[Histonet] RE: Breast IHC testing
Thank you all for your advice and comments. I know this has been discussed before but when I need quick answers I know that I can count on fellow Histonetters for help:) Have a great weekend. Gale Gale Limron CT,HT (ASCP) Histology Supervisor Union Hospital 659 Boulevard Dover, Ohio 44622 330-343-3311 ext 2562 This e-mail is intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. Dissemination, distribution or copying of this e-mail or the information herein by anyone other than the intended recipient, or an employee or agent responsible for delivering the message to the intended recipient, is prohibited. If you received this message in error, please delete without copying and kindly e-mail a reply to inform us of the mistake in delivery. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] RE: Breast IHC testing
Thanks Tom. Yes, and even much longer fixation has not been shown to adversely affect detection, while short fixation does. The problem is rarely long fixation and is commonly short fixation. Chis van der Loos did a nice study on tonsil with many antibodies showing very short fixation resulted in lower detection than extremely long fixation (one year!). In fact for some epitopes longer fixation seems to be beneficial. Tim Morken Supervisor, Histology, IPOX UCSF Medical Center San Francisco, CA, USA -Original Message- From: Podawiltz, Thomas [mailto:tpodawi...@lrgh.org] Sent: Friday, February 03, 2012 8:57 AM To: Morken, Timothy; 'Gale Limron'; histonet@lists.utsouthwestern.edu Subject: RE: Breast IHC testing This abstract is in the January 2012 edition of CAP Today. Effect of prolonged fixation on evaluation of ER, PR, and HER2 expression in breast cancer Expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 is important in predicting a response to targeted therapies in breast cancer. Therefore, immunohistochemical assays to determine hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status must be accurate and reproducible. Tissue fixation has been shown to play a crucial role in determining consistency in quality. Although guidelines impose upper limits for the fixation period, the data on which these limits are based are scant. The authors conducted a study to prospectively examine the effect of fixation of longer than 72 hours on these assays. In 101 invasive breast cancer samples, HR and HER2 status were compared between tumor blocks undergoing a short fixation period and those undergoing a period of prolonged fixation. Discordances were classified as an incremental change between categories of (i) a single order of magnitude-that is, a difference in the status of low positive (Allred score, 3) compared with positive (Allred score, 4 to 8) or negative (Allred score, 0 or 2) and vice versa for HRs and a difference in HER2 status of equivocal compared with negative or positive and vice versa or (ii) greater than a single order of magnitude-that is, a difference in the status of positive compared with negative or vice versa. The median fixation time for the short fixation group was 13 hours and 18 minutes (mean, 13 hours and 17 minutes; range, 10 hours and 33 minutes to 17 hours and 45 minutes) and for the prolonged fixation group was 79 hours and 22 minutes (mean, 79 hours and 35 minutes; range, 73 hours and 33 minutes to 102 hours and 30 minutes). Eight cases showed discordances, all of which were of a single order of magnitude, including one for ER, five for PR, and two for HER2. In six of these, a higher score was seen in the prolonged fixation group. The authors concluded that fixation for limited periods beyond 72 hours does not reduce assay sensitivity in determining ER, PR, or HER2 immunohistochemical status. Tong LC, Nelson N, Tsourigiannis J, et al. The effect of prolonged fixation on the immunohistochemical evaluation of estrogen receptor, progesterone receptor, and HER2 expression in invasive breast cancer: a prospective study. Am J Surg Pathol. 2011;35:545-552. Correspondence: Anna Marie Mulligan at mullig...@smh.ca [ Top ] Tom Podawiltz HT (ASCP) Histology Section Head/Laboratory Safety Officer. LRGHealthcare Laconia, NH 03246 603-524-3211 ext: 3220 Anatomic pathology abstracts editors: Michael Cibull, MD, professor and vice chair, Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, assistant professor of pathology and laboratory medicine, University of Kentucky College of Medicine; and Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Morken, Timothy Sent: Friday, February 03, 2012 11:14 AM To: 'Gale Limron'; histonet@lists.utsouthwestern.edu Subject: [Histonet] RE: Breast IHC testing Remember that you can validate your testing for longer fixation. Run parallel ER/PR/Her2 testing with tissue fixed for various lengths of times and look at the staining correlation between groups. Most likely your longer fixation won't be a problem. If you do see a drop off with longer times you can probably adjust antigen retrieval time to alleviate that. Tim Morken Supervisor, Histology, IPOX UCSF Medical Center San Francisco, CA, USA -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Gale Limron Sent: Friday, February 03, 2012 7:24 AM To: histonet@lists.utsouthwestern.edu Subject: [Histon
