Is ER Immunohistochemical Sensitivity Affected by Different Breast Biopsy Techniques with Differing Cold Ischemia Times?
Victoria Sujoy, Andre Pinto, Ada P Romilly, Merce Jorda, Carmen R Gomez-Fernandez. Jackson Memorial Hospital/University of Miami, Miami, FL; Jackson Memorial Hospital, Miami, FL
Background: When a patient has a suspicious mammographic abnormality or a palpable breast mass, the obligatory diagnostic tool is a biopsy.
Breast biopsies can be done in different ways. In our institution the three most common ways of obtaining breast biopsies are clinical (without imaging support), ultrasound-guided and stereotactic procedures. Clinical biopsies are placed immediately in formalin, ultrasound guided biopsies are placed in formalin after 5 minutes and stereotactic biopsies are placed in formalin after being radiographed which takes up to 10 minutes.
Each technique entails different time delays to formalin fixation (cold ischemia time), which may affect the immunohistochemical sensitivity of Estrogen Receptor (ER) status.
A positive reaction for Progesterone Receptor (PR) generally reflects a functional ER, and should be either equivalent or of lesser intensity/proportion to the positive reaction for ER. We utilized this paradigm to evaluate the expression of ER.
Design: Archival slides from formalin-fixed (6-48 hrs.) core biopsies of ER+ (1D5 DAKO)/PR+ (636 DAKO) invasive mammary carcinomas were retrieved from our files. Thirty cases were collected, clinical biopsies (10), ultrasound guided (10) and stereotactic (10).
Proportion and intensity of ER and PR were recorded using the Quick Score (Q-Score) and compared between the 3 different biopsy techniques.
Results: The clinical biopsies all had an ER Q-Score of 7 (mean=7) and a PR Q-Score ranging from 3 to 7 (mean=6.6). The ultrasound guided biopsies had an ER Q-Score ranging from 3 to 7 (mean=6.1) and a PR Q-Score ranging from 3 to 7 (mean=6.3). The stereotactic biopsies all had an ER Q-Score of 7 (mean=7) and a PR Q-Score ranging from 4 to 7 (mean=6.3).
PR had an equal or lesser Q-Score than ER in all of the clinical and stereotactic biopsy groups. In the ultrasound guided group PR had a Q-Score slightly higher than ER in 4 of 10 cases.
Conclusions: The positive reaction for ER did not differ across the 3 different technique groups with their inherent varying ischemic times of up to 10 minutes. When compared to the positive reaction for PR by Q score, ER was generally equivalent or of greater intensity/proportion. Four cases in the ultrasound group had a PR reaction with a slightly higher Q score than ER, but the difference was minimal. Therefore, ER immunohistochemical sensitivity is not affected by whether the breast biopsy is performed clinically, ultrasound guided, or by stereotactic procedure.
Monday, March 19, 2012 1:00 PM
Poster Session II # 310, Monday Afternoon