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East Florida


HCA Florida Westside Hospital



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estrogen, progesterone, Her2, invasive breast carcinoma


Diagnosis | Medicine and Health Sciences | Neoplasms | Pathology


BACKGROUND: The current College of American Pathologist (CAP) recommendation is that breast biomarkers Estrogen (ER), Progesterone (PR) and HER2 neu (Her2) testing be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors with the aim to identify patients that will benefit from hormonal treatment or anti-Her2 therapy. Repeat testing on a subsequent specimen is not usually indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need of adopting universal reflex re-testing of breast biomarkers in subsequent excision specimens. The rationale behind this study was based upon the observed widespread trend of reflex re-testing in all cases sent to other medical facilities in our community and national reference centers for either second opinion or for continuation of care despite standard recommendations arguing against this practice.

DESIGN: The study population included 70 sequential invasive breast cancer patients where the results of ER, PR and Her2 performed in the initial primary diagnostic biopsy were available for comparison with our repeated ER, PR and Her2 testing performed in the subsequent resection specimens. We aim to identify if there is a significant number of discordant cases or if there are any significant tumor variables (size, presence of DCIS, T stage, N stage, neo-adjuvant therapy) in the discordant cases that will justify adopting reflex re-testing of breast biomarkers in the excision specimens.

RESULTS: Of the 70 patients, 17 (24.3%) patients had received neoadjuvant therapy. The rate of ER, PR, or HER2 discordance between biopsy and subsequent resection specimens was 7.5% in the control group and 35.3% in the neoadjuvant therapy group (p = 0.0096). Three (37.5%) of the discordant ER positive patients became negative, three (37.5%) of the PR positive patients became PR negative, and 2 (50%) of HER2 positive patients became HER negative. One (14.3%) of PR negative patients became PR positive and five (7.6%) of HER2 negative patients became HER2 positive.

CONCLUSIONS: Adopting universal reflex re-testing of breast biomarkers in breast cancer excision specimens is not justified based on our results. We do not recommend implementing reflex re-testing in all excision specimens, except in post-neoadjuvant, newly metastatic tumors, and triple negative tumors on a case by case basis.

Comparing the expression of ER, PR, HER-2 between initial biopsy and excision specimens in invasive breast carcinoma cases. Is there a need for universal repeat testing?



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