Advertisement

Virchows Archiv

, Volume 445, Issue 2, pp 119–128 | Cite as

Consistency of staining and reporting of oestrogen receptor immunocytochemistry within the European Union—an inter-laboratory study

  • The European Working Group for Breast Screening Pathology
  • C. A. Wells
  • J. P. Sloane
  • D. Coleman
  • C. Munt
  • I. Amendoeira
  • N. Apostolikas
  • J. P. Bellocq
  • S. Bianchi
  • W. Boecker
  • G. Bussolati
  • C. E. Connolly
  • P. Dervan
  • M. Drijkoningen
  • I. O. Ellis
  • C. W. Elston
  • V. Eusebi
  • D. Faverly
  • P. Heikkila
  • R. Holland
  • J. Jacquemier
  • M. Lacerda
  • J. Martinez-Penuela
  • C. De Miguel
  • J. L. Peterse
  • F. Rank
  • A. Reiner
  • E. Saksela
  • B. Sigal-Zafrani
  • M. Sylvan
  • B. Borisch
  • G. Cserni
  • T. Decker
  • H. Kerner
  • J. Kulka
  • P. Regitnig
  • A. Sapino
  • A. M. Tanous
  • S. Thorstenson
  • E. Zozaya
Original Article

Abstract

To assess the variability of oestrogen receptor (ER) testing using immunocytochemistry, centrally stained and unstained slides from breast cancers were circulated to the members of the European Working Group for Breast Screening Pathology, who were asked to report on both slides. The results showed that there was almost complete concordance among readers (kappa=0.95) in ER-negative tumours on the stained slide and excellent concordance among readers (kappa=0.82) on the slides stained in each individual laboratory. Tumours showing strong positivity were reasonably well assessed (kappa=0.57 and 0.4, respectively), but there was less concordance in tumours with moderate and low levels of ER, especially when these were heterogeneous in their staining. Because of the variation, the Working Group recommends that laboratories performing these stains should take part in a external quality assurance scheme for immunocytochemistry, should include a tumour with low ER levels as a weak positive control and should audit the percentage positive tumours in their laboratory against the accepted norms annually. The Quick score method of receptor assessment may also have too many categories for good concordance, and grouping of these into fewer categories may remove some of the variation among laboratories.

Keywords

Oestrogen receptor Immunohistochemistry Quality assessment Variability 

References

  1. 1.
    Barnes DM, Hanby AM (2001) Oestrogen and progesterone receptors in breast cancer: past, present and future. Histopathology 38:271–274CrossRefPubMedGoogle Scholar
  2. 2.
    Barnes DM, Millis RR, Beex LVAAM, Thorpe SM, Leake RE (1998) Increased use of immunohistochemistry for oestrogen receptor measurement in mammary carcinoma: the need for quality assurance. Eur J Cancer 34:1677–1682CrossRefPubMedGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists Collaborative Group (1998) Tamoxifen for early breast cancer: an overview of randomised trials. Lancet 351:1451–1467CrossRefPubMedGoogle Scholar
  4. 4.
    Elledge RM, Green S, Pugh R, Allred DC, Clark GM, Hill J, Ravdin P, Martino S, Osborne CK (2000) Estrogen receptor (ER) and progesterone receptor (PgR), by ligand-binding assay compared with ER, PgR and pS2, by immuno-histochemistry in predicting response to tamoxifen in metastatic breast cancer: a Southwest Oncology Group Study. Int J Cancer 89:111–117CrossRefPubMedGoogle Scholar
  5. 5.
    Ferrero-Pous M, Trassard M, Le Doussal V, Hacene K, Tubiana-Hulin M, Spyratos F (2001) Comparison of enzyme immunoassay and immunohistochemical measurements of estrogen and progesterone receptors in breast cancer patients. Appl Immunohistochem Mol Morphol 9:267–275CrossRefPubMedGoogle Scholar
  6. 6.
    Harvey JM, Clark GM, Osborne CK, Allred DC (1999) Oestrogen receptor status by immunohistochemistry is superior to the ligand-binding assays for predicting response to adjuvant therapy in breast cancer. J Clin Oncol 17:1474–1485PubMedGoogle Scholar
  7. 7.
    Lacroix M, Querton G, Hennebert P, Larsimont D, Leclercq G (2001) Estrogen receptor analysis in primary breast tumors by ligand-binding assay, immunocytochemical assay, and northern blot: a comparison. Breast Cancer Res Treat 67:263–271CrossRefPubMedGoogle Scholar
  8. 8.
    Leake R (2000) Detection of the oestrogen receptor (ER). Immunohistochemical versus cytosol measurements. Eur J Cancer 36[Suppl 4]:S18–S19Google Scholar
  9. 9.
    Leake R, Barnes D, Pinder S, Ellis I, Anderson L, Anderson T, Adamson R, Rhodes T, Miller K, Walker R (2000) Immunohistochemical detection of steroid receptors in breast cancer: a working protocol. UK Receptor Group, UK NEQAS, The Scottish Breast Cancer Pathology Group, and The Receptor and Biomarker Study Group of the EORTC. J Clin Pathol 53:634–635CrossRefPubMedGoogle Scholar
  10. 10.
    Lee H, Douglas-Jones AG, Morgan JM, Jasani B (2002) The effect of fixation and processing on the sensitivity of oestrogen receptor assay by immunohistochemistry in breast carcinoma. J Clin Pathol 55:236–238PubMedGoogle Scholar
  11. 11.
    Regitnig P, Reiner A, Dinges HP, Hoefler G, Mueller-Holzner E, Lax SF, Obrist P, Rudas M, Quehenberger F (2002) Quality assurance for estrogen and progesterone receptors by immunohistochemistry in Austrian pathology laboratories. Virchows Arch 441:328–334CrossRefPubMedGoogle Scholar
  12. 12.
    Rhodes A, Jasani B, Balaton AJ, Barnes DM, Miller KD (2000) Frequency of oestrogen and progesterone receptor positivity by immunohistochemical analysis in 7016 breast carcinomas: correlation with patient age, assay sensitivity, threshold value, and mammographic screening. J Clin Pathol 53:688–696CrossRefPubMedGoogle Scholar
  13. 13.
    Rhodes A, Jasani B, Balaton AJ, Miller KD (2000) Immunohistochemical demonstration of oestrogen and progesterone receptors: correlation of standards achieved on in house tumours with that achieved on external quality assessment material in over 150 laboratories from 26 countries. J Clin Pathol 53:292–301CrossRefPubMedGoogle Scholar
  14. 14.
    Rhodes A, Jasani B, Barnes DM, Bobrow LG, Miller KD (2000) Reliability of immunohistochemical demonstration of oestrogen receptors in routine practice: interlaboratory variance in the sensitivity of detection and evaluation of scoring systems. J Clin Pathol 53:125–130CrossRefPubMedGoogle Scholar
  15. 15.
    Thike AA, Chng MJ, Fook-Chong S, Tan PH (2001) Immunohistochemical expression of hormone receptors in invasive breast carcinoma: correlation of results of H-score with pathological parameters. Pathology 33:21–25CrossRefPubMedGoogle Scholar
  16. 16.
