| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- B1580what scores of the IHC Her 2stain you will give (cqz 14)
The interpretation of ER, PR and Her2 stain results is critical for oncologists to treat invasive breast cancers with neoadjunvant chemotherapy before or after the surgery. From here you can tell that we, pathologists play a very important role in patient care.
I showed two cases above. If there are your cases, what score (0, 1, 2, 3) will you give?
Negative: 0-1
Equivocal: 2
Positive: 3
case 2 is easy. I would call it 3 without hesitation. case 1 looks like 3, but compare to case 1, the staining is less stronge. when i see it closely, there are still cells not showing circumferential staining. In real life i may call it 3 or 2 depending on my confidence. I know it's not right. I would like to hear your opinion and guidance.
By the way, i would always check the internal control before giving the decision.
| 以下是引用漫游人在2009-2-23 10:03:00的发言：
case 2 is easy. I would call it 3 without hesitation. case 1 looks like 3, but compare to case 1, the staining is less stronge. when i see it closely, there are still cells not showing circumferential staining. In real life i may call it 3 or 2 depending on my confidence. I know it's not right. I would like to hear your opinion and guidance. By the way, i would always check the internal control before giving the decision. |
-
本帖最后由 于 2009-03-01 03:04:00 编辑
See your scores above.
Positive controls:
Fig 1-2 for case 1, 200x, 400x.
Fig 3-4 for case 2, 200x, 400x.
The control tissue and sample were in the same slide.
Now do you want to change your score?
If you score 3, the oncologists will treat patients based on her2 positive.
If you score 1, it means Her 2 is negative.
If you score 2, the Her2 Fish will be performed.
Above are what we are doing in our hospital. How about in China?
名称：图1
描述：图1
名称：图2
描述：图2
名称：图3
描述：图3
名称：图4
描述：图4
-
本帖最后由 于 2009-03-01 10:45:00 编辑
| 以下是引用Elizabeth在2009-3-1 8:26:00的发言：
Yes, the sitiuation is same in our hospital. |
How about other hospitals in China?
As pathologists are you sure that the patients should receive Herceptin treatment? We call positive the oncologists may provide this drug for these women.
Hope every one checks the websites and know the price of the medicine and side effect. Are you confident?
http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=50242013468&trx=1Z5006
http://www.chemocare.com/bio/herceptin.asp
http://www.breastcancer.org/treatment/targeted_therapies/herceptin/
| 以下是引用杨宝军在2009-3-2 21:39:00的发言：
2 请问：Dr. Zhao,评分是以强度为主还是以数量为主，还是两者结合，如果是，怎么结合？ 如果没有参照组织片依靠什么标准判断强度？ |
See this topic. http://www.ipathology.cn/forum/forum_display.asp?keyno=16236
The guidline paper.
http://jop.ascopubs.org/cgi/content/full/3/1/48
Brief description about the scores
Tissue fixed using formalin 8-96 hours.
0 = No staing is observed or membrane staining is observed in less than 10% of the tumor cells.
1+ = A faint/barely perceptoble membrane staining is detected in more than 10% of the tumor cells. The cells are only stained in part of their membrane
score 0, 1 called negative
2+ = A weak to moderate complete membrane staining is observed in more than 10% of the tumor cells.
2+ means equivocal
3+ = A strongly complete membrane staining is observed in more than 30% of the tumor cells.
3+ means positive.
-
本帖最后由 于 2009-03-12 01:20:00 编辑
First case, definitely we should NOT call pasitive (score 3). (sorry I did not type not in the begining until I saw abin's talk)
Second case, I agree with most of you. It should be score 3 based on the criteria. But it still has weaker stain compare with control. It is too important for pathologists to call positive or negative. For this purpose I called both cases eqivocal (score 2). Automatically the Her2 FISH will be performed on the cases with score 2 in our institute. I will let you know the fish results when I am back Pittsburgh.
