The HercepTest and routine C-erbB2 immunohistochemistry in breast cancer: any difference?

INTRODUCTION: The proto-oncogene c-erbB2, located on chromosome 17q21, encodes a 185-kD transmembrane glycoprotein. It is known to be overexpressed, amplified, or both in 20% to 30% of breast cancers. C-erbB2 belongs to the human epidermal growth factor receptor (tyrosine kinase receptor) family that plays an important role in cell cycle regulation and differentiation. Although there are various methods to assess c-erbB2 status in breast cancer, protein overexpression determined by immunohistochemistry and gene amplification using fluorescence in situ hybridisation are most commonly utilised. This study compares the results of the DAKO HercepTest with the immunohistochemical assay (A0485, DAKO), which is routinely used in our pathology laboratory. MATERIALS AND METHODS: Paraffin-embedded breast cancer tissues from 41 patients operated in a tertiary hospital during the year 2000 were subjected to immunohistochemistry by the above methods. C-erbB2 positivity was defined by cytoplasmic membrane staining of 2+ or 3+ intensity. RESULTS: Overexpression of c-erbB2 protein was present in 36.6% and 41.5% of cases when detected by HercepTest and the DAKO A0485 antibody, respectively. There was almost perfect agreement between both methods (k = 0.898) when positive versus negative results were considered, and moderate agreement in terms of individual staining intensities (k = 0.554). CONCLUSION: Routine immunohistochemistry using the DAKO A0485 antibody is a reliable, cost-effective alternative to the HercepTest in determining prognosis and suitability of patients for Herceptin therapy.

Immunohistochemical expression of hormone receptors in invasive breast carcinoma: correlation of results of H-score with pathological parameters.

The results of H-scores of oestrogen and progesterone receptor (ER and PR) expression in 150 invasive breast cancers were correlated with conventional pathological prognostic parameters: tumour size, histological grade and subtype, lymph node status, lymphovascular invasion, Nottingham Prognostic Index (NPI) and pathological stage. ER and PR status was determined by immunohistochemical staining of sections cut from archival paraffin-embedded tissue blocks. We defined positive receptor expression as a H-score of 50 and above. Our findings revealed ER and PR positivity in 98 (65%) and 52 (35%) cases, respectively. Fifty-one (34%) ER-positive cases also showed PR expression, while 51 (34%) tumours were negative for both ER and PR. Positive expression for ER and PR was significantly correlated with histological grade (P < 0.0005), mitotic score (P < 0.05) and nuclear pleomorphism (P < 0.05). When we used the relatively simpler method of a cut off of at least 10% tumour cell nuclear staining of moderate or greater intensity as positive receptor status, we found that it agreed well with results of the H-score, a more quantitative method of assessment.