ABSTRACT
AIM: The aim of this study was to validate the role of fluorescence in situ hybridization (FISH) in investigating HER2/neu gene amplification (human epidermal growth factor receptor 2) in patients with HER2/neu equivocal breast cancer diagnosed on immunohistochemistry (IHC). MATERIALS AND METHODS: This was a retrospective study conducted from January 2013 to October 2017. A total of 134 patients diagnosed with invasive breast carcinoma and HER2/neu equivocal status on IHC were analyzed. Also, the cases for the years 2016 and 2017 formed a subgroup that was analyzed further to study the impact of pre-analytical factors on IHC and FISH results. RESULTS: A total of 134 women with HER2/neu IHC equivocal breast cancer were included in the study with a median age of 50 years (range 25–81). HER2/neu amplification by FISH was noted in 72 (54%) cases, whereas it was non-amplified in 52 (39%) cases. Ten cases were reported as equivocal even on FISH (ASCO/CAP 2013 guidelines). Polysomy 17 was noted in 55 cases (41%), of which 26 patients were≤50 years and 29 patients were >50 years of age. Twenty (36%) of these 55 cases showed HER2/neu amplification, whereas 26 (48%) cases were non-amplified and 9 (16%) cases were reported as equivocal on FISH. Also, more than half of the polysomy cases were hormone receptor negative. CONCLUSION: IHC is a good screening tool for negative and positive results. Any patient targeted for trastuzumab therapy should undergo confirmation of HER2/neu equivocal status by FISH analysis. We also suggest that if a non-classical FISH pattern is seen, the test should be repeated with a non-centromeric chromosome 17 reference locus probe for better treatment planning.
ABSTRACT
Background: The use of adjuncts along with Lidocaine during intravenous regional anesthesia (IVRA) decreases tourniquet pain and prolongs post-operative analgesia. Addition of ketamine reduces the time for onset of block, delays the onset of tourniquet pain and reduces postoperative analgesic requirement. Verapamil potentiates the effect of neuromuscular blocking agents. This study was designed to evaluate the effect of adding Verapamil (2.5 mg) to Lidocaine plus Ketamine (0.5 mg/kg) in comparison with lidocaine plus ketamine IVRA. Materials and methods: Hundred and twenty patients, aged 18–50 years, ASA physical status I and II undergoing elective hand or forearm surgery under Bier’s Block lasting one to one and half hours were included in this double-blinded, randomized and controlled study. Patients were divided into two groups of 60 patients each. Group- I (control group) received 40 ml of 0.5% Lidocaine plus ketamine (0.5 mg/kg) and Group- II received an addition of 2.5 mg of verapamil IVRA. Sensory and motor block onset and recovery time were noted. After the tourniquet deflation: pain, sedation values, time to first analgesic requirement and side effects were evaluated over a period of 12 hours. Results: Significant postoperative hemodynamic changes, sedation score, pain score and delayed first request for analgesia was observed in-group II when compared to group I. Sensory and motor block characteristics were significant in-group II as against group I. The side effect profile of verapamil (2.5mg) was minimal with a few episodes of hypotension and bradycardia, which were clinically managed by ephedrine and atropine respectively.