[Histonet] RE: Breast IHC testing
This abstract is in the January 2012 edition of CAP Today. Effect of prolonged fixation on evaluation of ER, PR, and HER2 expression in breast cancer Expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 is important in predicting a response to targeted therapies in breast cancer. Therefore, immunohistochemical assays to determine hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status must be accurate and reproducible. Tissue fixation has been shown to play a crucial role in determining consistency in quality. Although guidelines impose upper limits for the fixation period, the data on which these limits are based are scant. The authors conducted a study to prospectively examine the effect of fixation of longer than 72 hours on these assays. In 101 invasive breast cancer samples, HR and HER2 status were compared between tumor blocks undergoing a short fixation period and those undergoing a period of prolonged fixation. Discordances were classified as an incremental change between categories of (i) a single order of magnitude-that is, a difference in the status of low positive (Allred score, 3) compared with positive (Allred score, 4 to 8) or negative (Allred score, 0 or 2) and vice versa for HRs and a difference in HER2 status of equivocal compared with negative or positive and vice versa or (ii) greater than a single order of magnitude-that is, a difference in the status of positive compared with negative or vice versa. The median fixation time for the short fixation group was 13 hours and 18 minutes (mean, 13 hours and 17 minutes; range, 10 hours and 33 minutes to 17 hours and 45 minutes) and for the prolonged fixation group was 79 hours and 22 minutes (mean, 79 hours and 35 minutes; range, 73 hours and 33 minutes to 102 hours and 30 minutes). Eight cases showed discordances, all of which were of a single order of magnitude, including one for ER, five for PR, and two for HER2. In six of these, a higher score was seen in the prolonged fixation group. The authors concluded that fixation for limited periods beyond 72 hours does not reduce assay sensitivity in determining ER, PR, or HER2 immunohistochemical status. Tong LC, Nelson N, Tsourigiannis J, et al. The effect of prolonged fixation on the immunohistochemical evaluation of estrogen receptor, progesterone receptor, and HER2 expression in invasive breast cancer: a prospective study. Am J Surg Pathol. 2011;35:545-552. Correspondence: Anna Marie Mulligan at mullig...@smh.ca [ Top ] Tom Podawiltz HT (ASCP) Histology Section Head/Laboratory Safety Officer. LRGHealthcare Laconia, NH 03246 603-524-3211 ext: 3220 Anatomic pathology abstracts editors: Michael Cibull, MD, professor and vice chair, Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, assistant professor of pathology and laboratory medicine, University of Kentucky College of Medicine; and Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Morken, Timothy Sent: Friday, February 03, 2012 11:14 AM To: 'Gale Limron'; histonet@lists.utsouthwestern.edu Subject: [Histonet] RE: Breast IHC testing Remember that you can validate your testing for longer fixation. Run parallel ER/PR/Her2 testing with tissue fixed for various lengths of times and look at the staining correlation between groups. Most likely your longer fixation won't be a problem. If you do see a drop off with longer times you can probably adjust antigen retrieval time to alleviate that. Tim Morken Supervisor, Histology, IPOX UCSF Medical Center San Francisco, CA, USA -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Gale Limron Sent: Friday, February 03, 2012 7:24 AM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Breast IHC testing I would like to know what other hospitals are doing with breast specimens that are resected on Friday and are in formalin longer than the maximum number of hours that CAP allows for ER/PR and HER2/neu testing. We are running into this problem since we don't currently work Saturday hours. Thank you! Gale Limron CT,HT (ASCP) Histology Supervisor Union Hospital 659 Boulevard Dover, Ohio 44622 330-343-3311 ext 2562 This e-mail is intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. Dissemination, distribution or copying of this e-mail or the information herein by anyone other than the intend
[Histonet] RE: Breast IHC testing
