Breast Hormonal Receptors Test Should Be Repeated on Excisional Biopsies after Negative Core Biopsy
S Zhang, Y Zakharia, W Tan, G Wilding, S Edge, W Liu, D Tan, T Khoury. Roswell Park Cancer Institute, Buffalo; Unity Hospital, Rochester; MD Anderson Cancer Center, Houston
Background: Accurate estrogen receptor (ER) and progesterone receptor (PR) results are important for therapeutic decision making for patients with breast carcinoma. The purpose of this study was to assess the concordance of breast cancer immunohistochemical receptor assays on core biopsy and surgical specimens.
Design: We identified 176 patients whose core biopsy was performed either at Roswell Park Cancer Institute (RPCI) or at an outside facility between 2007 and 2009. Surgical specimens were processed in RPCI. ER and PR, for biopsies and excisions, were scored using Allred scoring system. While biopsies were processed in 12 different laboratories, stained in 5 different laboratories using 3 different vendors, the excisional biopsies were processed and stained in RPCI using one vendor (Dako). While the following antibodies were used for ER, 1D5, 6F11 and SP1, the following antibodies were used for PR, PgR636, 16 and 1E2 from Dako, Leica and Ventana respectively. Correlation of scores of biopsies with matching excision was analyzed using Spearman correlation coefficient test.
Results: Seventeen (9.7%) patients were biopsied in RPCI and 159 (90.3%) patients in an outside facility. While there were 141 (80.1%) cases positive for ER and 118 (67%) cases positive for PR for the core biopsy, there were 143 (81.3%) cases positive for ER and 130 (73.9%) cases positive for PR for the excision. Concordance for ER and PR was seen in 93% and 89.8% respectively. Table illustrates the concordance between biopsy and excision for both markers based on vendors. Spearman correlation coefficient between biopsy and excision was 0.75 for ER and 0.79 for PR (p<0.0001 each).
|Dako (No. 23)||Leica (No. 124)||Ventana (No. 29)||P value|
|ER: BX+EX+||16 (69.6)*||100 (81.3)||20 (66.7)||0.11|
|ER: BX+EX-||0 (0)||3 (2.4)||2 (6.7)|
|ER: BX-EX+||3 (13)||3 (2.4)||1 (3.3)|
|ER: BX-EX+||4 (17.4)||17 (13.8)||7 (23.3)|
|PR: BX+EX+||13 (56.5)||85 (69.1)||17 (56.7)||0.48|
|PR: BX+EX-||0 (0)||2 (1.6)||1 (3.3)|
|PR: BX-EX+||2 (8.7)||11 (8.9)||2 (6.7)|
|PR: BX-EX+||8 (34.8)||25 (20.3)||10 (33.3)|