Research Breast Invasive Carcinoma ER PR HER2Influence Factors Detected By Immunohistochemistry

Objective: Human Immunohistochemical detection forepidermal factor receptor2(HER2), estrogen receptor (ER), progesteronereceptor (PR) has become routine index for invasive breast cancertreatment. The results are important basis for patients adjuvant therapydecision.Many factors affect the ER, PR, HER2immunohistochemistrydetection results. The experiment focuses on:①To compare repeation ofresults interpretation for ER PR HER2of different qualificationpathologist,seeking objective and accurate reporting.②To comparerepeation of results interpretation for ER PR HER2between differentlaboratories, seeking to improve the accuracy of IHC results of differentlaboratories.③Research on the relationship between the fixed delay andthe level expression of ER, PR,HER2. Methods:Test A, slices of141cases is selected from routine pathology archives of Department ofPathology Luzhou Medical College during2012-2013.They werediagnosed to breast invasive carcinoma,including different levels ofER,PR,HER2. The ER,PR,HER2expression of141cases of breast cancerwere diagnosed by three different qualification pathologists for tworounds by independent blind method. Referring recommendations forHER2testing in breast cancer guideline by ASCO/CAP in2013and recommendations for ER PR testing for breast cancer guideline byASCO/CAP in2010. The Kappa analysis for ER, PR and HER2consistency between three different qualification pathologists UsingSTATA10.0Software. Test results P <0.05was considered statisticallysignificant.Test B, The90cases were selected from routine pathologyarchives of Department of Pathology of the Fourth People’s Hospital ofZigong City(Laboratory one),Sichuan during2012-2013,which wasdiagnosed to breast invasive carcinoma and was reviewed by highqualification pathologist.The immunohistochemical staining of ER, PRand HER2for57paraffin blocks from90cases by Department ofPathology of Luzhou Medical College (Laboratory two). The positive rateand staining intensity of ER,PR and HER2was diagnosed by twoexperienced pathologists by independent blind method.The sum of thepositive rate and staining intensity is M.ER,PR of M is the sum of thepositive rate and staining intensity, range of M values is0-6. HER2scoreof0-3+, M value through0-3. The Kappa analysis for reproducibility ofresults interpretation of ERＭ,PRＭ,HER2Ｍbetween two laboratoriesUsing STATA10.0Software.Test results P <0.05was consideredstatistically significant.Test C,20cases of surgery resection breastinvasive carcinoma tissue respectively immediately fixed, a fixed delay of2hours, a fixed delay of4hours for IHC detection.. The expression ofER, PR, HER2of these cases was diagnosed. ER, PR and HER2staining results were evaluated using the M value.Immediately fixed, the fixeddelay of2hours, fixed delay of4hours values are expressed as M1, M2,M4. M value was analyzed using SPSS11.5software rank sum test. Testresults P <0.05was considered statistically significant. Result:①TheKappa value of the positive rate and staining intensity of ER,PR is rangedfrom0.6103-0.6721among various qualificated pathologists (professor,associate professor, assistant professor). P<0.05was statistical significant.The Kappa value of the staining intensity of HER2is0.6923amongvarious qualificated pathologists.②ER, PR negative reproducibility isgood in94cases, Kappa values is ranged from0.8208-0.9339(P＜0.05).③HER23+positive reproducibility is good in47cases, Kappa values is0.8624(P＜0.05);HER21+positive reproducibility is low, Kappa valuesis0.3246(P＜0.05);④After two round, the results of three differentqualificated pathologists oneself reproducibility:Kappa values ofprofessor is0.7212-0.7471,(P <0.05), consistency is still good;Kappavalues of associate professor is0.7224-0.8029(P <0.05),consistency isbetter; Kappa values of assistant professor is0.8511-0.9306(P <0.05),consistency is excellent.⑤ER, PR, HER2IHC staining reproducibleresults between different laboratories analyze: The Kappa value of ERMis0.6667, consistent rate is80%(P <0.05);The Kappa value of PRMis0.6216, consistent rate is76.67%(P <0.05); Their reproducibility belongto a good level. The Kappa value of HER2Mis0.5263, consistent rate is 70%(P <0.05), reproducibility is a general.⑥The consistent rate ofnegative cases results of ER, PR, HER2is preferable among differentlaboratories,it is84.47%,Kappa value is0.7013(P <0.05), The consistentrate results of a high positive rate cases and a high staining intensity casesis low,its consistent rate is66.67%,Kappa value is0.4375(P <0.05).⑦20cases of PR:2cases M1＞M2＞M4；4cases M1＞M2=M4；6casesM1=M2＞M4；2cases M2=M4=0；4cases M4=0；2cases M1=M2=M4。（P＜0.05）20cases of HER2：4cases M1＞M2＞M4；6cases M1＞M2=M4；7cases M2=M4；1case M4=0；2cases M1=M2=M4(P＜0.05）.20cases of ER:1case M1＞M2＞M4；1case M2=M4=0；8casesM1=M2=M4；6cases M1＞M2=M4；4cases M1=M2＞M4（P＞0.05）,The difference was not statistically significant.Conclusion:①Theinterpretation reproducibility of ER, PR, HER2is still good among threequalificated pathologists. The results of professor interpretation isexcellent accuracy.The accuracy of the results is related to the experienceof pathologists.②The interpretation reproducibility results of moderatepositive rate,low positive rate, week and moderate staining intensity ofER,PR are slightly worse. It may be able to be more objective by using Msummed value of the positive rate and the staining intensity scores oftumor cells, but it needs to be more accumulated data.③It will be likelyget better repeatability when The antibody of the same number ofantibody clones and producted from the same company is used by different laboratories.④ER, PR immunohistochemistry should bedetected the sooner the better;The archived paraffin blocks withdecreased antigenicity is useful to explain the difference of test results ofER, PR, HER2between different laboratories and it also help to avoidmedical disputes.⑤The expression level of PR,HER2has a certainrelationship to fixed delay. fixed delay effect immunogenicity ofPR,HER2to some extent.The influence has also relationship totime.Postoperative tissue should be fixed as soon as possible to avoid thefixed delay of the center of tissue.