The Effect of Cold Ischemia Time and/or Formalin Fixation on Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor-2 Results in Breast Carcinoma

Abstract

Aims. To compare the results of estrogen and progesterone receptors (ER, PR), and human epidermal growth factor receptor-2 (HER2) expression status on biopsy and excision specimens and to evaluate the effect of cold ischemia time and/or formalin fixation on these biomarkers. Methods. Breast carcinomas that were diagnosed between 2007 and 2009 by core needle biopsy, and subsequently excised in our institution, were included in the study. Data regarding the tumor morphology, grade, and ER, PR, and HER2 status were retrospectively collected from the pathology reports. Results. Five out of 149 (3.4%) cases with ER-positive receptor status in the biopsy specimen became ER-negative in the subsequent excision specimen. Nine out of 126 (7.1%) cases with PR-positive receptor status in the biopsy specimen became PR-negative in the excision specimen. Receptor status change was predominantly seen in tumors with low ER and PR receptor expression. HER2 results were consistent between biopsy and excision specimens in all cases tested. Conclusions. Cold ischemia time and/or formalin fixation affect mainly ER and PR testing with low Allred scores and support the implementation of the ASCO/CAP guidelines. HER2 results, however, were not affected in our limited number of patients.

Figure 1

Histology and hormone receptor staining of a case with estrogen-receptor (ER-) positive, progesterone-receptor- (PR-) positive results in biopsy and ER-negative, PR-negative results in subsequent excision. (a) Biopsy, invasive ductal carcinoma, Nottingham Grade III, hematoxylin & eosin (400x); (b) biopsy, ER (+), Allred score 3 (400x); (c) biopsy, PR (+), Allred score 3 (400x); (d) excision, invasive ductal carcinoma, Nottingham Grade III, hematoxylin & eosin (400x); (e) excision, ER (−), Allred score 0 (400x); (f) excision, PR (−), Allred score 0 (400x).