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We tend to dance around the issue of FISH vs IHC, hoping that those of us who only had the IHC have a correct reading. What I personally see from my reading is that
1. The IHC is a less expensive test than the FISH. The comparison in base price that I saw was $5 for the IHC and $50 for the FISH (this price was a couple of years ago). It is now standard for all those diagnosed with bc in the U.S. to be tested by one or the other. If they get it wrong either way it can cost a lot...
2. Scientists were shocked to learn that IHC's done in facilities where the test was less frequently done resulted in incorrect results in around 18% to 23% of the cases. The FISH was much more accurate, so they got pickier about which test they would use as the basis for clinical trials. They did feel that results from 6 labs that were central facilities did the IHC often enough that those results were credible enough that they were willing to accept the those IHCs.
3. The pathologists themselves were concerned about the difference, and now I understand that labs that do the test less often can be (or are?) subject to regular comparison with the FISH, and this is improving accuracy.
4. Before starting patients on courses of expensive drugs like Herceptin, some oncs are having those with IHC's done again by FISH so that everybody isn't wasting time and effort and money.
A.A.
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