HER2 - two different test results one +ve one -ve

[bjj]

HI

Can anyone help me this one before I go insane - just seem to be going round in circles?

I am in the UK. HER2 status is not routinely tested for. I was diagnosed in January - Grade 2, negative lymph nodes, tumour 1.5 cm, ER+

I have been pushing and pushing my onc to do HER2 test - she finally relented last month and it was done and came back IHC3+. She said she wouldn't recommend Hercpetin in my case.

I decided to get a second opinion from the hospital where I had my radiotherapy. They are refusing to see me as according to their records I am HER2 negative. Apparently the doctor in charge of my radiotherapy requested the test in February/March and it came back IHC1+. Nobody told me at the time. My oncologist and doctor were not informed either that I was being tested or of the result.

I don't know what to do. I have an HER2 test from Feb/March that says I am IHC1+ and therefore I am HER2 negative and I have a recent test that says I am IHC3+ and therefore I am HER2 positive.

Both places are saying that I don't need the FISH test as in one case it was clearly negative and in another clearly positive.

Has anyone else had this happen to them?

I am at a total loss as to what to do. My inclination is to have a further test done but I am now not sure that I would believe the result whatever it is.

I would be so very grateful for any help.

Thanks

[mts]

I am so sorry you are having a difficult time with your doc's. I can certainly understand your frustration. It seems to me that another test is in order... I would try to get a FISH test because it is either neg or pos. In the end, it would certainly resolve your anxiety. I had the IHC test done and my first onc said I had nothing to worry about. When I got a 2nd opinion, the new onc suggested FISH and it came back +++ All I can say is that you alone are the one that will have to make the choices. Hopefully you can find a way to get a FISH and be done with he worries.
Remember that the FISH requires a sampling of your tumor.

Warmly, Maria

[UnregisteredL]

It is best done in large centers who do it routinely and are good at it.

That said, there is a way to have your paraffin-embedded block or slides dent to any of a number of large US cancer centers such as Stanford, Memorial Sloane Kettering, Mayo Clinic, MD Anderson Hospital, etc. even if you are in the UK and have them do a pathological second opinion. It may be possible to ask them to do a FISH test only--of that I am not sure.

This spring/summer, I helped a Danish woman arrange to have her slides sent to the US for a second opinion.

At least according to Danish law (and US law) your doctor could not refuse your request to have the specimens sent.

It may embarrass them so much that they agree to do a FISH test, but be sure it is done in a large teaching hospital which does them routinely.

If I misread your letter and you meant that you had two tests done, one FISH and one IHC, then there is a test (CISH) designed to be a tie-breaker, which is still being proven:





1: Saez A, Andreu FJ, Segui MA, Bare ML, Fernandez S, Dinares C, Rey M. Related Articles, Links
HER-2 gene amplification by chromogenic in situ hybridisation (CISH) compared with fluorescence in situ hybridisation (FISH) in breast cancer-A study of two hundred cases.
Breast. 2005 Nov 11; [Epub ahead of print]
PMID: 16290155 [PubMed - as supplied by publisher]
2: Dandachi N, Dietze O, Hauser-Kronberger C. Related Articles, Links
Chromogenic in situ hybridization: a novel approach to a practical and sensitive method for the detection of HER2 oncogene in archival human breast carcinoma.
Lab Invest. 2002 Aug;82(8):1007-14.
PMID: 12177239 [PubMed - indexed for MEDLINE]
3: Arnould L, Denoux Y, MacGrogan G, Penault-Llorca F, Fiche M, Treilleux I, Mathieu MC, Vincent-Salomon A, Vilain MO, Couturier J. Related Articles, Links
Agreement between chromogenic in situ hybridisation (CISH) and FISH in the determination of HER2 status in breast cancer.
Br J Cancer. 2003 May 19;88(10):1587-91.
PMID: 12771927 [PubMed - indexed for MEDLINE]
4: Hauser-Kronberger C, Dandachi N. Related Articles, Links
Comparison of chromogenic in situ hybridization with other methodologies for HER2 status assessment in breast cancer.
J Mol Histol. 2004 Aug;35(6):647-53.
PMID: 15614619 [PubMed - indexed for MEDLINE]
5: Zhao J, Wu R, Au A, Marquez A, Yu Y, Shi Z. Related Articles, Links
Determination of HER2 gene amplification by chromogenic in situ hybridization (CISH) in archival breast carcinoma.
Mod Pathol. 2002 Jun;15(6):657-65.
PMID: 12065780 [PubMed - indexed for MEDLINE]
6: Thomson TA, Hayes MM, Spinelli JJ, Hilland E, Sawrenko C, Phillips D, Dupuis B, Parker RL. Related Articles, Links
HER-2/neu in breast cancer: interobserver variability and performance of immunohistochemistry with 4 antibodies compared with fluorescent in situ hybridization.
Mod Pathol. 2001 Nov;14(11):1079-86.
PMID: 11706067 [PubMed - indexed for MEDLINE]
7: Loring P, Cummins R, O'Grady A, Kay EW. Related Articles, Links
HER2 positivity in breast carcinoma: a comparison of chromogenic in situ hybridization with fluorescence in situ hybridization in tissue microarrays, with targeted evaluation of intratumoral heterogeneity by in situ hybridization.
Appl Immunohistochem Mol Morphol. 2005 Jun;13(2):194-200.
PMID: 15894935 [PubMed - indexed for MEDLINE]
8: Lebeau A, Deimling D, Kaltz C, Sendelhofert A, Iff A, Luthardt B, Untch M, Lohrs U. Related Articles, Links
Her-2/neu analysis in archival tissue samples of human breast cancer: comparison of immunohistochemistry and fluorescence in situ hybridization.
J Clin Oncol. 2001 Jan 15;19(2):354-63.
PMID: 11208826 [PubMed - indexed for MEDLINE]
9: Gong Y, Gilcrease M, Sneige N. Related Articles, Links
Reliability of chromogenic in situ hybridization for detecting HER-2 gene status in breast cancer: comparison with fluorescence in situ hybridization and assessment of interobserver reproducibility.
Mod Pathol. 2005 Aug;18(8):1015-21.
PMID: 15861212 [PubMed - indexed for MEDLINE]
10: Madrid MA, Lo RW. Related Articles, Links
Chromogenic in situ hybridization (CISH): a novel alternative in screening archival breast cancer tissue samples for HER-2/neu status.
Breast Cancer Res. 2004;6(5):R593-600. Epub 2004 Jul 29.
PMID: 15318940 [PubMed - indexed for MEDLINE]
11: Isola J, Tanner M, Forsyth A, Cooke TG, Watters AD, Bartlett JM. Related Articles, Links
Interlaboratory comparison of HER-2 oncogene amplification as detected by chromogenic and fluorescence in situ hybridization.
Clin Cancer Res. 2004 Jul 15;10(14):4793-8.
PMID: 15269154 [PubMed - indexed for MEDLINE]
12: Todorovic-Rakovic N, Jovanovic D, Neskovic-Konstantinovic Z, Nikolic-Vukosavljevic D. Related Articles, Links
Comparison between immunohistochemistry and chromogenic in situ hybridization in assessing HER-2 status in breast cancer.
Pathol Int. 2005 Jun;55(6):318-23.
PMID: 15943788 [PubMed - indexed for MEDLINE]
13: Lopez-Guerrero JA, Navarro S, Noguera R, Almenar S, Pellin A, Vazquez C, Llombart-Bosch A. Related Articles, Links
Histological tumor grade correlates with HER2/c-erB-2 status in invasive breast cancer: a comparative analysis between immunohistochemical (CB11 clone and Herceptest), FISH and differential PCR procedures.
Arkh Patol. 2003 Jan-Feb;65(1):50-5.
PMID: 12669615 [PubMed - indexed for MEDLINE]
14: Wixom CR, Albers EA, Weidner N. Related Articles, Links
Her2 amplification: correlation of chromogenic in situ hybridization with immunohistochemistry and fluorescence in situ hybridization.
Appl Immunohistochem Mol Morphol. 2004 Sep;12(3):248-51.
PMID: 15551739 [PubMed - indexed for MEDLINE]
15: Bartlett JM, Going JJ, Mallon EA, Watters AD, Reeves JR, Stanton P, Richmond J, Donald B, Ferrier R, Cooke TG. Related Articles, Links
Evaluating HER2 amplification and overexpression in breast cancer.
J Pathol. 2001 Nov;195(4):422-8.
PMID: 11745673 [PubMed - indexed for MEDLINE]
16: Press MF, Slamon DJ, Flom KJ, Park J, Zhou JY, Bernstein L. Related Articles, Links
Evaluation of HER-2/neu gene amplification and overexpression: comparison of frequently used assay methods in a molecularly characterized cohort of breast cancer specimens.
J Clin Oncol. 2002 Jul 15;20(14):3095-105.
PMID: 12118023 [PubMed - indexed for MEDLINE]
17: Tanner M, Gancberg D, Di Leo A, Larsimont D, Rouas G, Piccart MJ, Isola J. Related Articles, Links
Chromogenic in situ hybridization: a practical alternative for fluorescence in situ hybridization to detect HER-2/neu oncogene amplification in archival breast cancer samples.
Am J Pathol. 2000 Nov;157(5):1467-72.
PMID: 11073807 [PubMed - indexed for MEDLINE]
18: Sartelet H, Lagonotte E, Lorenzato M, Duval I, Lechki C, Rigaud C, Cucherousset J, Durlach A, Graesslin O, Abboud P, Doco-Fenzy M, Quereux C, Costa B, Polette M, Munck JN, Birembaut P. Related Articles, Links
Comparison of liquid based cytology and histology for the evaluation of HER-2 status using immunostaining and CISH in breast carcinom1: Saez A, Andreu FJ, Segui MA, Bare ML, Fernandez S, Dinares C, Rey M. Related Articles, Links
HER-2 gene amplification by chromogenic in situ hybridisation (CISH) compared with fluorescence in situ hybridisation (FISH) in breast cancer-A study of two hundred cases.
Breast. 2005 Nov 11; [Epub ahead of print]
PMID: 16290155 [PubMed - as supplied by publisher]
2: Dandachi N, Dietze O, Hauser-Kronberger C. Related Articles, Links
Chromogenic in situ hybridization: a novel approach to a practical and sensitive method for the detection of HER2 oncogene in archival human breast carcinoma.
Lab Invest. 2002 Aug;82(8):1007-14.
PMID: 12177239 [PubMed - indexed for MEDLINE]
3: Arnould L, Denoux Y, MacGrogan G, Penault-Llorca F, Fiche M, Treilleux I, Mathieu MC, Vincent-Salomon A, Vilain MO, Couturier J. Related Articles, Links
Agreement between chromogenic in situ hybridisation (CISH) and FISH in the determination of HER2 status in breast cancer.
Br J Cancer. 2003 May 19;88(10):1587-91.
PMID: 12771927 [PubMed - indexed for MEDLINE]
4: Hauser-Kronberger C, Dandachi N. Related Articles, Links
Comparison of chromogenic in situ hybridization with other methodologies for HER2 status assessment in breast cancer.
