Many pathologists, if they have any doubt about the score will just say that it is 2+ so that its gets HER2 by FISH which is considered the best method for determining HER2 status. Even if by the scoring criteria it is a 1+ but the intensity is a little stronger than normal (but maybe basolateral or not complete staining) they just go with 2+. Sometimes its high grade 1+ and it doesn't quite meet the 2+ staining criteria and they call it 2+ too. If these things are happening enough it could mean calling more 2+ cases. They don't always follow the scoring criteria to the letter.
We use digital image analysis for HER2 IHC scoring and the computer is pretty right on (matches with FISH), but sometimes the pathologist will change the score in the report to 2+ even though it's a 1+ by the computer. There is one pathologist in particular who doesn't believe in the computer reading the HER2 score and is trying very hard to find cases that are positive by FISH but that the computer is calling the IHC 1+. He also requests FISH on some 3+ cases to try and find any over-calling by the computer. The thought of a woman getting a toxic drug needlessly really bothers him. So without Wilson posting more info there's not much help that I think anyone can offer. This is stain that has to be validated more extensively than others, so the protocol shouldn't just be tweaked. How do the controls look? Was there any lot to lot variation? Lots of questions.. Mark On Tue, Feb 5, 2013 at 12:49 PM, Rene J Buesa <rjbu...@yahoo.com> wrote: > Yes, that is sometimes a common occurrence amongst pathologists, BUT those > differences have to be solved in conference before issuing the report. > Difficult cases (at least at my hospital) are reviewed in conference, > I agree with you: your protocol (specially if it is based on DAKO'sprotocol) > should remain as is. > The diagnosis differences should not determine a change. > René J. > > *From:* Mark Tarango <marktara...@gmail.com> > *To:* Wilson A <wilson6...@yahoo.com> > *Cc:* "histonet@lists.utsouthwestern.edu" < > histonet@lists.utsouthwestern.edu> > *Sent:* Tuesday, February 5, 2013 2:24 PM > *Subject:* Re: [Histonet] HER-2 > > I'd be interested to know if all your pathologists agree that the 2+ cases > are 2+. Is it possible that one of the pathologists is calling more cases > as 2+ than the rest? I would have a lot of questions before modifying the > staining protocol. It would be helpful you posted more info. > > Mark T. > > On Fri, Feb 1, 2013 at 6:52 PM, Wilson A <wilson6...@yahoo.com> wrote: > > > > > Hi, > > Our pathologists are concerned we may be reporting too many 2+ > > HER2’s. Can someone help with this? > > > > Thanks, > > Wilson > > _______________________________________________ > > Histonet mailing list > > Histonet@lists.utsouthwestern.edu > > http://lists.utsouthwestern.edu/mailman/listinfo/histonet > > > _______________________________________________ > Histonet mailing list > Histonet@lists.utsouthwestern.edu > http://lists.utsouthwestern.edu/mailman/listinfo/histonet > > > _______________________________________________ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet