乳腺癌免疫组织化学HER2检测的实验室自身重复性及不同方法检测结果的分析

目的 探讨乳腺癌HER2免疫组织化学(IHC)检测的实验室自身重复性及影响其重复性的因素,同时比较单克隆抗体CB11与HercepTest试剂盒染色结果 的一致性及其意义.方法 使用CB11抗体以相同的实验方法 和步骤对37例乳腺浸润性导管癌进行5次IHC染色,检测结果 由两位乳腺专科病理医师共同判读确定,判读标准包括HercepTest评分系统和美国临床肿瘤协会/美国病理学家学院(ASCO/CAP)2007年HER2检测指南评分系统.运用Kappa分析对5次染色结果 的重复性进行评估并比较两种评分系统的一致性.然后用HercepTest试剂盒对该组标本进行检测,将CB11染色结果 与其比较.结果 实验室5次CB11染色的自身重复性较好;排除抗体批号影响后所获得的染色重复性接近"极好"等级(HercepTost评分系统Kappa值为0.7858).两种评分系统的判读一致性"极好"(Kappa值为0.8549).HercepTest试剂盒与CB11染色结果 划分为阳性和阴性时符合率为83.78%.结论 管理和训练良好的实验室能够保证其内部较好的HER2染色结果 重复性.重复性分析是必要的实验室内部HER2检测的质量评估方法 .规范操作下的不同批号的抗体所获染色结果 对实验室内部重复性有一定影响,但尚不会导致染色结果 等级的变化.与已获认证的方法 进行一致性分析后证实,CB11抗体进行的HER2染色在日常病理工作中具有筛查意义.

Intralaboratory reproducibility of HER2 testing in breast cancer by immunohistochemistry and comparison of results obtained by different assays

Objectives To investigate the intralaboratory reproducibility of immunohistochemistry (IHC) testing for HER2 status in breast cancer, and to evaluate the factors which influence the reproducibility. The concordance between monoclonal antibody CB11 and HercepTest was also assessed. Methods HER2 overexpression on paraffin sections from thirty-seven cases of breast invasive ductal carcinoma was evaluated using CB11 and the evaluation procedure had been repeated for five times scored the tests together according to the HercepTest and new American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) grading schemes by 2 experienced pathologists together. Reproducibility rates of the five rounds were assessed using Kappa statistic, and the results from two scoring systems were compared. HercepTest kit was applied to the same cases afterward and the results were compared with CB11. Results Substantial intralaboratory reproducibility was achieved among 5 rounds tests. Excluding the influence effect of changing antibody lots, the intralaboratory reproducibility was closed to the perfect threshold (Kappa =0.7858, HercepTest scheme). The results derived from the two grading schemes had an almost perfect agreement ( Kappa = 0.8549 ). The concordance ( positive vs. negative) between CB11 and HercepTest was 83.78%. Conclusions Laboratory work with strict supervision and more experience will ensure a reliable testing consistency. Reproducibility analysis could be adopted to evaluate the intralaboratory staining quality on HER2 testing. Different antibody lots bring some influence to the intralaboratory reproducibility,but not significant. CB11 could be accepted to screen HER2 status in routine practice after testing validation.