Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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Implementation of a microwave-assisted tissue-processing system and an automated embedding system for breast needle core biopsy samples: morphology, immunohistochemistry, and FISH evaluation.

Author(s): Pegolo E, Pandolfi M, Di Loreto C

Publication: Appl Immunohistochem Mol Morphol, 2013, Vol. 21, Page 362-70

PubMed ID: 23060302 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared morphology, FISH, and IHC staining in conventionally and microwave-assisted processed FFPE breast cancer specimens. Under ultrasound-guidance, four passes with a 14-gauge needle were used to obtain needle core breast biopsies from 233 patients. Biopsies were immediately fixed in 10% formalin for 18-24 h. Half the cores from each case were sent for conventional processing (14 h) and the other half of the cores were sent for microwave-assisted rapid processing using Sakura Tissue-Tek Xpress 120 (1 h). Importantly, conventional processing used xylene and graded alcohol and specimens were manually embedded in paraffin while the microwave-assisted processor used acetone and isopropyl alcohol followed by automated embedding. Sections of paired specimens processed using both methods were placed together on the slides. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) IHC staining and HER-2 amplification by FISH was scored as specified in the American Society of Clinical Oncology (ASCO) and College of American Pathologists (CAP) guidelines. Ki-67 staining was divided into low (≤14%) and high (>14%) labeling index. Morphology, IHC staining, and FISH were evaluated by a single pathologist.

   Summary of Findings:

   Overall, the morphological quality (tissue architecture, stroma, cell morphology, nuclear morphology, and presence of microcalcifications) and IHC staining intensity and patterns were comparable between specimens processed conventionally using xylene and those processed with acetone and microwave-assistance. Further, ER and PR status by IHC were concordant between processing methods in 100% of cases. A comparable percentage of conventionally-processed and microwave-processed specimens stained for ER (65.06% and 66%, respectively) and Ki-67 (26.33% and 25.57%, respectively). Although HER-2 status by IHC was found to be discordant in 2 cases (unamplified in conventionally processed and equivocal in microwave-processed), the addition of FISH confirmed no amplification in both cases and thereby allowed for 100% concordance between processing methods. A very strong agreement was observed between specimens processed conventionally and with microwave assistance for the Ki-67 labelling index (κ=0.91) and HER-2 status by IHC (κ=0.93). 

   Biospecimens

   • Tissue - Breast

   Preservative Types

   • Formalin

   Diagnoses:

   • Neoplastic - Benign
   • Normal
   • Neoplastic - Lymphoma
   • Neoplastic - Carcinoma

   Platform:

   Analyte	Technology Platform
   Morphology	H-and-E microscopy
   Protein	Immunohistochemistry
   DNA	FISH
   Morphology	Light microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   FISH Specific	Targeted nucleic acid	HER-2
   Biospecimen Preservation	Duration of tissue/ specimen processing	Conventional processing (14 h) Microwave-assisted processing (1 h)
   Immunohistochemistry Specific	Targeted peptide/protein	HER-2 ER PR Ki-67

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