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Comparing subjective and digital image analysis HER2/neu expression scores with conventional and modified FISH scores in breast cancer

¹ Department of Pathology, Stavanger University Hospital, Stavanger, Norway
² Department of Pathology, The Gade Institute, University of Bergen, Norway
³ Department of Pathology, Free University, Amsterdam, The Netherlands

Correspondence to:
Professordr J P A Baak, Department of Pathology, Stavanger University Hospital, Box 8100, 4068 Stavanger, Norway; baja{at}sus.no

Background: HER2/neu expression and fluorescence in situ hybridisation (FISH) amplification have therapeutic significance.

Aims: To compare subjective HER2/neu expression scores with digital image analysis (DIA) and conventional and modified FISH scores in breast cancer.

Methods: Sixty HercepTest-immunostained breast carcinomas, prospectively scored as consensus 2+ and 3+ (DAKO protocol) by two observers, were analysed with DIA, and conventional (Vysis) and modified FISH scoring protocols.

Results: With consensus scoring, 23 (38%) of the 60 cases were 2+ and 37 (62%) were 3+. Agreement with DIA scores was 100%. With conventional FISH scoring, 4 of the 3+ cases did not show amplification, but all of those negative cases had high HER2/neu copy numbers. With the modified FISH scoring protocol, all HercepTest immunohistochemical 3+ cases were amplified. Of the 2+ cases, 3 were amplified with the modified FISH protocol and 4 with the conventional FISH protocol.

Conclusions: Modified FISH scores were better correlated with HercepTest 3+ consensus and DIA scores than were conventional FISH scores. HER2/neu DIA scoring is a cost-effective supplementary tool in surgical pathology.