Interobserver Variation in the Assessment of Immunohistochemistry Expression Levels in HER2-Negative Breast Cancer: Can We Improve the Identification of Low Levels of HER2 Expression by Adjusting the Criteria? An International Interobserver Study

Ximena Baez-Navarro;Van Bockstal, Mieke;Diënna Nawawi;Glenn Broeckx;Carolien H. M. van Deurzen;et.al.
(2023) Modern Pathology — Vol. 36, n° 1, p. 100009 [1-8] (2023)

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Authors
  • Ximena Baez-Navarro
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  • Van Bockstal, Miekeorcid-logoUCLouvain
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  • Diënna Nawawi
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  • Glenn Broeckx
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  • Carolien H. M. van Deurzen
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Abstract
The classification of human epidermal growth factor receptor 2 (HER2) expression is optimized to detect HER2-amplified breast cancer (BC). However, novel HER2-targeting agents are also effective for BCs with low levels of HER2. This raises the question whether the current guidelines for HER2 testing are sufficiently reproducible to identify HER2-low BC. The aim of this multicenter international study was to assess the interobserver agreement of specific HER2 immunohistochemistry scores in cases with negative HER2 results (0, 1+, or 2+/in situ hybridization negative) according to the current American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines. Furthermore, we evaluated whether the agreement improved by redefining immunohistochemistry (IHC) scoring criteria or by adding fluorescent in situ hybridization (FISH). We conducted a 2-round study of 105 nonamplified BCs. During the first assessment, 16 pathologists used the latest version of the ASCO/CAP guidelines. After a consensus meeting, the same pathologists scored the same digital slides using modified IHC scoring criteria based on the 2007 ASCO/CAP guidelines, and an extra "ultralow" category was added. Overall, the interobserver agreement was limited (4.7% of cases with 100% agreement) in the first round, but this was improved by clustering IHC categories. In the second round, the highest reproducibility was observed when comparing IHC 0 with the ultralow/1+/2+ grouped cluster (74.3% of cases with 100% agreement). The FISH results were not statistically different between HER2-0 and HER2-low cases, regardless of the IHC criteria used. In conclusion, our study suggests that the modified 2007 ASCO/CAP criteria were more reproducible in distinguishing HER2-0 from HER2-low cases than the 2018 ASCO/CAP criteria. However, the reproducibility was still moderate, which was not improved by adding FISH. This could lead to a suboptimal selection of patients eligible for novel HER2-targeting agents. If the threshold between HER2 IHC 0 and 1+ is to be clinically actionable, there is a need for clearer, more reproducible IHC definitions, training, and/or development of more accurate methods to detect this subtle difference in protein expression levels.
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Ximena Baez-Navarro, Van Bockstal, M., Diënna Nawawi, Glenn Broeckx, Cecile Colpaert, Shusma C. Doebar, Marieke C. H. Hogenes, Esther Koop, Kathleen Lambein, Dieter E. J. Peeters, Renata H. J. A. Sinke, Johannes Bastiaan van Brakel, José van der Starre-Gaal, Bert van der Vegt, Koen van de Vijver, celien P. H. Vreuls, Willem Vreuls, Pieter J. Westenend, & Carolien H. M. van Deurzen. (2023). Interobserver Variation in the Assessment of Immunohistochemistry Expression Levels in HER2-Negative Breast Cancer: Can We Improve the Identification of Low Levels of HER2 Expression by Adjusting the Criteria? An International Interobserver Study. Modern Pathology, 36(1), 100009 [1-8]. https://doi.org/10.1016/j.modpat.2022.100009. (Original work published 2023)