Evaluation of Dual Immunohistochemistry and Chromogenic In Situ Hybridization for HER2 on a Single Section

Department of Pathology, University of Alabama at Birmingham, USA.
American Journal of Clinical Pathology (Impact Factor: 2.51). 01/2012; 137(1):102-10. DOI: 10.1309/AJCPLNHINN9O6YSF
Source: PubMed


The evaluation of HER2 status in invasive breast carcinoma can be performed by multiple methods. We assessed the feasibility of performing 2 of these, chromogenic in situ hybridization (CISH) and immunohistochemical staining, on single tissue sections of breast carcinoma. During assay development, sequential performance of immunohistochemical staining after CISH resulted in weaker HER2 expression than that obtained when immunohistochemical staining was performed alone; this was ameliorated by increased antibody incubation time. Performance of both techniques in a combined/hybrid protocol resulted in HER2 protein expression and gene signals identical to those produced by the individual techniques performed alone. Prospective validation of these dual staining protocols in 31 cases of breast carcinoma resulted in 100% concordance with results of CISH when performed alone, but was still associated with a reduced immunohistochemical signal in some cases. Although further testing is needed, we conclude that performance of both immunohistochemical staining and CISH on a single section is possible and could allow for direct "cell-by-cell" comparison of HER2 signals and potentially offer a more economical and real-time method for ongoing validation of HER2 testing.

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    • "All previous studies with settings comparable to our analysis used chromogenic or fluorescence in situ hybridization (CISH or FISH). Downs-Kelly et al. [14] combined standard IHC with a deposition of metallic silver by EnzMetTM on a tissue microarray (TMA) of breast carcinomas and compared the results of IHC and fluorescence in situ hybridization (FISH) when performed alone. In another study, the authors has indeed used the combination of IHC and silver in situ hybridization (SISH) in TMA of breast and gastric cancer samples, but compared the results of those obtained by IHC and fluorescence in situ hybridization (FISH) as single staining [16]. "
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    ABSTRACT: HER2 status assessment is a prerequisite for the establishment of an appropriate treatment strategy in gastric cancer. Gastric cancers are very heterogeneous and separate evaluations of gene amplification and protein expression lead to uncertainties in localizing distinct clones and are time consuming. This study evaluates the equivalence of the novel method combining both gene and protein platforms on one slide. Immunohistochemistry (IHC) and HER2 dual-colour silver in situ hybridization (SISH) as single methods (IHC/SISH) and gene-protein platform combining both methods on one slide (gene/protein) were performed in randomly collected 100 cases of gastric adenocarcinoma. Results of IHC/SISH were compared with gene/protein staining. 96 of 100 samples were assessable. In the gene/protein staining, pathologists were able to assess gene amplification and consequent protein expression at the single cell level. In comparison trials, gene amplification was observed in 14.6% by both, conventional SISH and gene/protein platform (agreement 100%; Kappa-coefficient κ = 1.0). Protein expression scores by IHC were 70.8% (0), 10.4% (1+), 9.4% (2+), and 9.4% (3+). Protein expression by gene/protein method were: 70.8% (0), 11.5% (1+), 7.3% (2+) and 10.4% (3+) of patients. There were complete concordances in IHC assessment of cases with score 0 (100.0%; κ = 1). High concordances are shown in score 1+ (98.96%; κ = 0.947) and 3+ (96.88%; κ = 0.825) cases and good concordances in 2+ cases (95.83%; κ = 0.728). This novel combined platform has the advantage of being able to evaluate both gene and the protein status in the same cancer cell and may be of particular interest for research and patient’s care. Article category Disease Biomarker.
    Full-text · Article · Jun 2014 · Journal of Translational Medicine
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    • "The simultaneous brightfield detection of HER2 protein and HER2 gene expression “HER2 gene-protein assay” in FFPE breast cancer tissue sections has been previously reported by three independent groups [7-9]. First, Downs-Kelly et al.[7] successfully combined an alkaline phosphatase (AP)-based fast red dye system for HER2 IHC with a horseradish peroxidase (HRP)-based silver deposition system for HER2 ISH. "
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    ABSTRACT: The eligibility of breast cancer patients for human epidermal growth factor receptor 2 (HER2)-directed therapies is determined by the HER2 gene amplification and/or HER2 protein overexpression status of the breast tumor as determined by in situ hybridization (ISH) or immunohistochemistry (IHC), respectively. Our objective was to combine the US Food and Drug Administration (FDA)-approved HER2 & chromosome 17 centromere (CEN17) brightfield ISH (BISH) and HER2 IHC assays into a single automated HER2 gene-protein assay allowing simultaneous detection of all three targets in a single tissue section. The HER2 gene-protein assay was optimized using formalin-fixed, paraffin-embedded (FFPE) samples of the xenograft tumors MCF7 [HER2 negative (non-amplified gene, protein negative)] and Calu-3 [HER2 positive (amplified gene, protein positive)]. HER2 IHC was performed using a rabbit monoclonal anti-HER2 antibody (clone 4B5) and a conventional 3,3'-diaminobenzidine IHC detection. The HER2 & CEN17 BISH signals were visualized using horseradish peroxidase-based silver and alkaline phosphatase-based red detection systems, respectively with a cocktail of 2,4-dinitrophenyl-labeled HER2 and digoxigenin-labeled CEN17 probes. The performance of the gene-protein assay on tissue microarray slides containing 189 randomly selected FFPE clinical breast cancer tissue cores was compared to that of the separate HER2 IHC and HER2 & CEN17 BISH assays. HER2 protein detection was optimal when the HER2 IHC protocol was used before (rather than after) the BISH protocol. The sequential use of HER2 IHC and HER2 & CEN17 BISH detection steps on FFPE xenograft tumor sections appropriately co-localized the HER2 protein, HER2 gene, and CEN17 signals after mitigating the silver background staining by using a naphthol phosphate-containing hybridization buffer for the hybridization step. The HER2 protein and HER2 gene status obtained using the multiplex HER2 gene-protein assay demonstrated high concordance with those obtained using the separate HER2 IHC and HER2 & CEN17 BISH assays, respectively. We have developed a protocol that allows simultaneous visualization of the HER2 IHC and HER2 & CEN17 BISH targets. This automated protocol facilitated the determination of HER2 protein and HER2 gene status in randomly selected breast cancer samples, particularly in cases that were equivocal or exhibited tumor heterogeneity. The HER2 gene-protein assay produced results virtually equivalent to those of the single FDA-approved HER2 IHC and HER2 & CEN17 BISH assays. Virtual slides The virtual slides for this article can be found here:
    Full-text · Article · May 2012 · Diagnostic Pathology
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    ABSTRACT: Recent studies imply the importance of rapid and reliable diagnostic assessment of 1p/19q status in oligodendroglial tumors. To date, fluorescent in situ hybridization (FISH) is the most commonly applied technique. FISH, however, has several technical shortcomings that are suboptimal for diagnostic applications: results must be viewed in a fluorescence microscope, results are usually evaluated by a single investigator only and signal fading excludes physical archiving. Also, in gliomas, the distinction of diffusely infiltrating tumor cells from reactively altered normal tissue may be challenging in fluorescence microscopy. Dual- color chromogenic in situ hybridization (CISH) has started to replace FISH in some diagnostic tests performed in pathology. Here, we present the first single institute experience with a side- by side analysis of 1p/19q FISH and CISH in a series of 42 consecutive gliomas. FISH and CISH produced identical results for 1p and 19q in 93% of cases (n= 39/42). Discrepant results were re-evaluated by repeated FISH and a PCR- based microsatellite marker analysis for loss of heterozygosity. Re-evaluation confirmed CISH data in all three cases. We conclude that CISH is a reliable alternative in 1p/19q testing in paraffin embedded tissues likely to be more sensitive to detect 1p/19q status than FISH analysis.
    Full-text · Article · Oct 2012 · Brain Pathology
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