J Mol Histol. 2004 Aug;35(6):647-53.
PMID: 15614619 [PubMed - indexed for MEDLINE]
5: Zhao J, Wu R, Au A, Marquez A, Yu Y, Shi Z. Related Articles, Links
Determination of HER2 gene amplification by chromogenic in situ hybridization (CISH) in archival breast carcinoma.
Mod Pathol. 2002 Jun;15(6):657-65.
PMID: 12065780 [PubMed - indexed for MEDLINE]
6: Thomson TA, Hayes MM, Spinelli JJ, Hilland E, Sawrenko C, Phillips D, Dupuis B, Parker RL. Related Articles, Links
HER-2/neu in breast cancer: interobserver variability and performance of immunohistochemistry with 4 antibodies compared with fluorescent in situ hybridization.
Mod Pathol. 2001 Nov;14(11):1079-86.
PMID: 11706067 [PubMed - indexed for MEDLINE]
7: Loring P, Cummins R, O'Grady A, Kay EW. Related Articles, Links
HER2 positivity in breast carcinoma: a comparison of chromogenic in situ hybridization with fluorescence in situ hybridization in tissue microarrays, with targeted evaluation of intratumoral heterogeneity by in situ hybridization.
Appl Immunohistochem Mol Morphol. 2005 Jun;13(2):194-200.
PMID: 15894935 [PubMed - indexed for MEDLINE]
8: Lebeau A, Deimling D, Kaltz C, Sendelhofert A, Iff A, Luthardt B, Untch M, Lohrs U. Related Articles, Links
Her-2/neu analysis in archival tissue samples of human breast cancer: comparison of immunohistochemistry and fluorescence in situ hybridization.
J Clin Oncol. 2001 Jan 15;19(2):354-63.
PMID: 11208826 [PubMed - indexed for MEDLINE]
9: Gong Y, Gilcrease M, Sneige N. Related Articles, Links
Reliability of chromogenic in situ hybridization for detecting HER-2 gene status in breast cancer: comparison with fluorescence in situ hybridization and assessment of interobserver reproducibility.
Mod Pathol. 2005 Aug;18(8):1015-21.
PMID: 15861212 [PubMed - indexed for MEDLINE]
10: Madrid MA, Lo RW. Related Articles, Links
Chromogenic in situ hybridization (CISH): a novel alternative in screening archival breast cancer tissue samples for HER-2/neu status.
Breast Cancer Res. 2004;6(5):R593-600. Epub 2004 Jul 29.
PMID: 15318940 [PubMed - indexed for MEDLINE]
11: Isola J, Tanner M, Forsyth A, Cooke TG, Watters AD, Bartlett JM. Related Articles, Links
Interlaboratory comparison of HER-2 oncogene amplification as detected by chromogenic and fluorescence in situ hybridization.
Clin Cancer Res. 2004 Jul 15;10(14):4793-8.
PMID: 15269154 [PubMed - indexed for MEDLINE]
12: Todorovic-Rakovic N, Jovanovic D, Neskovic-Konstantinovic Z, Nikolic-Vukosavljevic D. Related Articles, Links
Comparison between immunohistochemistry and chromogenic in situ hybridization in assessing HER-2 status in breast cancer.
Pathol Int. 2005 Jun;55(6):318-23.
PMID: 15943788 [PubMed - indexed for MEDLINE]
13: Lopez-Guerrero JA, Navarro S, Noguera R, Almenar S, Pellin A, Vazquez C, Llombart-Bosch A. Related Articles, Links
Histological tumor grade correlates with HER2/c-erB-2 status in invasive breast cancer: a comparative analysis between immunohistochemical (CB11 clone and Herceptest), FISH and differential PCR procedures.
Arkh Patol. 2003 Jan-Feb;65(1):50-5.
PMID: 12669615 [PubMed - indexed for MEDLINE]
14: Wixom CR, Albers EA, Weidner N. Related Articles, Links
Her2 amplification: correlation of chromogenic in situ hybridization with immunohistochemistry and fluorescence in situ hybridization.
Appl Immunohistochem Mol Morphol. 2004 Sep;12(3):248-51.
PMID: 15551739 [PubMed - indexed for MEDLINE]
15: Bartlett JM, Going JJ, Mallon EA, Watters AD, Reeves JR, Stanton P, Richmond J, Donald B, Ferrier R, Cooke TG. Related Articles, Links
