Chemotherapy naive breast cancer: a correlation study between BD Cytorich™ Red cell blocks and formalin- fixed paraffinembedded tissue blocks

Van Rooyen, Evelyn (2019-04)

Thesis (MMed)--Stellenbosch University, 2019.

Thesis

Background: The ever increasing burden of breast cancer, the most common cancer among women, demands a diagnostic test that is rapid, reliable, informative and cost-effective; particularly in countries with limited financial and medical resources. FNAB cytology and cell block combination has gained worldwide utility and has been described to be accurate and reliable. Aim: Henceforth the aim of this study was to retrospectively correlate the expression of prognostication markers, namely, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) performed on cell blocks (using the BD CytorichTM Red method) and formalin-fixed, paraffin-embedded cell blocks (FFPET) in chemotherapy naive breast carcinomas, by immunochemistry (immunocytochemistry and immunohistochemistry respectively) and to perform fluorescence in-situ hybridization (FISH) testing for over- expression of the HER2 gene. Methods: Between 2013 and 2016, 132 cases of primary breast carcinoma were identified that had both cytology (including Cytorich™ Red cell blocks) and histology specimens that were both chemotherapy naive. Immunostaining for ER, PR and HER2 was performed. The staining was scored according to the Allred scoring system for histology specimen and this system was slightly adapted for cytology specimens, which also took the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines into account. FISH for HER2 over-expression was performed. The grade of the carcinoma was also analysed on both the cytology specimens (using the Robertson’s grading system) and the histology specimens (using the Modified Elston & Ellis system). Results: ER and PR performed on cell blocks had good correlation with FFPET with 91% and 85% sensitivity, respectively. HER2 on cell blocks had an agreement of 88% with FFPET. 87.88% of cell blocks had more than a 100 tumour cells present on H&E sections and cytological grading had an agreement of 41.41% with histological grading. Conclusion: The cell block technique continues to play a vital role in the diagnosis of primary, recurrent and metastatic breast carcinoma, allowing assessment of prognosis and prediction of response to therapy.

Agtergrond: Borskanker is die allergrootste las wat op vouens rus en is die mees algemeenste kanker onder vroue. As gevolg hiervan is diagnostiese toetse wat vinnig, bertroubaar en insiggewend is belangrik, veral in lande met beperkte mediese en finansiële hulpbronne. Fyn naald aspirasie en die selblok kombinasie het wêreldwyd nut verwerf en word beskryf as ‘n betroubare en akkurate toets. Doelwitte: Die doelwit van hierdie studie was om retrospektief te korreleer of voorspelling merkers, naamlik estrogeen reseptor (ER), progesteroon reseptor (PR) en menslike epidermale groei faktor reseptor 2 (HER2) uitgevoer op selblokke (met gebruik van die BD Cytorich ™ Red metode) en formalien gefikseerde, paraffien inbedding weefsel blokke in chemoterapie naἲve borskarsinome te korreleer deur immunochemie. Die uitvoering van FISH toetse vir die oor uitdrukking van die HER2 geen was ook gedoen. Metodes: Tussen 2013 en 2016 was 132 gevalle geidentifiseer met ‘n primêre diagnose van borskarsinoom, wat albei sitologie (insluitend BD Cytorich™ Red selblokke) en histologie monsters het. Immunokleuring vir ER, PR en HER2 was gedoen en die kleuring was deur ‘n puntestelsel volgens die Allred stelsel vir histologie gedoen wat egter effens aangepas vir sitologie selblokke was. Die Amerikaanse vereniging van kliniese onkologie (ASCO)/ kollege van amerikaanse patoloë (CAP) riglyne was ook toegepas vir HER2 ontleding asook FISH toetse vir HER2 ekspressie. Die gradering van karsinome was ook geontleed vir beide sitologie monsters met aanwending van die Robinson’s gradering sisteem en vir histolgie monsters met aanwending van die gemodifiseerde Elston en Ellis sisteem. Resultate: ER en PR uitgevoer op selblokke het goeie korrelasie met weefsel blokke getoon met ‘n sensitiwiteit van 91% en ‘n spesifisiteit van 62% vir ER en ‘n sensitiwiteit van 85% en spesifisiteit van 84% vir PR. HER2 op selblokke het ‘n ooreenstemming van 88% gehad met weefsel blokke en 87.88% van die selblokke het meer as 100 tumor selle teenwoordig gehad op H&E snitte. Gradering van sitologie het ‘n ooreenstemming van 41.41% met histologie gradering gehad. Gevolgtrekkinge: Die selblok tegniek speel ‘n belangrike rol in die diagnose van primêre, terugkerende en metastase van borskarsinoom. Terselfte tyd word die berekening van prognose toegelaat asook die voorspelling van toepaslike behandeling.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106074
This item appears in the following collections: