principles-of-neoadjuvant-management-of-breast-cancer#H4238568521\|title=General principles of neoadjuvant management of breast cancer\|author=William M Sikov, MD, FACP, FNCBCJudy C Boughey, MD, FACSZahraa Al-Hilli, MD, FACS, FRCSI\|website=UpToDate}}~~</ref>~~		Look at local protocols for what immunohistochemistry tests and other biomarker test need to be tested for each case of invasive breast cancer, or what needs to be retested for subsequent excisions at the primary site or at metastatic sites.<ref group=note>If the previous biopsy was negative for ER and PR receptors, and the patient has undergone '''neoadjuvant chemotherapy''' before excision, then generally retest ER/PR on the excision. Retesting ER/PR on any excision with previously negative ER/PR on biopsy on a patient having received neoadjuvant therapy has no scientific support nor opposition.<br>- {{cite web\|url=https://www.uptodate.com/contents/general-principles-of-neoadjuvant-management-of-breast-cancer#H4238568521\|title=General principles of neoadjuvant management of breast cancer\|author=William M Sikov, MD, FACP, FNCBCJudy C Boughey, MD, FACSZahraa Al-Hilli, MD, FACS, FRCSI\|website=UpToDate}}

	In breast cancer '''metastases''', generally retest estrogen and progesterone receptors, and HER2 in the following circumstances:		In breast cancer '''metastases''', generally retest estrogen and progesterone receptors, and HER2 in the following circumstances:

Mikael Häggström: Local protocols

2023-05-15T02:57:40Z

Local protocols

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 ===Immunohistochemistry===
 ====Ki-67 index====
 [[File:Positive immunohistochemistry of KI-67 in invasive breast cancer.jpg|thumb|Ki-67 in an invasive breast cancer: cancer nuclei are stained (brown). There is tumor cell positivity in 70% of the cells (''Ki-67 labelling index'' = 70%).]]
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 If the initial HER2 result is negative for a needle biopsy of a primary breast cancer, a new HER2 test may be performed on the subsequent breast excision.<ref name=HER2fish group=note/>
 <noinclude>
 {{Bottom}}
 </noinclude>

Mikael Häggström: /* HER2 FISH */ Noted

2022-10-26T18:37:55Z

HER2 FISH: Noted

← Older revision		Revision as of 14:37, 26 October 2022
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	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Counting HER2 versus CEP17 probes in FISH of HER2 amplified cell.png		File:Counting HER2 versus CEP17 probes in FISH of HER2 amplified cell.png
	File:HER2 FISH algorithm.svg\|Algorithm for the evaluation of HER2 on fluorescence ''in situ'' hybridization (FISH).<ref name=HER2fish>Diagram and table by Mikael Häggström, MD. Adapted from: {{cite journal\| author=Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS \| display-authors=etal\| title=Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. \| journal=J Clin Oncol \| year= 2018 \| volume= 36 \| issue= 20 \| pages= 2105-2122 \| pmid=29846122 \| doi=10.1200/JCO.2018.77.8738 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29846122 }}</ref>		File:HER2 FISH algorithm.svg\|Algorithm for the evaluation of HER2 on fluorescence ''in situ'' hybridization (FISH).<ref name=HER2fish>Diagram and table by Mikael Häggström, MD. Adapted from: {{cite journal\| author=Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS \| display-authors=etal\| title=Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. \| journal=J Clin Oncol \| year= 2018 \| volume= 36 \| issue= 20 \| pages= 2105-2122 \| pmid=29846122 \| doi=10.1200/JCO.2018.77.8738 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29846122 }}</ref> See source article in cases where additional workup is indicated.<ref name=HER2fish group=note/>
	</gallery>		</gallery>
	If the HER2/CEP17 ratio is borderline (1.8-2.2), count an additional 20 nuclei and recalculate a ratio for the total of 40 nuclei.		If the HER2/CEP17 ratio is borderline (1.8-2.2), count an additional 20 nuclei and recalculate a ratio for the total of 40 nuclei.

Mikael Häggström: /* HER2 FISH */ Prepare

2022-10-20T17:08:53Z

HER2 FISH: Prepare

← Older revision		Revision as of 13:08, 20 October 2022
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	HER2 FISH usually uses ''chromosome enumeration probe 17'' (CEP17) to count the amount of chromosomes. Hence, the HER2/CEP17 ratio reflects any amplification of HER2 as compared to the number of chromosomes.		HER2 FISH usually uses ''chromosome enumeration probe 17'' (CEP17) to count the amount of chromosomes. Hence, the HER2/CEP17 ratio reflects any amplification of HER2 as compared to the number of chromosomes.

	To interpret a HER2 FISH ~~case~~, first perform a quality control check of the slide as per manufacturer and/or local protocol (generally including checking for proper signals from a control specimen). In cases of both invasive and ''in situ'' carcinoma in the same specimen, only score the invasive cells. The signals of 20 cells are usually counted. Also focus up and down on each nucleus to find all signals therein.		To '''prepare''' a slide for HER2 testing, you may need to choose a paraffin-embedded and mark the resulting slide so that you or whoever interprets it knows where to look for the target tumor cells. When there are multiple blocks of the same case, choose the the one with most tumor. {{Moderate-begin}}If a block has undergone sectioning for immunohistochemistry (such as ER, PR and/or Ki67) make sure that you have a new H&E slide at a level next to the one to be used for FISH, so that they will correlate better.{{Moderate-end}} In cases of both invasive and ''in situ'' carcinoma in the same specimen, mark all invasive carcinoma (also for crushed tissue or with other artifacts) but not the ''in situ'' carcinoma. Also mark a small area of normal tissue as an internal control. If possible, it should be a bit away from the tumor, even if only consisting of fatty tissue.

