Discrepant cases and impact on patient management
| Case | Section ICC | TMA | ||||
|---|---|---|---|---|---|---|
| ICC | FISH | |||||
| RCSI mean score (score/core) | UHW mean score (score/core) | RCSI | UHW mean grade (individual grades) | Potential impact on decision to offer Herceptin treatment | ||
| *Although the RCSI results revealed no amplification by FISH the whole section score of 3+ and the amplification revealed by the Ventana probe meant that the patient would have been recommended for treatment, presumably inappropriately; †no patient impact at the RCSI but impact at the UHW. The UHW TMA ICC was non-contributory. The individual ICC scores for each core at the RCSI are of interest in terms of the absence of amplification determined at the UHW; ‡This is clearly a difficult case, where FISH testing produced a borderline result on two occasions at the RCSI. It is of interest that the 4 cores gave a score of 2+ by ICC. In both institutions the patient would have received Herceptin treatment. | ||||||
| ICC, immunocytochemistry; FISH, fluorescence in situ hybridisation; NT, no tumour remaining; RCSI, Royal College of Surgeons in Ireland; TMA, tissue microarray; UHW, University Hospital of Wales. | ||||||
| 7 | 2+ | 1 (1, 1, 1, 1) | 2 (2, 2, 2, 2) | 1.59 | 0.75 (1, 1, 1, 0) | None |
| 32 | 3+ | 1.5 (2, 2, 1, 1) | 1.75 (2, 2, 0, 2) | 0.94 | 1.75 (1, 2, 2, 2) | * |
| 34 | 2+ | 0.3 (−, 0, 1, 0) | 0.75 (1, 1, 1, 0) | 0.85 | 0.67 (−, 1, 1, 0) | None |
| 52 | 3+ | 1.25 (2, 2, 1, 0) | NT (−, −, −, 0) | 3.01 | 1.5 (2, 2, 1, 1) | † |
| 53 | 3+ | 2 (2, 2, 2, 2) | 0.3 (−, 0, 0, 2) | 1.99 and 1.97 | 2 (2, 1, 3, 2) | ‡ |