Hello Nancy, 
 
Given your interest in best practices for validations,  I’d like to offer some 
recent literature references that may be of some use.
 
Your use of 20 positives and 20 negatives exceeds the minimum standard, from 
CAP Guidance. For purely diagnostic markers. (10+ and 10- are suggested in such 
cases), while 20+ and 20- are suggested as a minimum for predictive markers, 
such as ER, PR, etc… Your practice exceeds the minimum, but is certainly an 
excellent approach for better control of your assays!  
 
Patrick, L. F., Linda, A. B., Lisa, A. F., Alsabeh, R., Regan, S. F., Jeffrey, 
D. G., … Swanson, P. E. (2014). Principles of analytic validation of 
immunohistochemical assays: Guideline from the College of American Pathologists 
Pathology and Laboratory Quality Center. Archives of Pathology and Laboratory 
Medicine, 138(11), 1432–1443. https://doi.org/10.5858/arpa.2013-0610-CP
 
With respect to negative controls, there is another good reference, below:
 
Torlakovic, E. E., Francis, G., Garratt, J., Gilks, B., Hyjek, E., Ibrahim, M., 
… Vyberg, M. (2014). Standardization of Negative Controls in Diagnostic 
Immunohistochemistry. Applied Immunohistochemistry & Molecular Morphology, 
22(4), 241–252. https://doi.org/10.1097/PAI.0000000000000069
 
Internal negative control elements can definitely be part of the validation 
plan and can be used in specificity calculations.  Of course, it is important 
to confirm that these internal negatives are in fact negative!  However, it is 
also best practice to design validations as “fit for purpose”. That is,  does 
the assay reliably distinguish among the differential diagnostic  
considerations?  So, for specificity, a collection of “pertinent negatives” 
should also be included in the validation.  As an example: in the case of 
Beta-catenin for the diagnosis of fibromatosis, one should include some cases 
that resemble fibromatosis.  These might include, GIST, SCHWANNOMA, LEIOMYOMA, 
NEUROFIBROMA, and others, as your question clearly anticipated. 
 
I hope this of some use to you. 
 
Feel free to contact me if I can be of any further help. 
 
Regan



Regan Fulton, MD/PhD
 
CEO
Array Science, LLC
Tissue Microarray Technologies
475 Gate 5 Road, #102
Sausalito, CA 94965

ful...@arrayscience.com

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