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Impact of repeat HER2 testing after initial equivocal HER2 FISH results using 2013 ASCO/CAP guidelines

Breast Cancer Research and Treatment volume 166, pages 757–764 (2017)Cite this article

Abstract

Purpose

The updated 2013 American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 (HER2) testing have made some major changes in HER2 fluorescence in situ hybridization (FISH) interpretation criteria with additional FISH equivocal cases. Repeat HER2 testing is recommended after initial HER2 FISH equivocal results; however, little is known about its impact on final HER2 status. The aim of this study is to investigate whether reflex test clarifies HER2 status, and to characterize clinicopathological features of the newly defined HER2 equivocal group.

Methods

A total of 886 consecutive cases of primary invasive breast cancer conducted with dual-probe HER2 FISH testing between November 2013 and December 2015 were reviewed. HER2 immunohistochemistry (IHC) and FISH testing were performed on a different tissue block or a new specimen after initial HER2 FISH equivocal results.

Results

Compared to 2007 guideline, 85 (9.6%) cases changed their category by using 2013 guideline. The major change of the 85 cases is that 57 (6.4%) cases in HER2 FISH-negative category changed to equivocal, and the equivocal category cases increased from 36 to 67. HER2 FISH equivocal was significantly associated with HER2 IHC equivocal (2+) and chromosome 17 polysomy (P < 0.01). Repeat testing by IHC and FISH clarified HER2 status in 33 and 42% of HER2 equivocal cases, respectively. Overall 32 (48%) initial HER2 equivocal cases stayed HER2 equivocal after repeat FISH and or IHC testing. These tumors were ER/PR+, with high KI-67 index.

Conclusion

New guidelines classify more HER2 FISH equivocal cases. Repeat HER2 testing clarifies HER2 status in about 50% of initial HER2 FISH equivocal cases. In addition, HER2 equivocal cases merit further study as there is limited information about prognosis and optimal treatment strategy for this population.

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Abbreviations

HER2:

Human epidermal growth factor 2

IHC:

Immunohistochemistry

FISH:

Fluorescence in situ hybridization

ASCO:

American Society of Clinical Oncology

CAP:

College of American Pathologists

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Acknowledgements

This study is supported by Grants from Guangdong Medical Science and Technology Research Fund (No. A2016086) and National Clinical Key Subject Construction Project Fund of China.

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Author notes

  1. Fang-Ping Xu and Kun Wang have contributed equally to this work.

Affiliations

  1. Department of Pathology and Laboratory Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Lu, Guangzhou, 510080, China

    Fang-Ping Xu, Jie Xu, Jie Chen, Hong-Mei Wu, Ming-Hui Zhang, Xiao-Xu Long, Xin-Lan Luo, Ke-Ping Zhang, Dan-Yi Lin & Yan-Hui Liu

  2. Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Kun Wang & Yi-Fang Zhang

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  1. Fang-Ping Xu
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  2. Kun Wang
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Correspondence to Yan-Hui Liu.

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Xu, FP., Wang, K., Xu, J. et al. Impact of repeat HER2 testing after initial equivocal HER2 FISH results using 2013 ASCO/CAP guidelines. Breast Cancer Res Treat 166, 757–764 (2017). https://doi.org/10.1007/s10549-017-4479-y

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  • DOI: https://doi.org/10.1007/s10549-017-4479-y

Keywords

  • Breast cancer
  • HER2
  • Immunohistochemistry
  • Fluorescence in situ hybridization
  • Equivocal
  • Chromosome 17 polysomy