Assessment Of Her2 In Breast Core Needle Biopsies

Several reports have shown that the assessment of HER2 status on needle core biopsies (NCBs) in breast cancer is accurate and reliable.62 65 A study of 325 primary breast cancer patients investigated the accuracy of HER2 status using IHC and FISH on NCBs, and compared the result with surgical specimens.66 They found that the accuracy of IHC assessment of HER2 in NCBs was 92% and increased to 96% with additional FISH analysis, which was applied to all strongly positive cases. Therefore, they recommended performing FISH analysis for cases with strong IHC positivity on NCBs in order to minimize the number of false-positive results. Although NCBs have the advantage of good fixation, there can be crushing that makes it difficult to interpret the pattern of staining, and there may be staining at the edge of the cores (edge artefact). In addition, more care should be taken to differentiate between DCIS staining and invasive tumor staining for HER2 in NCBs, and a comparison with hemotoxylin and eosin (H&E) may be helpful in this regard. There is no data available to indicate whether repeating staining on resected specimens in cases where HER2 is 1+ or 2+ on NCBs is of value, but this may be appropriate until evidence-based data are available.

expression and its relationship with other prognostic factors. Using specimens from 1210 consecutive patients treated between 1968 and 1971 at a single institution (National Cancer Institute of Milan), with no systemic adjuvant therapy and 20-year follow-up, they found overexpression of HER2 in 23% of cases and showed a negative impact on survival of node-positive but not node-negative patients. Some studies have also reported lack of prognostic significance in node-negative group;68-70 however, others have found a prognostic value for HER2 in node-negative patients in selected subgroups.71-73 This plethora of conflicting results may be explained by low numbers of patients evaluated in some studies and the diversity of methods used.

There is, at present, no agreement on the association between HER2 and other prognostic factors. Several studies suggest a lack of association between HER2 status and increasing tumor size,3,74 yet some do find a correlation.70,75 Most studies have failed to find an association between patient age at diagnosis and HER2 status.3,70,76 Similar inconsistencies have been reported for aneuploidy, grade, and proliferation index.67,76,77

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