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ER staining levels affect HER2 staining and heterogeneity

Breast Cancer volume 28, pages 720–726 (2021)Cite this article

Abstract

Purpose

This study explored the relationship of ER expression levels with HER2 staining properties and heterogeneity and discussed the differences in HER2 assessment caused by the 2018 ASCO/CAP guideline updates from that of the 2013 version.

Methods

HER2-positive breast cancer was divided into three groups of the high hormone receptor expression (LH-high) group, low expression (LH-low) group, or negative (NLH) group to (1) compare differences in the percentage of the HER2 IHC test score of 2 + based on the 2013 ASCO/CAP guideline and in the intratumor heterogeneity of HER2 expression for breast cancer with an IHC score of 3 + among these groups, (2) compare the HER2/CEP17 ratio and the average HER2 copy number, and classified ISH groupings according to the 2018 ASCO/CAP guideline algorithm.

Results

(1) Of 244 HER2-positive breast cancers, the cases with a HER2 IHC score of 2 + (n = 54, 22.1%) were significantly more common in the LH-high group (n = 45, P < 0.001). The frequency of heterogeneity was low (n = 25, 10.2%) for the HER2 score of 3 + (n = 190, 77.9%), and significantly higher in the LH-high group (n = 19, 76%, P = 0.002). (2) In a HER2 IHC score of 2 + , Group 2 which is deemed HER2 negative according to the revised 2018 ASCO/CAP guideline was observed in 17 (39.5%) out of 43 cases, of which 16 cases (94.1%) were in the LH-high group.

Conclusions

The LH-high group is a heterogeneous group largely consisting of heterogeneous cases with HER2 IHC scores of 2 + or 3 + . NLH, in contrast, is a homogenous group.

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Acknowledgements

We thank Editor Express (www.editorexpress.co.jp) for editing a draft of this manuscript.

Funding

The study was partially supported by JSPS KAKENHI grant number JP17K08707.

Author information

Affiliations

  1. Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan

    Momoko Akashi, Rin Yamaguchi, Hironori Kusano & Hirohisa Yano

  2. Department of Breast Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan

    Momoko Akashi

  3. Department of Pathology and Laboratory Medicine, Kurume University Medical Center, 155-1 Kokubu, Kurume, Fukuoka, 859-0863, Japan

    Rin Yamaguchi

  4. Departmen of Surgery, Japan Community Healthcare Organization Kurume General Hospital, Kurume, Fukuoka, Japan

    Miki Yamaguchi & Maki Tanaka

  5. Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan

    Jun Akiba

  6. Biostatistics Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan

    Tatsuyuki Kakuma

  7. Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan

    Yoshito Akagi

Authors
  1. Momoko Akashi
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  2. Rin Yamaguchi
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  3. Hironori Kusano
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  4. Miki Yamaguchi
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  5. Jun Akiba
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  6. Tatsuyuki Kakuma
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  7. Maki Tanaka
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  8. Yoshito Akagi
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  9. Hirohisa Yano
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Contributions

MA and RY designed the study and wrote the manuscript. MY and MT collected surgical resection specimens. HK and JA supervised the work. TK performed the data analysis. HY and YA performed research supervision and management, as well as dissertation writing.

Corresponding author

Correspondence to Rin Yamaguchi.

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Conflict of interest

There are no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective study was approved by the Kurume General Hospital Ethical Committee (No. 187) and Kurume University Ethical Committee (No. 16272).

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Informed consent was not required for this retrospective study.

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Akashi, M., Yamaguchi, R., Kusano, H. et al. ER staining levels affect HER2 staining and heterogeneity. Breast Cancer 28, 720–726 (2021). https://doi.org/10.1007/s12282-020-01208-7

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  • DOI: https://doi.org/10.1007/s12282-020-01208-7

Keywords

  • HER2 positive breast carcinoma
  • HER2 staining; heterogeneity
  • Hormone receptor
  • HER2 ASCO/CAP guideline