Detection of estrogen receptor proteins in breast tumors using an improved APAAP immunohistochemical technique

Detection of lymphatic invasion in resected cases of primary pancreatic cancer based on immunohistochemistry of D2-40

We investigated the presence of lymphatic invasion detected by D2-40 immunostaining compared to conventional hematoxylin-eosin (HE) staining in primary pancreatic cancer. We also compared the alkaline phosphatase-fast red detection method with the 3,3'-diaminobenzidine (DAB) detection method. We reviewed 25 cases of pancreatic cancer with lymph node (LN) metastases and 15 cases without LN metastases and evaluated the detection rate of lymphatic invasion by HE stain slide alone and D2-40 immunostains. Regarding the cases with positive LN metastasis, 4 (16%) of the 25 cases showed lymphatic invasion by HE slide alone, whereas 7 cases (28%) demonstrated positive lymphatic invasion by D2-40 immunostain. On the other hand, even in cases with negative LN metastasis, 3 of the 15 cases revealed lymphatic invasion by D2-40 immunostaining. Lymphatic invasion was easily detected by alkaline phosphatase-fast red technique, especially at the lower magnification. Regarding the location of lymphatic invasion, it was recognized not only at the peripheral portion but also in the central part of the tumors by D2-40 immunostains; this was difficult to identify by HE stain slide alone. Our study indicates that lymphatic invasion may be overlooked when only HE stain slides are used. In addition, the alkaline phosphatase-fast red detection method (vivid red color) is a distinctive advantage compared with the DAB detection method (brown color), especially in detecting lymphatic invasion at the lower magnification.

Hormone receptor expression in male breast cancers

SummaryMale breast cancers are rare but have been found in higher proportions in Black Africans. Prognostic factors for breast cancers include tumour size, grade and stage, and hormone receptor status. The hormone receptor status is an invaluable guide in the use of adjuvant endocrine therapy, but none of the reports available in the literature from Africa showed any receptor work.This study was conducted to determine the grade, lymph node status and hormone receptor status of male breast cancers in Ghana.Nine archival cases of male breast cancers from the Pathology Department of Korle Bu Teaching Hospital were selected and studied on the basis of the presence of enough material for immunocytochemistry. Haematoxylin and Eosin (H & E) stained slides were reviewed and graded by Bloom and Richardson's criteria. Lymph node status was also assessed and sections were stained for oestrogen and progesterone receptors.Seven of the nine tumours were invasive ductal carcinomas and six of these were grade II, and one was grade III. Four cases had axillary lymph nodes removed at surgery and three were positive for metastases. Six (66%) of the cases were positive for oestrogen receptors with an H score ranging from 20 to 300. Using the criteria of McCarty et al, positivity for oestrogen receptor was reduced to 44%, which is lower than for Caucasians. We believe that this may be explained by the fact that in Ghana male breast cancers are seen a decade earlier. Only two cases were positive for progesterone receptor with an H score of 10 and 75. The two cases positive for progesterone receptors were also positive for oestrogen receptors.It is concluded that hormone receptor study is important in deciding on endocrine and adjuvant chemotherapy in male breast cancers and should be done routinely to help surgeons plan postoperative management of these patients. We recommend further research in this area.

Comparative analysis of the biochemical and immunohistochemical determination of hormone receptors in invasive breast carcinoma influence of the tumor-stroma ratio

Tumor samples obtained from 106 primary breast cancer patients were examined biochemically (DCCA) and immunohistochemically (IHC) for estrogen (ER) and progesterone receptors (PR) to assess a quantitative relationship between both assays and to study the influence of the tumor-stroma ratio on this quantitative relationship. We used a model of logit transformation of IHC values (% of positive cells) and logarithmic transformation of DCCA values (fmol receptor/mg cytosolic protein). Tumors were subdivided into three categories according to the tumor-stroma ratio (more (t > s), equal amounts (t = s) or less (t < s) tumor than stroma), and the influence of the tumor-stroma ratio was studied using multiple regression analysis. We report a mathematical relationship between the results of the biochemical and immunohistochemical assays for the determination of ER status and PR status in primary breast cancer patients (ER: log DCCA(fmol/mg) = 0.369 logit (IHC(%pos cells)) + 2.328 (r = 0.573; p < 0.0001); PR: log DCCA (fmol/mg) = 0.474 logit (IHC(%pos cells)) + 0, 00 (r = 0.634; p < 0.0001)). In tumors overexpressing ER immunohistochemically (>10% nuclear positivity), median ER-DCCA is significantly higher if the tumor-stroma ratio is greater than 1. As these patients respond to hormonal treatment, depending on the degree of expression of both receptors, this study suggests that the biochemical assay be avoided because this technique is hampered by false-negative or falsely low results due to the loss of morphological information on the tumor-stroma ratio.

Prognostic significance of estrogen receptors in 405 primary breast cancers: a comparison of immunohistochemical and biochemical methods

Over the last few years, estrogen receptor determination by means of immunohistochemistry has been extensively used. The aim of this study was to compare this technique with estrogen receptor determination by means of dextran-coated charcoal, and to evaluate whether one of the two methods is more predictive of prognosis. Estrogen receptors were determined by means of both the dextran-coated charcoal method and immunohistochemistry in 405 patients with primary breast cancer; age, pathological tumor size, nodal status, and progesteron receptors by dextran-coated charcoal method were also recorded. The disease-free and overall survival probabilities were estimated using the product-limit method; Cox's proportional hazard model was used to evaluate the prognostic role of estrogen receptors as determined by the two methods. There appears to be a close association between estrogen receptor determination by the two methods (81.5% of concordant results) and their prognostic role was similar, even when the patients were divided into different groups (on the basis of their estrogen receptor status) and adjustments for the effect of other prognostic variables were taken into account. Our study shows that the two methods can be used indifferently to evaluate estrogen receptor status as a prognostic factor in breast cancer patients.

Estrogen receptors in 699 primary breast cancers: a comparison of immunohistochemical and biochemical methods

BACKGROUND

Over the last few years, estrogen receptor (ER) determination by immunohistochemistry (ER-ICA) has been extensively used, but it still remains to be established whether this method can replace the standard biochemical technique using dextran-coated charcoal (ERDCC).

PATIENTS AND METHODS

ER were determined by both the dextran-coated charcoal (DCC) method and immunohistochemistry (ICA) in 699 patients with primary breast cancer; other parameters (age, pathological T-pT- and nodal status -pN-, progesterone receptors by DCC, proliferative index by ICA) were also recorded. The 'best' cut-off for ERICA was evaluated by means of Receiver Operating Characteristics (R.O.C.) analysis; logistic regression analysis was used to find adequate 'weights' for stain intensity.

RESULTS AND CONCLUSIONS

A significant correlation was found between the two methods (p < 0.001). R.O.C. analysis revealed that the 'best' cut-off for the ERICA score was 45% (sensitivity 0.810, specificity 0.804). Logistic regression analysis showed that an ERICA score which also considers staining intensity does not add any useful information concerning ER content in breast cancers.

Oestrogen receptor, progesterone receptor, pS2, ERD5, HSP27 and cathepsin D in invasive ductal breast carcinomas

Hormonal receptors and markers for prognostic evaluation were detected immunohistochemically in 196 infiltrating ductal breast carcinomas. Immunohistochemical detection of progesterone and oestrogen receptor is a method giving results generally concordant with those of the binding assay. However, immunohistochemical detection seems better. It allows the detection of hormonal receptors on small carcinomas, it is not modified by the endogenous hormones, and it has a slightly better correlation with prognosis and with the response to hormone therapy. Immunohistochemical detection of progesterone receptor has a prognostic value, sorting a negative subgroup with a poor prognosis from the oestrogen receptor positive tumours. These results can be obtained without quantitative immunohistological methods. ERD5, pS2, HSP27 and cathepsin D are associated with oestrogen receptor positivity. pS2 and HSP27 are interesting markers. They characterize a subgroup of oestrogen receptor negative tumours with a good prognosis. Moreover, pS2 is a marker of response to hormone therapy. ERD5 and cathepsin D do not appear to be of value as markers of prognosis.

A simplified histoscore for the estrogen receptor assay in breast cancer

Different histoscores combining the number of positive cells and the intensity of staining have been used to evaluate the estrogen receptor immunocytochemical assay (ER-ICA). Our aim was to investigate if the simple estimation of the amount of positive cells could be sufficient for the semiquantitative analysis of ER-ICA. Tissue from 51 women with ductal breast carcinoma was used. Half of each sample was processed with the quantitative assay (ER-EIA) and the other half with ER-ICA. Microscopical analysis was performed by two independent observers and classified on a simple scale from 0 to 4+. With EIA 31 cases (60.78%) were positive and 20 (39.21%) negative. With ER-ICA 29 (56.86%) had immunostaining, whereas 22 (43.13%) did not. 95.83% of the ER-ICA positive cases and 77.7% of ER-ICA negative had a good correlation with EIA values. Statistical analysis showed a high degree of correlation (r = 0.88 p 0.001). Hence, simple semiquantitative estimation in ER-ICA is sufficient to provide useful information for clinical use about ER content in tissue sections.

Determination of estrogen receptors in paraffin-embedded tissue. Techniques and the value in breast cancer treatment

Estrogen receptor (ER) analysis in breast cancer has been used in three clinical situations: to select patients with advanced breast cancer for hormonal therapy, as a prognostic parameter, and for selection of women with early breast cancer to adjuvant hormonal treatment. ER has traditionally been measured using labelled hormone in binding assays--often in dextran-coated charcoal assays (DCC). Monoclonal antibodies to ER has permitted development of a solid phase enzyme immunoassay (ER-EIA) used for quantitative determination of ER in tissue homogenates, and have also been used for determination of ER using an immunohistochemical assay in frozen sections (ER-ICA) or in formalin-fixed, paraffin-embedded tissue (ER-PAR). A large number of studies has compared ER-EIA with ER-DCC assays. There is a good linear correlation between the two types of assay but ER-EIA measure more ER and classify a larger fraction of tumors ER-positive than conventional ER assays. Lack of clinical data makes the significance of this uncertain. Numerous studies have reported on the correlation between ER-ICA and ER-DCC or ER-EIA. There is a good correlation among the assays on classification of ER status with a median 86% concordance, but a somewhat poorer correlation between semiquantified ER of immunohistochemical assays and ER determined by the quantitative methods (median coefficient of correlation 0.67). There is a large variation in the cut-off level for definition of ER-positive in immunohistochemical assays emphasizing the need for quality control studies. The major problem involved in ER analysis in paraffin-embedded tissue is a considerable loss of immunoreactivity compared to sections from frozen tissue. This can partly be overcome by modifications of the immunohistochemical technique using enzyme pretreatment and other amplification systems, but the sensitivity of ER-PAR remains lower than ER-ICA despite these modifications, and the ER status is less reliably determined in tumors with low ER contents (< 100 fmol). The prognostic value of ER-PAR was evaluated with a multivariate analysis. The endpoint was disease-free interval in systemically untreated patients with early breast cancer, and the variables used were: ER-DCC, ER-PAR, age, tumor size, tumor grade, and nodal status. A total of 133 patients from the Danish Breast Cancer Cooperative Group's (DBCG) 77c protocols had a complete set of variables. The analysis showed that only nodal status, ER-DCC, and tumor grade were significant and independent prognostic variables. An overview of larger multivariate studies on mainly node-negative patients failed to show independent prognostic significance of ER-DCC.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies. Histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival

Breast cancer specimens from 600 women were assayed for estrogen receptors (ER) using an immunocytochemical assay (ICA) employing the monoclonal antiestrophilin antibody H222 Sp gamma. Results showed significant correlation with biochemical ER determinations as well as with tumor grade and menopausal status. In 449 cases, results of progesterone receptor assay by ICA using the monoclonal anti-PgR antibody KD 68, also correlated significantly with biochemical PgR measurements. The ERICA/PgRICA positivity was significantly more frequent in postmenopausal white women. Colloid carcinomas were most likely to be ERICA positive and PgRICA positive whereas medullary carcinomas were most often negative. In 47 patients with advanced mammary carcinoma, results of ERICA and PgRICA were more closely related to endocrine response than those of ER and PgR by dextran-coated charcoal assay (DCC). In 339 women with Stage I or Stage II breast cancer, ERICA was significantly associated with disease-free survival. Analysis by Cox's proportional hazard model, however, showed PgRICA to be the best predictor of survival and disease-free survival in 197 women at the same stages of disease. These data indicate that ICA is more predictive of prognosis than biochemical ER and PgR. The ease of ICA performance coupled with these results indicate that the method is an acceptable substitute for DCC in analyzing breast cancers for ER/PgR.

Biological response modifiers in the management of patients with breast cancer

Despite impressive progress in understanding the biology of breast cancer, mechanisms of host defense, and the pathophysiology of the metastatic process, this burgeoning fact bank has made little impact on the management of patients with breast cancer. There are many interesting ideas for improved diagnosis and therapy in various stages of development, but few have actually translated into improved survival of patients with breast cancer. Potentially useful biological agents include cytokines, monoclonal antibodies, immunotoxins, vaccines, and adoptive cellular therapies. Therapies targetting growth factor receptors and the cellular machinery required for metastasis may become useful, especially when used in combination with other cytotoxic agents. Colony-stimulating factors may allow a test of the hypothesis that augmented dose-intensity of cytotoxic chemotherapy will cure more patients. Though we are not yet sure precisely how to use all of these new tools, there can be little doubt that their application will make a significant impact on the management of patients with breast cancer and other malignancies in the next decade.

Oestrogen receptors in macrophages

The presence of receptors for oestradiol-17 beta and 5 alpha-dihydrotestosterone (5 alpha-DHT) in the human monocytic leukaemia cell line J111 and rat peritoneal macrophages was investigated using whole-cell assays. For both cell types, high-affinity binding species for oestrogen were detected, whereas no indication of specific binding was observed for 5 alpha-DHT. Analysis of the data according to Scatchard showed curved lines, indicating the presence of two different oestrogen-binding species. The dissociation constant (Kd) values for the receptors of the rat peritoneal macrophages were calculated to be 1.4 x 10(-10) M and 3.3 x 10(-9) M, while for the J111 cells, the Kd values were 8.7 x 10(-11) M and 2.5 x 10(-9) M. Sucrose-gradient ultracentrifugation identified one oestrogen-binding species of 7.1S. The receptors had a relatively high affinity for diethylstilboestrol (DES) but did not bind to a monoclonal antibody specific for the classical oestrogen receptor, suggesting that oestrogen receptors in macrophages could be of a different type.

Coexistence of cytoplasmic and nuclear estrogen receptors. A histochemical study on human mammary cancer and rabbit uterus

Consecutive serial cryostat-frozen sections of 157 human mammary carcinomas and the uteri of six immature New Zealand white rabbits were stained histochemically for cytoplasmic estrogen receptor (ER) and nuclear ER by a fluorescent estrogen compound (Fluorocep Estrogen, Zeus Technologies, Inc., Raritan, NJ) and by a monoclonal antibody immunoperoxidase technique (ER-ICA, Abbott Laboratories, North Chicago, IL), respectively. The percentage of the ER-positive cells in the cancer cell population under observation was estimated and recorded. The results of the cytoplasmic ER assay were compared with those of the nuclear ER assay in each tumor; all cancers with less than 10% ER-positive cancer cells were grouped together as ER-negative tumors, the cancers with 30% or more ER-positive cancer cells as ER-positive tumors, and those with 10% to 29% ER-positive cancer cells as borderline positive. According to this manner of classification, 94% to 97% of the ER-positive mammary carcinomas diagnosed by one histochemical assay would have been identified as such by the other with no more than 10% difference in the ER-positive cell counts. The majority of ER-positive breast cancer cells and practically all of the luminal lining cells of the immature rabbit endometrium had coexistent cytoplasmic and nuclear ER. In the mammary cancers containing less than 30% ER-positive cancer cells, there was a greater (up to 20%) discrepancy in positive cell counts between the cytoplasmic ER assay and the nuclear ER assay. This discrepancy may be due to sampling errors of small clones of ER-positive cancer cells in two adjacent sections, difference in antigenic determinants between the cytoplasmic and the nuclear ER, and the binding sites in the nuclear ER being preoccupied by estrogen. The findings of this study appear to support the hypothesis that there are ER in the cytoplasm and the nucleus of the mammary carcinoma cells and the epithelial cells of the endometrium.