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Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor-2 Testing in Breast Cancer

Assessing the Value of Repeated Centralized Testing in Excision Specimens

Hariri, Nosaibah, MBBS; Hasteh, Farnaz, MD; Walavalkar, Vighnesh, MD; Roma, Andres A., MD; Fadare, Oluwole, MD

Applied Immunohistochemistry & Molecular Morphology: January 2019 - Volume 27 - Issue 1 - p 1–7
doi: 10.1097/PAI.0000000000000525
Research Article

At some tertiary breast care centers, where many patients are referred from other institutions, it is routine to repeat testing for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2/neu) in excision specimens if these tests were performed on the preceding biopsy at the referring facility. The goal of this study is to assess the value of this practice. We documented results from ER, PR, and HER2 testing in 541 consecutive invasive breast cancers excised over a 2.5-year period and analyzed the subset (n=153) for which testing was performed on the excision specimen solely due to the fact that testing on the preceding biopsy was performed at an outside institution. The rates and directions of biopsy-to-excision change were as follows: ER [1.3% (2/153), 100% from (+) to (−)]; PR [4% (6/153), 83% from (+) to (−)]; HER2/neu assessed by immunohistochemistry [21% (29/137)]; HER2/neu assessed by fluorescence in situ hybridization [3.3% (2/61); 50% from amplified to nonamplified and 50% vice versa]. There were no ER(−) and PR(−) biopsy cases that became ER and/or PR(+) in the excision. By coordinate analysis for the hormone receptors [ie, ER and/or PR(+) being indicative of “hormone receptor” (HR) positivity], there were no cases that changed from HR(+) in the biopsy to HR(−) in the excision (or vice versa), which suggests that repeat testing for ER and PR in this setting is of limited value. In an analysis that incorporated both immunohistochemistry and in situ fluorescence hybridization results, there were 2 cases with a clinically significant biopsy-to-excision change in HER2/neu status in which that change was detected primarily because the excision was retested. These findings provide baseline data for formulating policies on whether repeat testing should routinely be performed in the described scenario.

Department of Pathology, University of California San Diego, San Diego, CA

Presented in part at the Annual Meeting of the United States and Canadian Academy of Pathologists, March 2017, San Antonio, TX.

The authors declare no conflict of interest.

Reprints: Oluwole Fadare, MD, Department of Pathology, UC San Diego Medical Center, 200 West Arbor Drive, MC 8720, Room 2-120, San Diego, CA 92103 (e-mail:

Received January 30, 2017

Accepted March 20, 2017

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