Remember that you can validate your testing for longer fixation. Run parallel ER/PR/Her2 testing with tissue fixed for various lengths of times and look at the staining correlation between groups. Most likely your longer fixation won't be a problem. If you do see a drop off with longer times you can probably adjust antigen retrieval time to alleviate that. Tim Morken Supervisor, Histology, IPOX UCSF Medical Center San Francisco, CA, USA -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Gale Limron Sent: Friday, February 03, 2012 7:24 AM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Breast IHC testing I would like to know what other hospitals are doing with breast specimens that are resected on Friday and are in formalin longer than the maximum number of hours that CAP allows for ER/PR and HER2/neu testing. We are running into this problem since we don't currently work Saturday hours. Thank you! Gale Limron CT,HT (ASCP) Histology Supervisor Union Hospital 659 Boulevard Dover, Ohio 44622 330-343-3311 ext 2562 This e-mail is intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. Dissemination, distribution or copying of this e-mail or the information herein by anyone other than the intended recipient, or an employee or agent responsible for delivering the message to the intended recipient, is prohibited. If you received this message in error, please delete without copying and kindly e-mail a reply to inform us of the mistake in delivery. ___ 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] RE: Breast IHC testing
We have a med tech take the tissue off the processor for us. It waits very patiently till we get in on Monday to embed it! j Joyce Weems Pathology Manager Saint Joseph's Hospital 5665 Peachtree Dunwoody Rd NE Atlanta, GA 30342 678-843-7376 - Phone 678-843-7831 - Fax -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Gale Limron Sent: Friday, February 03, 2012 10:24 To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Breast IHC testing I would like to know what other hospitals are doing with breast specimens that are resected on Friday and are in formalin longer than the maximum number of hours that CAP allows for ER/PR and HER2/neu testing. We are running into this problem since we don't currently work Saturday hours. Thank you! Gale Limron CT,HT (ASCP) Histology Supervisor Union Hospital 659 Boulevard Dover, Ohio 44622 330-343-3311 ext 2562 This e-mail is intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. Dissemination, distribution or copying of this e-mail or the information herein by anyone other than the intended recipient, or an employee or agent responsible for delivering the message to the intended recipient, is prohibited. If you received this message in error, please delete without copying and kindly e-mail a reply to inform us of the mistake in delivery. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet Confidentiality Notice: This e-mail, including any attachments is the property of Catholic Health East and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] RE: Breast IHC testing
When these guidelines were originally published, we moved some per diem hours from a Monday to a Sunday. This has assured minimum as well as maximum fixation times. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Gale Limron Sent: Friday, February 03, 2012 10:24 AM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Breast IHC testing I would like to know what other hospitals are doing with breast specimens that are resected on Friday and are in formalin longer than the maximum number of hours that CAP allows for ER/PR and HER2/neu testing. We are running into this problem since we don't currently work Saturday hours. Thank you! Gale Limron CT,HT (ASCP) Histology Supervisor Union Hospital 659 Boulevard Dover, Ohio 44622 330-343-3311 ext 2562 This e-mail is intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. Dissemination, distribution or copying of this e-mail or the information herein by anyone other than the intended recipient, or an employee or agent responsible for delivering the message to the intended recipient, is prohibited. If you received this message in error, please delete without copying and kindly e-mail a reply to inform us of the mistake in delivery. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet CONFIDENTIALITY NOTICE This message and any included attachments are from Somerset Medical Center and are intended only for the addressee. The information contained in this message is confidential and may contain privileged, confidential, proprietary and/or trade secret information entitled to protection and/or exemption from disclosure under applicable law. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or you may call Somerset Medical Center's computer Help Desk at 908-685-2200, ext. 4050. Be sure to visit Somerset Medical Center's Web site - www.somersetmedicalcenter.com - for the most up-to-date news, event listings, health information and more. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
