Difference between revisions of "Template:Immunohistochemistry evaluation of invasive breast cancer"

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====Ki-67 index====
 
====Ki-67 index====
 
[[File:Positive immunohistochemistry of KI-67 in invasive breast cancer.jpg|thumb|Ki-67 in an invasive breast cancer: cancer nuclei are stained (brown). There is tumor cell positivity in 70% of the cells (''Ki-67 labelling index'' = 70%).]]
 
[[File:Positive immunohistochemistry of KI-67 in invasive breast cancer.jpg|thumb|Ki-67 in an invasive breast cancer: cancer nuclei are stained (brown). There is tumor cell positivity in 70% of the cells (''Ki-67 labelling index'' = 70%).]]
For Ki-67 index, there are two main methods, a faster "hot spot" method and the more comprehensive ''IKWG global average'':
+
Ki-67 index is mainly relevant in those with stage T1-T2, N0-N1, to determine if chemotherapy is needed (if Ki67 is >30% rather than <5%).<ref name="DowsettNielsen2011">{{cite journal|last1=Dowsett|first1=M.|last2=Nielsen|first2=T. O.|last3=A'Hern|first3=R.|last4=Bartlett|first4=J.|last5=Coombes|first5=R. C.|last6=Cuzick|first6=J.|last7=Ellis|first7=M.|last8=Henry|first8=N. L.|last9=Hugh|first9=J. C.|last10=Lively|first10=T.|last11=McShane|first11=L.|last12=Paik|first12=S.|last13=Penault-Llorca|first13=F.|last14=Prudkin|first14=L.|last15=Regan|first15=M.|last16=Salter|first16=J.|last17=Sotiriou|first17=C.|last18=Smith|first18=I. E.|last19=Viale|first19=G.|last20=Zujewski|first20=J. A.|last21=Hayes|first21=D. F.|title=Assessment of Ki67 in Breast Cancer: Recommendations from the International Ki67 in Breast Cancer Working Group|journal=JNCI Journal of the National Cancer Institute|volume=103|issue=22|year=2011|pages=1656–1664|issn=0027-8874|doi=10.1093/jnci/djr393}}</ref>
  
