Testing for her2 in breast cancer: current pathology challenges faced in Canada

This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (her2)-positive breast cancer currently faced by pathologists in Canada: Pre-analysis issues affecting the accuracy of her2 testing in non-excision sample types: core-needle biopsies, effusion samples, fine-needle aspirates, and bone metastasesher2 testing of core-needle biopsies compared with surgical specimensCriteria for retesting her2 status upon disease recurrenceLiterature searches for each topic were carried out using the medline, Embase, International Pharmaceutical Abstracts, and biosis databases. In addition, the congress databases of the American Society of Clinical Oncology (2005-2011) and the San Antonio Breast Cancer Symposium (2007-2011) were searched for relevant abstracts.All authors are expert breast pathologists with extensive experience of her2 testing, and several participated in the development of Canadian her2 testing guidelines. For each topic, the authors present an evaluation of the current data available for the guidance of pathology practice, with recommendations for the optimization or improvement of her2 testing practice.

Updated recommendations from the Canadian National Consensus Meeting on HER2/neu testing in breast cancer

Testing for her2/neu in breast cancer at the time of primary diagnosis is now the standard of care. Accurate and standardized testing methods are of prime importance to ensure the proper classification of the patient’s her2/neu status. A meeting of pathologists from across Canada was convened to update the Canadian her2/neu testing guidelines. This National her2/neu Testing Committee reviewed the recently published American Society of Clinical Oncology/ College of American Pathologists (asco/cap) guidelines for her2/neu testing in breast cancer. The updated Canadian her2/neu testing guidelines are based primarily on the asco/cap guidelines, with some modifications. It is anticipated that widespread adoption of these guidelines will further improve the accuracy of her2/neu testing in Canada.

Brain hemorrhage associated with methanol poisoning

We recently treated seven patients who were victims of accidental methanol intoxication. Five of the seven patients died within 72 h of hospital admission. The two survivors were discharged from the hospital without visual or neurologic impairment. Hemorrhagic necrosis of the brain was found on CT scan and at autopsy in two patients who died. This complication of methanol intoxication prompted us to review our experience with this poison since 1980. Of 45 methanol intoxication patients treated in our ICU, CT scan was performed in 21, and brain hemorrhage was documented in six, thereby giving an incidence of at least six of 45 or 13.5%. Although hemorrhagic and nonhemorrhagic putamenal necrosis has been described from methanol poisoning previously, we postulate that heparinization during hemodialysis may contribute to brain hemorrhage complicating methanol poisoning and recommend the use of artificial kidneys with albumin-primed biocompatible membranes so that heparin administration during hemodialysis can be minimized.