    United Kingdom National Coordinating Group for Breast Screening Pathology (2001). Guidelines for non-operative diagnostic procedures and reporting in breast cancer screening. NHSBSP Publication, SheffieldGoogle Scholar
  17. 17.
    Zafrani B, Aubriot MH, Mouret E, De Cremoux P, De Rycke Y, Nicolas A, Boudou E, Vincent-Salomon A, Magdelenat H, Sastre-Garau X (2000) High sensitivity and specificity of immunohistochemistry for the detection of hormone receptors in breast carcinoma: comparison with biochemical determination in a prospective study of 793 cases. Histopathology 37:536–545CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • The European Working Group for Breast Screening Pathology
  • C. A. Wells
    • 1
  • J. P. Sloane
    • 2
  • D. Coleman
    • 3
  • C. Munt
    • 3
  • I. Amendoeira
    • 4
  • N. Apostolikas
    • 5
  • J. P. Bellocq
    • 6
  • S. Bianchi
    • 7
  • W. Boecker
    • 8
  • G. Bussolati
    • 9
  • C. E. Connolly
    • 10
  • P. Dervan
    • 11
  • M. Drijkoningen
    • 12
  • I. O. Ellis
    • 13
  • C. W. Elston
    • 13
  • V. Eusebi
    • 14
  • D. Faverly
    • 15
  • P. Heikkila
    • 16
  • R. Holland
    • 17
  • J. Jacquemier
    • 18
  • M. Lacerda
    • 19
  • J. Martinez-Penuela
    • 20
  • C. De Miguel
    • 21
  • J. L. Peterse
    • 22
  • F. Rank
    • 23
  • A. Reiner
    • 24
  • E. Saksela
    • 16
  • B. Sigal-Zafrani
    • 25
  • M. Sylvan
    • 26
  • B. Borisch
    • 27
  • G. Cserni
    • 28
  • T. Decker
    • 29
  • H. Kerner
    • 30
  • J. Kulka
    • 31
  • P. Regitnig
    • 32
  • A. Sapino
    • 9
  • A. M. Tanous
    • 33
  • S. Thorstenson
    • 34
  • E. Zozaya
    • 20
  1. 1.Department of HistopathologySt. Bartholomew’s Hospital Medical SchoolLondon United Kingdom
  2. 2.Department of PathologyLiverpoolUnited Kingdom
  3. 3.Cancer Screening Evaluation UnitInstitute of Cancer ResearchSutton SurreyUnited Kingdom
  4. 4.Department of PathologyInstituto de Patologia & Imunologia Molecular da Universidade do PortoPortoPortugal
  5. 5.Department of PathologySaint Savvas HospitalAthensGreece
  6. 6.Service d’Anatomie PathologiqueHopital de HautepierreStrasbourgFrance
  7. 7.Department of Human Pathology and OncologyUniversity of FlorenceItaly
  8. 8.Gerhard-Domagk Institut fur PathologieUniversitat et MunsterMunsterGermany
  9. 9.Istituto di Anatomia e Istologia PatologicaTorinoItaly
  10. 10.Department of PathologyClinical Sciences Institute, University College HospitalGalwayIreland
  11. 11.Pathology DepartmentMater Hospital, University CollegeDublinIreland
  12. 12.Pathologische OntleedkundeUniversity HospitalLeuvenBelgium
  13. 13.Department of HistopathologyCity HospitalNottinghamUnited Kingdom
  14. 14.Sezione Anatomia Patologica M. MalpigniUniversita di BolognaBolognaItaly
  15. 15.CMP LaboratoryBruxellesBelgium
  16. 16.Haartman InstituteUniversity of HelsinkiHelsinkiFinland
  17. 17.National Expert & Training Centre for Breast Cancer ScreeningAcademisch Ziekenhuis NijmegenNijmegenThe Netherlands
  18. 18.Institut Paoli CalmettesMarseilleFrance
  19. 19.Laboratorio De HistopatologicaCentro Regional De Oncologia De CoimbraCoimbraPortugal
  20. 20.Department of PathologyHospital de NavarraPamplonaSpain
  21. 21.Department of PathologyHospital Virgen del CaminoPamplonaSpain
  22. 22.Department of PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  23. 23.Center of Laboratory Medicine and Pathology, Department of PathologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
  24. 24.Institute of PathologyDonauspitalWienAustria
  25. 25.Institut CurieSection Medicale et HospitaliereParisFrance
  26. 26.Department of Clinical Pathology and CytologyHuddinge University HospitalStockholmSweden
  27. 27.Centre Médicale UniversitaireGenèveSwitzerland
  28. 28.Department of PathologyBács-Kiskun County Teaching HospitalKecskemétHungary
  29. 29.Department of PathologyThe Breast Unit, HELIOS Medical CentreBerlinGermany
  30. 30.Department of PathologyRambam HospitalHaifaIsrael
  31. 31.2nd Institute of PathologySemmelweis UniversityBudapestHungary
  32. 32.Institut fur Pathologie der Karl-Franzens Universitat GrazGrazAustria
  33. 33.Division d’Anatomie PathologiqueLaboratoire National de SantéLuxembourg
  34. 34.Kalmar County HospitalKalmarSweden

Personalised recommendations