乳腺癌HER2基因扩增的临床病理意义

HER2 Amplification in Breast Cancer and Its Clinicopathological Implications

目的检测乳腺癌组织中HER2基因扩增状态,评价其临床病理意义。方法应用FISH、IHC方法分析55例乳腺癌HER2基因扩增/蛋白表达状态与临床病理特征的关系,比对IHC法与FISH检测的一致性程度。结果 55例乳腺癌FISH检测有32例(58.2%)HER2基因扩增。IHC法HER2(+++)22例中21例(95.5%)HER2基因扩增;HER2(++)12例中10例(83.3%)HER2基因扩增;HER2(+/-)21例中1例(4.7%)HER2基因扩增。39例浸润性导管癌中30例(76.9%)有HER2基因扩增,12例浸润性小叶癌中仅1例(8.3%)HER2基因扩增。HER2基因扩增在浸润性导管癌的组织学分级间差异有统计学意义(P<0.001),组织学Ⅲ级的浸润性导管癌较Ⅰ、Ⅱ级有较高的HER2基因扩增率。HER2基因扩增与ER、PR阴性状态及腋淋巴结转移有显著相关性(P<0.01),与患者是否绝经无相关性(P>0.05)。结论浸润性小叶癌,ER、PR阳性以及组织学Ⅰ级的浸润性导管癌常少有HER2基因扩增;对于组织学Ⅲ的浸润性导管癌,同时ER、PR阴性者尽管IHC检测结果为阴性,仍需做FISH检测以明确是否有HER2基因扩增。

Objective To detect state of HER2amplification in breast cancer and assess its clinicopathological significance.Methods To analyze HER2 amplification/protein expressing status in 55 cases of breast cancer specimens with fluorescence in situ hybridization（FISH）and immunohistochemistry（IHC）,and the relationship wity clinicopathological characters.To compare the coincidence of the two assay methods（IHC and FISH）.Results Thirty-two of the 55 cases（58.2%） of breast cancer showed HER2 amplification.Twenty-one of the 22 cases（95.5%）with HER2（3＋） by immunohistochemistry was HER2 amplification by FISH testing.Ten of the 12cases（83.3%） with HER2（2＋） by immunohistochemistry were HER2amplification by FISH testing.Only one of the 21cases（4.7%） with HER2（＋/-） by immunohistochemistry was HER2amplification by FISH testing.Thirty of the 39 cases（76.9%） with invasive ductal carcinomas identified HER2 amplification.Only one of the 12 cases（8.3%）with invasive lobular carcinoma identified HER2 amplification.The presence of HER2 amplification was significant difference between histologic grade of the invasive ductal carcinoma（P〈0.001）.GradesⅢinvasive ductal carcinomas were more likely to demonstrate HER2 amplification than gradeⅠandⅡductal carcinoma.The presence of HER2 amplification was significantly correlated with negative ER and PR（P〈0.01）,and not related to postmenopausal（P〈0.05）.Conclusion The presence of HER2 amplification was less surprising in invasive lobular carcinoma and positive ER,PR and grade I invasive ductal carcinomas.We suggest that gradeⅢinvasive ductal carcinomas with negative ER and PR although the results was negative by IHC,detection of the neoplasm should be performed to confirm HER2 amplification by FISH testing.