American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer (Unabridged Version)

Author:

Hammond M. Elizabeth H.,Hayes Daniel F.,Dowsett Mitch,Allred D. Craig,Hagerty Karen L.,Badve Sunil,Fitzgibbons Patrick L.,Francis Glenn,Goldstein Neil S.,Hayes Malcolm,Hicks David G.,Lester Susan,Love Richard,Mangu Pamela B.,McShane Lisa,Miller Keith,Osborne C. Kent,Paik Soonmyung,Perlmutter Jane,Rhodes Anthony,Sasano Hironobu,Schwartz Jared N.,Sweep Fred C. G.,Taube Sheila,Torlakovic Emina Emilia,Valenstein Paul,Viale Giuseppe,Visscher Daniel,Wheeler Thomas,Williams R. Bruce,Wittliff James L.,Wolff Antonio C.

Abstract

Abstract Purpose.—To develop a guideline to improve the accuracy of immunohistochemical (IHC) estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer and the utility of these receptors as predictive markers. Methods.—The American Society of Clinical Oncology and the College of American Pathologists convened an international Expert Panel that conducted a systematic review and evaluation of the literature in partnership with Cancer Care Ontario and developed recommendations for optimal IHC ER/PgR testing performance. Results.—Up to 20% of current IHC determinations of ER and PgR testing worldwide may be inaccurate (false negative or false positive). Most of the issues with testing have occurred because of variation in pre-analytic variables, thresholds for positivity, and interpretation criteria. Recommendations.—The Panel recommends that ER and PgR status be determined on all invasive breast cancers and breast cancer recurrences. A testing algorithm that relies on accurate, reproducible assay performance is proposed. Elements to reliably reduce assay variation are specified. It is recommended that ER and PgR assays be considered positive if there are at least 1% positive tumor nuclei in the sample on testing in the presence of expected reactivity of internal (normal epithelial elements) and external controls. The absence of benefit from endocrine therapy for women with ER-negative invasive breast cancers has been confirmed in large overviews of randomized clinical trials.

Publisher

Archives of Pathology and Laboratory Medicine

Subject

Medical Laboratory Technology,General Medicine,Pathology and Forensic Medicine

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