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Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 2001 Dec;54(12):951–955. doi: 10.1136/jcp.54.12.951

Comparison of core oestrogen receptor (ER) assay with excised tumour: intratumoral distribution of ER in breast carcinoma

A Douglas-Jones 1, N Collett 1, J Morgan 1, B Jasani 1
PMCID: PMC1731334  PMID: 11729216

Abstract

Aims—The use of the H score (involving the assessment of intensity and distribution of positivity) on sections stained for the oestrogen receptor (ER) by immunocytochemistry (ICC) allows different samples to be compared and detailed correlations to be made between hormone receptor expression and morphology. This study assessed the reliability of core biopsy in predicting ER expression in the same tumour excised later at treatment. The distribution of ER within excised tumours was investigated.

Methods—The distribution of ER positivity was investigated in 51 diagnostic core biopsies and across the diameter of 51 subsequently excised tumours in a field by field (magnification, x40; field diameter, 0.4 mm) assessment using the semiquantitive H scoring system.

Results—The ER H score in diagnostic core biopsy was significantly higher (p = 0.05, paired rank test; overall mean, 130; n = 51) than the mean in the corresponding excised tumour (mean, 110; n = 51). There was a significant downward trend in ER positivity from the periphery of tumours towards the centre (p = 0.001). The reduction of ER positivity was 6 H score units (2%)/mm. If core biopsies were orientated with the tumour edge at one end no change in ER positivity with field number along the length of the core could be demonstrated.

Conclusions—ER estimation in core biopsies correlated well with expression in tumours but ER expression was higher in the core biopsies than in the excised tumours. ER expression was higher at the periphery of tumours than at the centre. The higher ER expression in cores may reflect the higher chance of sampling the peripheral part of a tumour using a needle core.

Key Words: breast carcinoma • oestrogen receptor • core biopsy

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Figure 1 Plot of field by field H scores across the diameter of a single whole excised tumour showing reduced immunopositivity for oestrogen receptors (ER) in the centre. No tumour was present for assessment in fields 4, 5, and 6 (NT, no tumour).

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Figure 2 Plot of all H scores from all excised tumours plotted from tumour edge (field 1) to tumour centre for regression analysis. There is a significant downward trend in oestrogen receptor (ER) positivity as the field number increases (p = 0.001).

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Figure 3 Plot of H scores from 10 core biopsy specimens in which the edge could be determined (orientated cores) plotted from tumour edge (field 1) towards tumour centre for regression analysis. For cores there is a no significant downward trend in oestrogen receptor (ER) positivity as the field number increases.

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Figure 4 Plot of mean of all H scores from core specimens against mean of all H scores from subsequently excised tumours. There is a significant correlation between oestrogen receptor (ER) positivity in cores and subsequently excised tumours (correlation coefficient = 0.876; p = 0.001).

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Figure 5 1: Plot of mean of H scores from all core specimens (n = 51) against mean of H scores from all subsequently excised tumours (n = 51) when oestrogen receptor (ER) immunocytochemistry (ICC) was performed on different slides in different assays. 2: Plot of mean of H scores from a sample of core specimens (n = 10) against mean of H scores from subsequently excised tumours (n = 10) when ER ICC was performed on the same slide in one assay. ER positivity is significantly higher in the cores (p = 0.05, paired rank test) using both approaches.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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