title: Surgical specimen can be replaced by core samples in assessment of ER, PR and HER-2 for invasive breast cancer.
abstract: OBJECTIVE
  To compare 14-gauge SCNB (stereotactic core needle biopsy) with surgery and to investigate tissue-heterogeneity of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth-factor receptor (HER-2) for nonpalpable breast cancers. To determine the number of cores needed for assessment of these factors.
  
  
  METHODS
  Cores of 41 invasive cancers were collected in three containers: the 1st into A, the 2nd and 3rd into B and subsequent cores into C. ER, PR and HER-2 were scored by immunohistochemistry and if 2+ or 3+, by chromogenic-in-situ-hybridisation (CISH) for containers and for surgical specimen.
  
  
  RESULTS
  Between SCNB and surgical specimen concordance was 83% (kappa = 0.39) for ER, 88% (kappa = 0.69) for PR and HER-2 and 93% (kappa = 0.63) for HER-2 after CISH. For the most discordant cases, status was positive in cores but negative in surgery: 5/7 for ER (p = 0.459), 5/5 for PR (p = 0.063), and 4/5 for HER-2 (p = 0.375), after CISH 3/3 (p = 0.250), but the difference was not statistically significant. Concordances between containers of cores was 100% (kappa = 1), 85% (kappa = 0.66) and 85% (kappa = 0.66), respectively. With more than three cores, sensitivities of 95%, 100% and 100% were reached.
  
  
  CONCLUSIONS
  SCNB is at least as sensitive as surgery in assessment of ER, PR and HER-2. Three cores are needed for reliable assessment of HER-2 after adding CISH and more than three cores for PR, possibly due to tissue heterogeneity. For ER sensitivity remained lower, 95%, even in multiple cores, therefore ER-negative cases should be further investigated from surgical specimens.
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital and Kuopio University, Finland. anna.sutela@kuh.fi
authors.forename: Anna
authors.initials: A
authors.lastname: Sutela
authors.forename: Ritva
authors.initials: R
authors.lastname: Vanninen
authors.forename: Mazen
authors.initials: M
authors.lastname: Sudah
authors.forename: Marja
authors.initials: M
authors.lastname: Berg
authors.forename: Vesa
authors.initials: V
authors.lastname: Kiviniemi
authors.forename: Jaana
authors.initials: J
authors.lastname: Rummukainen
authors.forename: Vesa
authors.initials: V
authors.lastname: Kataja
authors.forename: Vesa
authors.initials: V
authors.lastname: Kärjä
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D001943:Breast Neoplasms / Q000737:chemistry* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D012107:Research Design
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone