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Rakha EA, Tan PH, Quinn C, Provenzano E, Shaaban AM, Deb R, Callagy G, Starczynski J, Lee AHS, Ellis IO, Pinder SE. UK recommendations for HER2 assessment in breast cancer: an update. J Clin Pathol 2023; 76:217-227. [PMID: 36564170 DOI: 10.1136/jcp-2022-208632] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022]
Abstract
The last UK breast cancer (BC) human epidermal growth factor receptor 2 (HER2) testing guideline recommendations were published in 2015. Since then, new data and therapeutic strategies have emerged. The American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) published a focused update in 2018 that reclassified in situ hybridisation (ISH) Group 2 (immunohistochemistry (IHC) score 2+and HER2/chromosome enumeration probe 17 (CEP17) ratio ≥2.0 and HER2 copy number <4.0 signals/cell), as well as addressed other concerns raised by previous guidelines. The present article further refines UK guidelines, with specific attention to definitions of HER2 status focusing on eight key areas: (1) HER2 equivocal (IHC 2+) and assignment of the ASCO/CAP ISH group 2 tumours; (2) the definition of the group of BCs with low IHC scores for HER2 with emphasis on the distinction between IHC score 1+ (HER2-Low) from HER2 IHC score 0 (HER2 negative); (3) reporting cases showing HER2 heterogeneity; (4) HER2 testing in specific settings, including on cytological material; (5) repeat HER2 testing, (6) HER2 testing turnaround time targets; (7) the potential role of next generation sequencing and other diagnostic molecular assays for routine testing of HER2 status in BC and (8) use of image analysis to score HER2 IHC. The two tiered system of HER2 assessment remains unchanged, with first line IHC and then ISH limited to IHC equivocal cases (IHC score 2+) but emerging data on the relationship between IHC scores and levels of response to anti-HER2 therapy are considered. Here, we present the latest UK recommendations for HER2 status evaluation in BC, and where relevant, the differences from other published guidelines.
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Affiliation(s)
- Emad A Rakha
- Cellular Patthology Department, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Cecily Quinn
- Department of Histopathology, St Vincent's University Hospital, Elm Park and and UCD School of Medicine, Dublin, Ireland
| | - Elena Provenzano
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - Abeer M Shaaban
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trusts and Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rahul Deb
- Cellular Pathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Grace Callagy
- Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Jane Starczynski
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trusts, Birmingham, UK
| | - Andrew H S Lee
- Cellular Pathology Department, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian O Ellis
- Cellular Patthology Department, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah E Pinder
- School of Cancer & Pharmaceutical Sciences, Kings College London, London, UK
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Oberndorfer F, Moling S, Hagelkruys LA, Grimm C, Polterauer S, Sturdza A, Aust S, Reinthaller A, Müllauer L, Schwameis R. Risk Reclassification of Patients with Endometrial Cancer Based on Tumor Molecular Profiling: First Real World Data. J Pers Med 2021; 11:48. [PMID: 33467460 PMCID: PMC7830511 DOI: 10.3390/jpm11010048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Recently, guidelines for endometrial cancer (EC) were released that guide treatment decisions according to the tumors' molecular profiles. To date, no real-world data regarding the clinical feasibility of molecular profiling have been released. This retrospective, monocentric study investigated the clinical feasibility of molecular profiling and its potential impact on treatment decisions. Tumor specimens underwent molecular profiling (testing for genetic alterations, (immune-)histological examination of lymphovascular space invasion (LVSI), and L1CAM) as part of the clinical routine and were classified according to the European Society for Medical Oncology (ESMO) classification system and to an integrated molecular risk stratification. Shifts between risk groups and potential treatment alterations are described. A total of 60 cases were included, of which twelve were excluded (20%), and eight of the remaining 48 were not characterized (drop-out rate of 16.7%). Molecular profiling revealed 4, 6, 25, and 5 patients with DNA polymerase-epsilon mutation, microsatellite instability, no specific molecular profile, and TP53 mutation, respectively. Three patients had substantial LVSI, and four patients showed high L1CAM expression. Molecular profiling took a median of 18.5 days. Substantial shifts occurred between the classification systems: four patients were upstaged, and 19 patients were downstaged. Molecular profiling of EC specimens is feasible in a daily routine, and new risk classification systems will change treatment decisions substantially.
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Affiliation(s)
- Felicitas Oberndorfer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (F.O.); (L.A.H.); (L.M.)
| | - Sarah Moling
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.M.); (S.P.); (S.A.); (A.R.); (R.S.)
| | - Leonie Annika Hagelkruys
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (F.O.); (L.A.H.); (L.M.)
| | - Christoph Grimm
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.M.); (S.P.); (S.A.); (A.R.); (R.S.)
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, 1090 Vienna, Austria
| | - Stephan Polterauer
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.M.); (S.P.); (S.A.); (A.R.); (R.S.)
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, 1090 Vienna, Austria
| | - Alina Sturdza
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Stefanie Aust
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.M.); (S.P.); (S.A.); (A.R.); (R.S.)
| | - Alexander Reinthaller
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.M.); (S.P.); (S.A.); (A.R.); (R.S.)
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, 1090 Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (F.O.); (L.A.H.); (L.M.)
| | - Richard Schwameis
- Comprehensive Cancer Center, Gynecologic Cancer Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.M.); (S.P.); (S.A.); (A.R.); (R.S.)
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, 1090 Vienna, Austria
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