Quantitative immunohistochemistry of estrogen receptor in breast cancer "much ado about nothing!"

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

"The value of a clinical test should be assessed in the overall context of disease management." The ultimate goal of an assay for detection of estrogen receptor (ER) content in breast cancer tissue is to identify patients who will or will not benefit from endocrine therapy. In the past 2 decades, scenarios for ER testing of patient samples have shifted from tissue homogenatebased, biochemical ligand-binding assays to the more practical and clinically relevant slide-based immunohistochemical methods. Although the superiority of the predictive value of ER-immunohistochemistry (ER-IHC) over ligand-binding techniques has been established to everyone's satisfaction, there remains the controversial issue of quantitation of immunohistochemical results. The assumption that ER-IHC should be quantitative stems largely from the fact that the old biochemical assay results were numerical. Seasoned immunohistochemists, nevertheless, know that IHC of routinely fixed and processed tissue does not yield itself to accurate quantitation of results, even when performed by well-qualified laboratories. Furthermore, in the case of ER, immunohistochemical methods only identify a segment or epitope of ER protein that is immunologically reactive with the used antibody. Hence, as it is, an immunohistochemical technique gives no information about the functional status of ER molecule, and/or that of the complex downstream ER pathways. This may be one of the reasons why one-third of patients with ER-positive breast cancers initially, and another one-third eventually, do not respond to endocrine treatment modalities. In this review, I attempt to present an argument that is based on our current information; quantitation of ER-IHC is neither technically reliable nor clinically relevant.

Original languageEnglish
Pages (from-to)105-107
Number of pages3
JournalApplied Immunohistochemistry and Molecular Morphology
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2008

Fingerprint

Estrogen Receptors
Immunohistochemistry
Breast Neoplasms
Ligands
Disease Management
Epitopes
Antibodies
Therapeutics

Keywords

  • Breast cancer
  • Estrogen receptor
  • Immunohistochemistry
  • Quantitative immunohistochemistry

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology
  • Histology
  • Anatomy

Cite this

@article{c8fa6856141449f385d01249fe60f23d,
title = "Quantitative immunohistochemistry of estrogen receptor in breast cancer {"}much ado about nothing!{"}",
abstract = "{"}The value of a clinical test should be assessed in the overall context of disease management.{"} The ultimate goal of an assay for detection of estrogen receptor (ER) content in breast cancer tissue is to identify patients who will or will not benefit from endocrine therapy. In the past 2 decades, scenarios for ER testing of patient samples have shifted from tissue homogenatebased, biochemical ligand-binding assays to the more practical and clinically relevant slide-based immunohistochemical methods. Although the superiority of the predictive value of ER-immunohistochemistry (ER-IHC) over ligand-binding techniques has been established to everyone's satisfaction, there remains the controversial issue of quantitation of immunohistochemical results. The assumption that ER-IHC should be quantitative stems largely from the fact that the old biochemical assay results were numerical. Seasoned immunohistochemists, nevertheless, know that IHC of routinely fixed and processed tissue does not yield itself to accurate quantitation of results, even when performed by well-qualified laboratories. Furthermore, in the case of ER, immunohistochemical methods only identify a segment or epitope of ER protein that is immunologically reactive with the used antibody. Hence, as it is, an immunohistochemical technique gives no information about the functional status of ER molecule, and/or that of the complex downstream ER pathways. This may be one of the reasons why one-third of patients with ER-positive breast cancers initially, and another one-third eventually, do not respond to endocrine treatment modalities. In this review, I attempt to present an argument that is based on our current information; quantitation of ER-IHC is neither technically reliable nor clinically relevant.",
keywords = "Breast cancer, Estrogen receptor, Immunohistochemistry, Quantitative immunohistochemistry",
author = "Mehrdad Nadji",
year = "2008",
month = "3",
day = "1",
doi = "10.1097/PAI.0b013e3181607323",
language = "English",
volume = "16",
pages = "105--107",
journal = "Applied Immunohistochemistry and Molecular Morphology",
issn = "1541-2016",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Quantitative immunohistochemistry of estrogen receptor in breast cancer "much ado about nothing!"

AU - Nadji, Mehrdad

PY - 2008/3/1

Y1 - 2008/3/1

N2 - "The value of a clinical test should be assessed in the overall context of disease management." The ultimate goal of an assay for detection of estrogen receptor (ER) content in breast cancer tissue is to identify patients who will or will not benefit from endocrine therapy. In the past 2 decades, scenarios for ER testing of patient samples have shifted from tissue homogenatebased, biochemical ligand-binding assays to the more practical and clinically relevant slide-based immunohistochemical methods. Although the superiority of the predictive value of ER-immunohistochemistry (ER-IHC) over ligand-binding techniques has been established to everyone's satisfaction, there remains the controversial issue of quantitation of immunohistochemical results. The assumption that ER-IHC should be quantitative stems largely from the fact that the old biochemical assay results were numerical. Seasoned immunohistochemists, nevertheless, know that IHC of routinely fixed and processed tissue does not yield itself to accurate quantitation of results, even when performed by well-qualified laboratories. Furthermore, in the case of ER, immunohistochemical methods only identify a segment or epitope of ER protein that is immunologically reactive with the used antibody. Hence, as it is, an immunohistochemical technique gives no information about the functional status of ER molecule, and/or that of the complex downstream ER pathways. This may be one of the reasons why one-third of patients with ER-positive breast cancers initially, and another one-third eventually, do not respond to endocrine treatment modalities. In this review, I attempt to present an argument that is based on our current information; quantitation of ER-IHC is neither technically reliable nor clinically relevant.

AB - "The value of a clinical test should be assessed in the overall context of disease management." The ultimate goal of an assay for detection of estrogen receptor (ER) content in breast cancer tissue is to identify patients who will or will not benefit from endocrine therapy. In the past 2 decades, scenarios for ER testing of patient samples have shifted from tissue homogenatebased, biochemical ligand-binding assays to the more practical and clinically relevant slide-based immunohistochemical methods. Although the superiority of the predictive value of ER-immunohistochemistry (ER-IHC) over ligand-binding techniques has been established to everyone's satisfaction, there remains the controversial issue of quantitation of immunohistochemical results. The assumption that ER-IHC should be quantitative stems largely from the fact that the old biochemical assay results were numerical. Seasoned immunohistochemists, nevertheless, know that IHC of routinely fixed and processed tissue does not yield itself to accurate quantitation of results, even when performed by well-qualified laboratories. Furthermore, in the case of ER, immunohistochemical methods only identify a segment or epitope of ER protein that is immunologically reactive with the used antibody. Hence, as it is, an immunohistochemical technique gives no information about the functional status of ER molecule, and/or that of the complex downstream ER pathways. This may be one of the reasons why one-third of patients with ER-positive breast cancers initially, and another one-third eventually, do not respond to endocrine treatment modalities. In this review, I attempt to present an argument that is based on our current information; quantitation of ER-IHC is neither technically reliable nor clinically relevant.

KW - Breast cancer

KW - Estrogen receptor

KW - Immunohistochemistry

KW - Quantitative immunohistochemistry

UR - http://www.scopus.com/inward/record.url?scp=46749124761&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=46749124761&partnerID=8YFLogxK

U2 - 10.1097/PAI.0b013e3181607323

DO - 10.1097/PAI.0b013e3181607323

M3 - Article

VL - 16

SP - 105

EP - 107

JO - Applied Immunohistochemistry and Molecular Morphology

JF - Applied Immunohistochemistry and Molecular Morphology

SN - 1541-2016

IS - 2

ER -