:Hot spot:
+
Ki-67 index is most feasibly quantified by a '''hot spot''' method,<ref group=notes>Besides from a hot spot method of Ki67 counting, there is also a ''IKWG global average'' method which is more comprehensive. However, the inter-observer difference between the hot spot method and the 'IKWG global average'' is not statistically significant, and has not shown any significant difference in clinical outcome (theoretically, the area of highest Ki-67 proliferative index is probably most likely to correlate with malignant transformation and risk of metastasis, making the hot spot both more straightforward and clinically relevant than a global average).<br>- '''Reference and instructions for the ''IKWG global average'' method:''' {{cite journal|last1=Dowsett|first1=M.|last2=Nielsen|first2=T. O.|last3=A'Hern|first3=R.|last4=Bartlett|first4=J.|last5=Coombes|first5=R. C.|last6=Cuzick|first6=J.|last7=Ellis|first7=M.|last8=Henry|first8=N. L.|last9=Hugh|first9=J. C.|last10=Lively|first10=T.|last11=McShane|first11=L.|last12=Paik|first12=S.|last13=Penault-Llorca|first13=F.|last14=Prudkin|first14=L.|last15=Regan|first15=M.|last16=Salter|first16=J.|last17=Sotiriou|first17=C.|last18=Smith|first18=I. E.|last19=Viale|first19=G.|last20=Zujewski|first20=J. A.|last21=Hayes|first21=D. F.|title=Assessment of Ki67 in Breast Cancer: Recommendations from the International Ki67 in Breast Cancer Working Group|journal=JNCI Journal of the National Cancer Institute|volume=103|issue=22|year=2011|pages=1656–1664|issn=0027-8874|doi=10.1093/jnci/djr393}}</ref> Hot spots are areas in which Ki-67 staining is particularly higher relative to the adjacent tumor areas.<ref name="ColemanJang2017">{{cite journal|last1=Coleman|first1=William B.|last2=Jang|first2=Min Hye|last3=Kim|first3=Hyun Jung|last4=Chung|first4=Yul Ri|last5=Lee|first5=Yangkyu|last6=Park|first6=So Yeon|title=A comparison of Ki-67 counting methods in luminal Breast Cancer: The Average Method vs. the Hot Spot Method|journal=PLOS ONE|volume=12|issue=2|year=2017|pages=e0172031|issn=1932-6203|doi=10.1371/journal.pone.0172031}}</ref> Usually, the invasive edge of a tumor is a hot spot.<ref name="ColemanJang2017"/> When a tumor had several hot spots, the “hottest” spot is selected.<ref name="ColemanJang2017"/> Aim to count at least 500 cells in each case, but this is not always possible in cases with low tumor cell density and small tumor size.<ref name="ColemanJang2017"/> Also aim to include at least three high-power (×40 objective) fields. Count a nucleus as “positive” if there is any definite brown staining in the nucleus of an invasive breast cancer cell, above the surrounding background in the cytoplasm and extracellular matrix.<ref>{{cite web|url=https://www.ki67inbreastcancerwg.org/wp-content/uploads/2018/12/Ki67-Phase-3b-WS-protocol-v1.pdf|title=Ki67-QC international working group: whole section scoring protocol (global method)|date=2018-11-29|website=International Ki67 in Breast Cancer Working Group}}</ref> If a comparisons must be made between core biopsies and sections from an excision, evaluation of the latter should be across the whole tumor.<ref name="DowsettNielsen2011"/>  Only nuclear staining counts. Staining intensity of a positive nucleus is not relevant.<ref name="DowsettNielsen2011"/>
Hot spots are areas in which Ki-67 staining is particularly higher relative to the adjacent tumor areas.<ref name="ColemanJang2017">{{cite journal|last1=Coleman|first1=William B.|last2=Jang|first2=Min Hye|last3=Kim|first3=Hyun Jung|last4=Chung|first4=Yul Ri|last5=Lee|first5=Yangkyu|last6=Park|first6=So Yeon|title=A comparison of Ki-67 counting methods in luminal Breast Cancer: The Average Method vs. the Hot Spot Method|journal=PLOS ONE|volume=12|issue=2|year=2017|pages=e0172031|issn=1932-6203|doi=10.1371/journal.pone.0172031}}</ref> Usually, the invasive edge of a tumor is a hot spot.<ref name="ColemanJang2017"/> When a tumor had several hot spots, the “hottest” spot is selected.<ref name="ColemanJang2017"/> Aim to count at least 500 cells in each case, but this is not always possible in cases with low tumor cell density and small tumor size.<ref name="ColemanJang2017"/> Also aim to include at least three high-power (×40 objective) fields.<ref name="DowsettNielsen2011">{{cite journal|last1=Dowsett|first1=M.|last2=Nielsen|first2=T. O.|last3=A'Hern|first3=R.|last4=Bartlett|first4=J.|last5=Coombes|first5=R. C.|last6=Cuzick|first6=J.|last7=Ellis|first7=M.|last8=Henry|first8=N. L.|last9=Hugh|first9=J. C.|last10=Lively|first10=T.|last11=McShane|first11=L.|last12=Paik|first12=S.|last13=Penault-Llorca|first13=F.|last14=Prudkin|first14=L.|last15=Regan|first15=M.|last16=Salter|first16=J.|last17=Sotiriou|first17=C.|last18=Smith|first18=I. E.|last19=Viale|first19=G.|last20=Zujewski|first20=J. A.|last21=Hayes|first21=D. F.|title=Assessment of Ki67 in Breast Cancer: Recommendations from the International Ki67 in Breast Cancer Working Group|journal=JNCI Journal of the National Cancer Institute|volume=103|issue=22|year=2011|pages=1656–1664|issn=0027-8874|doi=10.1093/jnci/djr393}}</ref>
 
 
 
:IKWG global average:<ref name="NielsenLeung2021">{{cite journal|last1=Nielsen|first1=Torsten O|last2=Leung|first2=Samuel C. Y|last3=Rimm|first3=David L|last4=Dodson|first4=Andrew|last5=Acs|first5=Balazs|last6=Badve|first6=Sunil|last7=Denkert|first7=Carsten|last8=Ellis|first8=Matthew J|last9=Fineberg|first9=Susan|last10=Flowers|first10=Margaret|last11=Kreipe|first11=Hans H|last12=Laenkholm|first12=Anne-Vibeke|last13=Pan|first13=Hongchao|last14=Penault-Llorca|first14=Frédérique M|last15=Polley|first15=Mei-Yin|last16=Salgado|first16=Roberto|last17=Smith|first17=Ian E|last18=Sugie|first18=Tomoharu|last19=Bartlett|first19=John M. S|last20=McShane|first20=Lisa M|last21=Dowsett|first21=Mitch|last22=Hayes|first22=Daniel F|title=Assessment of Ki67 in Breast Cancer: Updated Recommendations From the International Ki67 in Breast Cancer Working Group|journal=JNCI: Journal of the National Cancer Institute|volume=113|issue=7|year=2021|pages=808–819|issn=0027-8874|doi=10.1093/jnci/djaa201}}</ref>
 
