Re: Interpretation of HER-2 FISH Results

From:Richard Cartun

Dear Bob:

Actually, the case was sent to us for consultation; I am not sure if we
qualify as "Big League", but I think we can certainly "play ball".  The
patient has an invasive tubular carcinoma, nuclear grade I, histologic
grade I (ER+/PR+) along with the extensive DCIS that showed 3+ HER-2/neu
protein overexpression.

R. Cartun

>>>  05/02/02 03:01PM >>>
Richard Cartun notes:

>>The topic of "who should interpret HER-2 FISH results" has recently
discussed on Histonet. - I just finished looking at a case of breast CA
the invasive mammary duct CA was negative for HER-2/neu protein 
overexpression, but the ductal carcinoma in-situ (DCIS) was 3+
positive. It 
was a very impressive specimen; the HER-2 positive DCIS surrounded the
focus of HER-2 negative invasive tumor. As you may already know, 
determination of ER/PR/HER-2 status should be performed on invasive
not carcinoma in-situ. I don't have a problem with non-MD's doing the 
interpretation of the FISH results (keep in mind that I am a Ph.D.),
whoever does the interpretation must know which cells to
evaluate. By all means, if there are questions regarding the
of the FISH slides, go to the pathologist who signed-out the case and
them to identify the tumor for evaluation. I requested FISH on this
for HER-2/neu gene amplification for academic purposes. Let's see if
correct tumor cells are evaluated!<<

This result doesn't surprise me, since other adverse prognostic
(starting with nuclear morphology) are often more striking in DCIS than
invasive cancer. I'm not surprised that HER-2 FISH follows this path
I'm more concerned about >>the small focus of HER-2 negative invasive 
tumor<<. The big league breast pathologists - particularly David L.
Page at 
Vanderbilt - are getting more and more reluctant to call such small
foci near 
high-grade DCIS invasive cancer, and this case may need to be sent out

I'm not surprised to see FISH results interpreted by non-pathologists,
in general new technology in pathology isn't done by pathologists. The

question the next generation will have to deal with is whether the
procedure should be done by non-pathologists. Fortunately, I shall have
gathered to my grandfathers by then.

Bob Richmond
Samurai Pathologist
Knoxville TN

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