			To '''interpret''' a HER2 FISH study, first perform a quality control check of the slide as per manufacturer and/or local protocol (generally including checking for proper signals from a control specimen). In cases of both invasive and ''in situ'' carcinoma in the same specimen, only score the invasive cells. The signals of 20 cells are usually counted. Also focus up and down on each nucleus to find all signals therein.
	<gallery mode=packed>		<gallery mode=packed>
	File:Tumor cells and normal tissue of the breast in FISH.jpg\|Identify the relevant tumor cells. It can be made easier by comparing to an H&E stained slide.		File:Tumor cells and normal tissue of the breast in FISH.jpg\|Identify the relevant tumor cells. It can be made easier by comparing to an H&E stained slide.

Mikael Häggström: Fixed

2022-10-19T19:45:15Z

Fixed

← Older revision		Revision as of 15:45, 19 October 2022
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	If the HER2/CEP17 ratio is borderline (1.8-2.2), count an additional 20 nuclei and recalculate a ratio for the total of 40 nuclei.		If the HER2/CEP17 ratio is borderline (1.8-2.2), count an additional 20 nuclei and recalculate a ratio for the total of 40 nuclei.
	{\| class="wikitable" align=center		{\| class="wikitable" align=center
	\|+ Classification of HER2 by fluorescence ''in situ'' hybridization (FISH)<ref name=~~HER2-FISH~~/>		\|+ Classification of HER2 by fluorescence ''in situ'' hybridization (FISH)<ref name=HER2fish group=note/>
	\|-		\|-
	\|rowspan=2 colspan=2\|		\|rowspan=2 colspan=2\|
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	\| HER2 negative		\| HER2 negative
	\|}		\|}
	If the initial HER2 result is negative for a needle biopsy of a primary breast cancer, a new HER2 test may be performed on the subsequent breast excision.<ref name=~~HER2-FISH~~/>		If the initial HER2 result is negative for a needle biopsy of a primary breast cancer, a new HER2 test may be performed on the subsequent breast excision.<ref name=HER2fish group=note/>

	===Biomarker retesting===		===Biomarker retesting===

Mikael Häggström: /* HER2 FISH */ Specified

2022-10-17T17:25:11Z

HER2 FISH: Specified

← Older revision		Revision as of 13:25, 17 October 2022
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	File:HER2 FISH with a yellow signal.png\|thumb\|A yellow signal cunts as one red and one green (which are overlapping)		File:HER2 FISH with a yellow signal.png\|thumb\|A yellow signal cunts as one red and one green (which are overlapping)
	</gallery>		</gallery>
	If a cytotechnologist has already performed a count, you do not have to recount, but make sure the count is reasonable regarding what you see. In any case, also look around for any tumor heterogeneity.		If a cytotechnologist has already performed a count, you do not have to recount, but make sure the count is reasonable regarding what you see. In any case, also look around for any obvious tumor heterogeneity in HER2 signals.
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Counting HER2 versus CEP17 probes in FISH of HER2 amplified cell.png		File:Counting HER2 versus CEP17 probes in FISH of HER2 amplified cell.png

Mikael Häggström: /* HER2 FISH */ Expand

2022-10-17T17:22:04Z

HER2 FISH: Expand

← Older revision		Revision as of 13:22, 17 October 2022
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	File:HER2 FISH algorithm.svg\|Algorithm for the evaluation of HER2 on fluorescence ''in situ'' hybridization (FISH).<ref name=HER2fish>Diagram and table by Mikael Häggström, MD. Adapted from: {{cite journal\| author=Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS \| display-authors=etal\| title=Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. \| journal=J Clin Oncol \| year= 2018 \| volume= 36 \| issue= 20 \| pages= 2105-2122 \| pmid=29846122 \| doi=10.1200/JCO.2018.77.8738 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29846122 }}</ref>		File:HER2 FISH algorithm.svg\|Algorithm for the evaluation of HER2 on fluorescence ''in situ'' hybridization (FISH).<ref name=HER2fish>Diagram and table by Mikael Häggström, MD. Adapted from: {{cite journal\| author=Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS \| display-authors=etal\| title=Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. \| journal=J Clin Oncol \| year= 2018 \| volume= 36 \| issue= 20 \| pages= 2105-2122 \| pmid=29846122 \| doi=10.1200/JCO.2018.77.8738 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29846122 }}</ref>
	</gallery>		</gallery>
			If the HER2/CEP17 ratio is borderline (1.8-2.2), count an additional 20 nuclei and recalculate a ratio for the total of 40 nuclei.
	{\| class="wikitable" align=center		{\| class="wikitable" align=center
	\|+ Classification of HER2 by fluorescence ''in situ'' hybridization (FISH)<ref name=HER2-FISH/>		\|+ Classification of HER2 by fluorescence ''in situ'' hybridization (FISH)<ref name=HER2-FISH/>