![]() In the group of patients who were node pretreatment node-positive, 28 of 50 (56%) were downstaged to N0 following chemotherapy. Overall, 30 of 85 patients' tumors (35.3%) showed pCR following neoadjuvant chemotherapy. Relationship Between Hormone Receptor and HER2 Results Before Neoadjuvant Chemotherapy Nonetheless, FISH was performed in this case and showed gene amplification with HER2/CEP17 ratio of 2.4. The classic lobular carcinoma reportedly yielded 2+ staining at an outside hospital, but repeated staining in our laboratory showed 1+ staining. Of the 3 lobular carcinomas in this series, the 2 with pleomorphic morphology showed 3+ staining. Per American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines this tumor was scored as 2+ and reflexed to FISH, which showed gene amplification ( HER2/CEP17: 2.2 HER2 signals per cell: 5.2) ( Figure 1, D). One tumor with micropapillary features showed a basolateral HER2 staining pattern, 19 characterized by relatively weak membranous staining that is noncircumferential and more pronounced in the basolateral aspect of the gland not facing the stroma ( Figure 1, C). Grade 3 tumors showed significantly more frequent HER2 3+ staining than grade 2 tumors (76.2% versus 46.5%, P =. 03), as was the mean number of HER2 signals per cell (15.03 versus 7.06, P =. ![]() The mean HER2 FISH ratio was significantly greater in IHC 3+ tumors than in those with 0 to 2+ staining (5.93 versus 3.27, P =. 14 For cases in which FISH was performed, the number of HER2 signals per cell and HER2/CEP17 ratio were recorded from the original FISH reports. 17 HER2 IHC stains were scored: 0, 1+, 2+, or 3+. 16 H-scores for HRs were grouped into 3 categories: low positive (1–100), moderate positive (101–200), and high positive (201–300). The H-score, which produces a value ranging from 0 (no staining) to 300 (diffuse strong staining), represents the sum of percentage of tumor nuclei staining at each intensity level multiplied by the staining intensity (0 = staining, 1 = weak staining, 2 = moderate staining, and 3 = strong staining). ER and PR were assessed by using a semiquantitative approach to generate an H-score for each case. The ER, PR, and HER2 IHC-stained slides were reviewed for all cases. Histologic type and any notable morphologic features such as mucinous, micropapillary, apocrine, or lobular differentiation were recorded. Each tumor was graded according to the Nottingham System. Hematoxylin-eosin slides from core biopsy and excision samples were reviewed by 3 pathologists. ![]()
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