#Before first use, access the IKWG website (https://www.ki67inbreastcancerwg.org/) and complete the Ki67 calibration exercise
 
#From Tools, link to the Online scoring app (or download and install the Ki67 counting app) and use the global method
 
#Using a regular light microscope, review the Ki67-stained breast cancer slide and input estimates of the percent area with negligible, low, medium, or high Ki67 index
 
#Score 100 nuclei negative or positive in each field type (as directed by the app)
 
#Record “Weighted global score” output as the Ki67 index for that slide
 
 
 
Regardless of method:<ref name="DowsettNielsen2011"/>
 
:*If a comparisons must be made between core biopsies and sections from an excision, evaluation of the latter should be across the whole tumor.
 
:*Only nuclear staining counts. Staining intensity of a positive nucleus is not relevant.
 
  
 
====HER2/neu ====
 
====HER2/neu ====

Revision as of 13:14, 19 September 2021

Immunohistochemistry

Ki-67 index

Ki-67 in an invasive breast cancer: cancer nuclei are stained (brown). There is tumor cell positivity in 70% of the cells (Ki-67 labelling index = 70%).

Ki-67 index is mainly relevant in those with stage T1-T2, N0-N1, to determine if chemotherapy is needed (if Ki67 is >30% rather than <5%).[1]

Ki-67 index is most feasibly quantified by a hot spot method,[notes 1] Hot spots are areas in which Ki-67 staining is particularly higher relative to the adjacent tumor areas.[2] Usually, the invasive edge of a tumor is a hot spot.[2] When a tumor had several hot spots, the “hottest” spot is selected.[2] Aim to count at least 500 cells in each case, but this is not always possible in cases with low tumor cell density and small tumor size.[2] Also aim to include at least three high-power (×40 objective) fields. Count a nucleus as “positive” if there is any definite brown staining in the nucleus of an invasive breast cancer cell, above the surrounding background in the cytoplasm and extracellular matrix.[3] If a comparisons must be made between core biopsies and sections from an excision, evaluation of the latter should be across the whole tumor.[1] Only nuclear staining counts. Staining intensity of a positive nucleus is not relevant.[1]

HER2/neu

Score[4] Status[4]
0 to 1+ HER2 negative
(not present)
2+ Borderline
3+ HER2 positive

Notes

  1. Besides from a hot spot method of Ki67 counting, there is also a IKWG global average method which is more comprehensive. However, the inter-observer difference between the hot spot method and the 'IKWG global average is not statistically significant, and has not shown any significant difference in clinical outcome (theoretically, the area of highest Ki-67 proliferative index is probably most likely to correlate with malignant transformation and risk of metastasis, making the hot spot both more straightforward and clinically relevant than a global average).
    - Reference and instructions for the
    IKWG global average method: Dowsett, M.; Nielsen, T. O.; A'Hern, R.; Bartlett, J.; Coombes, R. C.; Cuzick, J.; Ellis, M.; Henry, N. L.; et al. (2011). "Assessment of Ki67 in Breast Cancer: Recommendations from the International Ki67 in Breast Cancer Working Group ". JNCI Journal of the National Cancer Institute 103 (22): 1656–1664. doi:10.1093/jnci/djr393. ISSN 0027-8874. 


Main page

References

  1. 1.0 1.1 1.2 Dowsett, M.; Nielsen, T. O.; A'Hern, R.; Bartlett, J.; Coombes, R. C.; Cuzick, J.; Ellis, M.; Henry, N. L.; et al. (2011). "Assessment of Ki67 in Breast Cancer: Recommendations from the International Ki67 in Breast Cancer Working Group ". JNCI Journal of the National Cancer Institute 103 (22): 1656–1664. doi:10.1093/jnci/djr393. ISSN 0027-8874. 
  2. 2.0 2.1 2.2 2.3 Coleman, William B.; Jang, Min Hye; Kim, Hyun Jung; Chung, Yul Ri; Lee, Yangkyu; Park, So Yeon (2017). "A comparison of Ki-67 counting methods in luminal Breast Cancer: The Average Method vs. the Hot Spot Method ". PLOS ONE 12 (2): e0172031. doi:10.1371/journal.pone.0172031. ISSN 1932-6203. 
  3. . Ki67-QC international working group: whole section scoring protocol (global method). International Ki67 in Breast Cancer Working Group (2018-11-29).
  4. 4.0 4.1 . IHC Tests (ImmunoHistoChemistry). Breastcancer.org. Retrieved on 2019-10-04. Last modified on October 23, 2015

Image sources