Evaluating HER2 amplification and overexpression in breast cancer.
J Pathol. 2001 Nov;195(4):422-8.
PMID: 11745673 [PubMed - indexed for MEDLINE]
16: Press MF, Slamon DJ, Flom KJ, Park J, Zhou JY, Bernstein L. Related Articles, Links
Evaluation of HER-2/neu gene amplification and overexpression: comparison of frequently used assay methods in a molecularly characterized cohort of breast cancer specimens.
J Clin Oncol. 2002 Jul 15;20(14):3095-105.
PMID: 12118023 [PubMed - indexed for MEDLINE]
17: Tanner M, Gancberg D, Di Leo A, Larsimont D, Rouas G, Piccart MJ, Isola J. Related Articles, Links
Chromogenic in situ hybridization: a practical alternative for fluorescence in situ hybridization to detect HER-2/neu oncogene amplification in archival breast cancer samples.
Am J Pathol. 2000 Nov;157(5):1467-72.
PMID: 11073807 [PubMed - indexed for MEDLINE]
18: Sartelet H, Lagonotte E, Lorenzato M, Duval I, Lechki C, Rigaud C, Cucherousset J, Durlach A, Graesslin O, Abboud P, Doco-Fenzy M, Quereux C, Costa B, Polette M, Munck JN, Birembaut P. Related Articles, Links
Comparison of liquid based cytology and histology for the evaluation of HER-2 status using immunostaining and CISH in breast carcinom1: Saez A, Andreu FJ, Segui MA, Bare ML, Fernandez S, Dinares C, Rey M. Related Articles, Links
HER-2 gene amplification by chromogenic in situ hybridisation (CISH) compared with fluorescence in situ hybridisation (FISH) in breast cancer-A study of two hundred cases.
Breast. 2005 Nov 11; [Epub ahead of print]
PMID: 16290155 [PubMed - as supplied by publisher]
2: Dandachi N, Dietze O, Hauser-Kronberger C. Related Articles, Links
Chromogenic in situ hybridization: a novel approach to a practical and sensitive method for the detection of HER2 oncogene in archival human breast carcinoma.
Lab Invest. 2002 Aug;82(8):1007-14.
PMID: 12177239 [PubMed - indexed for MEDLINE]
3: Arnould L, Denoux Y, MacGrogan G, Penault-Llorca F, Fiche M, Treilleux I, Mathieu MC, Vincent-Salomon A, Vilain MO, Couturier J. Related Articles, Links
Agreement between chromogenic in situ hybridisation (CISH) and FISH in the determination of HER2 status in breast cancer.
Br J Cancer. 2003 May 19;88(10):1587-91.
PMID: 12771927 [PubMed - indexed for MEDLINE]
4: Hauser-Kronberger C, Dandachi N. Related Articles, Links
Comparison of chromogenic in situ hybridization with other methodologies for HER2 status assessment in breast cancer.
J Mol Histol. 2004 Aug;35(6):647-53.
PMID: 15614619 [PubMed - indexed for MEDLINE]
5: Zhao J, Wu R, Au A, Marquez A, Yu Y, Shi Z. Related Articles, Links
Determination of HER2 gene amplification by chromogenic in situ hybridization (CISH) in archival breast carcinoma.
Mod Pathol. 2002 Jun;15(6):657-65.
PMID: 12065780 [PubMed - indexed for MEDLINE]
6: Thomson TA, Hayes MM, Spinelli JJ, Hilland E, Sawrenko C, Phillips D, Dupuis B, Parker RL. Related Articles, Links
HER-2/neu in breast cancer: interobserver variability and performance of immunohistochemistry with 4 antibodies compared with fluorescent in situ hybridization.
Mod Pathol. 2001 Nov;14(11):1079-86.
PMID: 11706067 [PubMed - indexed for MEDLINE]
7: Loring P, Cummins R, O'Grady A, Kay EW. Related Articles, Links
HER2 positivity in breast carcinoma: a comparison of chromogenic in situ hybridization with fluorescence in situ hybridization in tissue microarrays, with targeted evaluation of intratumoral heterogeneity by in situ hybridization.
Appl Immunohistochem Mol Morphol. 2005 Jun;13(2):194-200.
PMID: 15894935 [PubMed - indexed for MEDLINE]
8: Lebeau A, Deimling D, Kaltz C, Sendelhofert A, Iff A, Luthardt B, Untch M, Lohrs U. Related Articles, Links
