title: Comparison of HER-2 and hormone receptor expression in primary breast cancers and asynchronous paired metastases: impact on patient management.
abstract: BACKGROUND
  The assessment of hormone receptors (HRs) and human epidermal growth factor receptor (HER)-2 is necessary to select patients who are candidates for hormonal and anti-HER-2 therapy. The evaluation of these parameters is generally carried out in primary tumors and it is not clear if reassessment in metastatic lesions might have an impact on patient management. The primary aim of this analysis was to compare HER-2 and HR status in primary tumors versus metastatic sites in breast cancer patients.
  
  
  METHODS
  Seventy-five patients with available samples from primary tumors and paired metastases were included. HER-2 status was evaluated by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH); HR status was assessed by IHC.
  
  
  RESULTS
  Nineteen percent of primary tumors were HER-2 positive; 77% were HR positive. Sites of biopsied or resected metastases were: locoregional soft tissues (n = 30), liver (n = 20), central nervous system (n = 5), bone (n = 5), pleura (n = 4), distant soft tissues (n = 3), abdomen (stomach, colon, peritoneum) (n = 3), bronchus (n = 3), and bone marrow (n = 2). For paired metastases, the HER-2 status was unchanged in 84% of cases; two patients changed from positive to negative, while 10 patients converted from negative to positive (agreement, 84%; kappa = 0.5681). A change in HR status was observed in 16 cases (21%): nine cases from positive to negative and seven cases from negative to positive (agreement, 78.7%; kappa = 0.4158).
  
  
  CONCLUSIONS
  Further studies are necessary to better define the level of discordance in HER-2 or HR status between primary tumors and paired metastases. However, a biopsy of metastatic disease can be recommended, if feasible with minimal invasiveness, because treatment options might change for a significant proportion of patients.
authors.affiliation: Department of Oncology and Hematology, Modena University Hospital, via del Pozzo 71, 41100 Modena, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Guarneri
authors.forename: Simona
authors.initials: S
authors.lastname: Giovannelli
authors.forename: Guido
authors.initials: G
authors.lastname: Ficarra
authors.forename: Stefania
authors.initials: S
authors.lastname: Bettelli
authors.forename: Antonino
authors.initials: A
authors.lastname: Maiorana
authors.forename: Federico
authors.initials: F
authors.lastname: Piacentini
authors.forename: Elena
authors.initials: E
authors.lastname: Barbieri
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Dieci
authors.forename: Roberto
authors.initials: R
authors.lastname: D'Amico
authors.forename: Gordana
authors.initials: G
authors.lastname: Jovic
authors.forename: PierFranco
authors.initials: P
authors.lastname: Conte
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D015870:Gene Expression; D015972:Gene Expression Regulation, Neoplastic; D018734:Genes, erbB-2 / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000235:genetics*; D011960:Receptors, Estrogen / Q000096:biosynthesis* / Q000235:genetics; D011980:Receptors, Progesterone / Q000096:biosynthesis* / Q000235:genetics; D012189:Retrospective Studies
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone