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Terrenato I, Arena V, Pizzamiglio S, Pennacchia I, Perracchio L, Buglioni S, Ercolani C, Sperati F, Costarelli L, Bonanno E, Baldini D, Candia S, Crescenzi A, Dal Mas A, Di Cristofano C, Gomes V, Grillo LR, Pasquini P, Pericoli MN, Ramieri MT, Di Stefano D, Ruco L, Scarpino S, Vitolo D, d’Amati G, Paradiso A, Verderio P, Mottolese M. External Quality Assessment (EQA) program for the preanalytical and analytical immunohistochemical determination of HER2 in breast cancer: an experience on a regional scale. J Exp Clin Cancer Res 2013; 32:58. [PMID: 23965490 PMCID: PMC3766003 DOI: 10.1186/1756-9966-32-58] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/10/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND An External Quality Assessment (EQA) program was developed to investigate the state of the art of HER2 immunohistochemical determination in breast cancer (BC) in 16 Pathology Departments in the Lazio Region (Italy). This program was implemented through two specific steps to evaluate HER2 staining (step 1) and interpretation (step 2) reproducibility among participants. METHODS The management activities of this EQA program were assigned to the Coordinating Center (CC), the Revising Centers (RCs) and the Participating Centers (PCs). In step 1, 4 BC sections, selected by RCs, were stained by each PC using their own procedures. In step 2, each PC interpreted HER2 score in 10 BC sections stained by the CC. The concordance pattern was evaluated by using the kappa category-specific statistic and/or the weighted kappa statistic with the corresponding 95% Jackknife confidence interval. RESULTS In step 1, a substantial/almost perfect agreement was reached between the PCs for scores 0 and 3+ whereas a moderate and fair agreement was observed for scores 1+ and 2+, respectively.In step 2, a fully satisfactory agreement was observed for 6 out of the 16 PCs and a quite satisfactory agreement was obtained for the remaining 10 PCs. CONCLUSIONS Our findings highlight that in the whole HER2 evaluation process the two intermediate categories, scores 1+ and 2+, are less reproducible than scores 0 and 3+. These findings are relevant in clinical practice where the choice of treatment is based on HER2 positivity, suggesting the need to share evaluation procedures within laboratories and implement educational programs.
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Affiliation(s)
- Irene Terrenato
- Biostatistic Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy
| | - Vincenzo Arena
- Institute of Pathology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
| | - Sara Pizzamiglio
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Pennacchia
- Institute of Pathology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
| | - Letizia Perracchio
- Pathology Department, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Simonetta Buglioni
- Pathology Department, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Cristiana Ercolani
- Pathology Department, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Francesca Sperati
- Biostatistic Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy
| | - Leopoldo Costarelli
- Department of Pathology, San Giovanni-Addolorata Hospital, Via dell’Amba Aradam 9, Rome, Italy
| | - Elena Bonanno
- Anatomic Pathology, Dept of Biomedicine and Prevention University of Rome Tor Vergata, Viale Oxford 81, Rome, Italy
| | - Daniela Baldini
- Pathology Department, San Filippo Neri Hospital, Via Martinotti 20, Rome, Italy
| | - Silvia Candia
- Pathology Department, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, Rome, Italy
| | - Anna Crescenzi
- Pathology Department, Regina Apostolorum Hospital, Via S.Francesco 50, Albano Laziale, Rome, Italy
| | - Antonella Dal Mas
- Pathology Department, San Salvatore Hospital, Via Vetoio-Coppito, L’Aquila, Italy
| | - Claudio Di Cristofano
- Department of Experimental Medicine, Sapienza University of Rome, I.C.O.T, Via Franco Faggiana 68, Latina, Italy
| | - Vito Gomes
- Pathology Department, Bel Colle Hospital, Strada S. Martinese, Viterbo, Italy
| | - Lucia Rosalba Grillo
- Pathology Department, San Camillo Forlanini Hospital, Via Gianicolense 1, Rome, Italy
| | - Paola Pasquini
- Pathology Department, Coelio Military Hospital, Piazza Cellimontana 50, Rome, Italy
| | | | | | - Domenica Di Stefano
- Department of Cytology and Histology, University of Rome La Sapienza, Ospedale S. Andrea, Via di Grottarossa 1035, Rome, 00189, Italy
| | - Luigi Ruco
- Department of Cytology and Histology, University of Rome La Sapienza, Ospedale S. Andrea, Via di Grottarossa 1035, Rome, 00189, Italy
| | - Stefania Scarpino
- Department of Cytology and Histology, University of Rome La Sapienza, Ospedale S. Andrea, Via di Grottarossa 1035, Rome, 00189, Italy
| | - Domenico Vitolo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, Rome, 00161, Italy
| | - Giulia d’Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, Rome, 00161, Italy
| | - Angelo Paradiso
- Clinical Experimental Oncology Department, National Cancer Research Centre, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Paolo Verderio
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcella Mottolese
- Pathology Department, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
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Konsti J, Lundin M, Joensuu H, Lehtimäki T, Sihto H, Holli K, Turpeenniemi-Hujanen T, Kataja V, Sailas L, Isola J, Lundin J. Development and evaluation of a virtual microscopy application for automated assessment of Ki-67 expression in breast cancer. BMC Clin Pathol 2011; 11:3. [PMID: 21262004 PMCID: PMC3040126 DOI: 10.1186/1472-6890-11-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 01/25/2011] [Indexed: 12/14/2022] Open
Abstract
Background The aim of the study was to develop a virtual microscopy enabled method for assessment of Ki-67 expression and to study the prognostic value of the automated analysis in a comprehensive series of patients with breast cancer. Methods Using a previously reported virtual microscopy platform and an open source image processing tool, ImageJ, a method for assessment of immunohistochemically (IHC) stained area and intensity was created. A tissue microarray (TMA) series of breast cancer specimens from 1931 patients was immunostained for Ki-67, digitized with a whole slide scanner and uploaded to an image web server. The extent of Ki-67 staining in the tumour specimens was assessed both visually and with the image analysis algorithm. The prognostic value of the computer vision assessment of Ki-67 was evaluated by comparison of distant disease-free survival in patients with low, moderate or high expression of the protein. Results 1648 evaluable image files from 1334 patients were analysed in less than two hours. Visual and automated Ki-67 extent of staining assessments showed a percentage agreement of 87% and weighted kappa value of 0.57. The hazard ratio for distant recurrence for patients with a computer determined moderate Ki-67 extent of staining was 1.77 (95% CI 1.31-2.37) and for high extent 2.34 (95% CI 1.76-3.10), compared to patients with a low extent. In multivariate survival analyses, automated assessment of Ki-67 extent of staining was retained as a significant prognostic factor. Conclusions Running high-throughput automated IHC algorithms on a virtual microscopy platform is feasible. Comparison of visual and automated assessments of Ki-67 expression shows moderate agreement. In multivariate survival analysis, the automated assessment of Ki-67 extent of staining is a significant and independent predictor of outcome in breast cancer.
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Affiliation(s)
- Juho Konsti
- FIMM - Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
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