Her-2/neu analysis in archival tissue samples of human breast cancer: comparison of immunohistochemistry and fluorescence in situ hybridization.
J Clin Oncol. 2001 Jan 15;19(2):354-63.
PMID: 11208826 [PubMed - indexed for MEDLINE]
9: Gong Y, Gilcrease M, Sneige N. Related Articles, Links
Reliability of chromogenic in situ hybridization for detecting HER-2 gene status in breast cancer: comparison with fluorescence in situ hybridization and assessment of interobserver reproducibility.
Mod Pathol. 2005 Aug;18(8):1015-21.
PMID: 15861212 [PubMed - indexed for MEDLINE]
10: Madrid MA, Lo RW. Related Articles, Links
Chromogenic in situ hybridization (CISH): a novel alternative in screening archival breast cancer tissue samples for HER-2/neu status.
Breast Cancer Res. 2004;6(5):R593-600. Epub 2004 Jul 29.
PMID: 15318940 [PubMed - indexed for MEDLINE]
11: Isola J, Tanner M, Forsyth A, Cooke TG, Watters AD, Bartlett JM. Related Articles, Links
Interlaboratory comparison of HER-2 oncogene amplification as detected by chromogenic and fluorescence in situ hybridization.
Clin Cancer Res. 2004 Jul 15;10(14):4793-8.
PMID: 15269154 [PubMed - indexed for MEDLINE]
12: Todorovic-Rakovic N, Jovanovic D, Neskovic-Konstantinovic Z, Nikolic-Vukosavljevic D. Related Articles, Links
Comparison between immunohistochemistry and chromogenic in situ hybridization in assessing HER-2 status in breast cancer.
Pathol Int. 2005 Jun;55(6):318-23.
PMID: 15943788 [PubMed - indexed for MEDLINE]
13: Lopez-Guerrero JA, Navarro S, Noguera R, Almenar S, Pellin A, Vazquez C, Llombart-Bosch A. Related Articles, Links
Histological tumor grade correlates with HER2/c-erB-2 status in invasive breast cancer: a comparative analysis between immunohistochemical (CB11 clone and Herceptest), FISH and differential PCR procedures.
Arkh Patol. 2003 Jan-Feb;65(1):50-5.
PMID: 12669615 [PubMed - indexed for MEDLINE]
14: Wixom CR, Albers EA, Weidner N. Related Articles, Links
Her2 amplification: correlation of chromogenic in situ hybridization with immunohistochemistry and fluorescence in situ hybridization.
Appl Immunohistochem Mol Morphol. 2004 Sep;12(3):248-51.
PMID: 15551739 [PubMed - indexed for MEDLINE]
15: Bartlett JM, Going JJ, Mallon EA, Watters AD, Reeves JR, Stanton P, Richmond J, Donald B, Ferrier R, Cooke TG. Related Articles, Links
Evaluating HER2 amplification and overexpression in breast cancer.
J Pathol. 2001 Nov;195(4):422-8.
PMID: 11745673 [PubMed - indexed for MEDLINE]
16: Press MF, Slamon DJ, Flom KJ, Park J, Zhou JY, Bernstein L. Related Articles, Links
Evaluation of HER-2/neu gene amplification and overexpression: comparison of frequently used assay methods in a molecularly characterized cohort of breast cancer specimens.
J Clin Oncol. 2002 Jul 15;20(14):3095-105.
PMID: 12118023 [PubMed - indexed for MEDLINE]
17: Tanner M, Gancberg D, Di Leo A, Larsimont D, Rouas G, Piccart MJ, Isola J. Related Articles, Links
Chromogenic in situ hybridization: a practical alternative for fluorescence in situ hybridization to detect HER-2/neu oncogene amplification in archival breast cancer samples.
Am J Pathol. 2000 Nov;157(5):1467-72.
PMID: 11073807 [PubMed - indexed for MEDLINE]
18: Sartelet H, Lagonotte E, Lorenzato M, Duval I, Lechki C, Rigaud C, Cucherousset J, Durlach A, Graesslin O, Abboud P, Doco-Fenzy M, Quereux C, Costa B, Polette M, Munck JN, Birembaut P. Related Articles, Links
Comparison of liquid based cytology and histology for the evaluation of HER-2 status using immunostaining and CISH in breast carcinom

Hope this helps!