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Brief fixation enables same-day breast cancer diagnosis with reliable assessment of hormone receptors, E-cadherin and HER2/Neu
  1. Altuna Halilovic1,
  2. Joris Bulte2,
  3. Yvonne Jacobs1,
  4. Hanneke Braam1,
  5. Patricia van Cleef1,
  6. Margrethe Schlooz-Vries2,
  7. Annelies Werner2,
  8. Oliver Boelens3,
  9. Iris Nagtegaal1,
  10. Hans de Wilt2,
  11. Peter Bult1
  1. 1 Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
  2. 2 Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
  3. 3 Department of Surgery, Hospital Pantein, Boxmeer, The Netherlands
  1. Correspondence to Altuna Halilovic, Department of Pathology, 824, Radboud university medical center, PO Box 9101, Nijmegen 6500 HB, The Netherlands; Altuna.Halilovic{at}


Aims Preoperative core needle biopsy (CNB) is commonly used to confirm the diagnosis of breast cancer. For treatment purposes and for determining histological type, especially in case of neoadjuvant therapy, oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and E-cadherin assessments are crucial. Considering the increasing demand for same-day diagnosis of breast lesions, an accelerated method of CNB processing was developed, in which the tissue fixation time is radically reduced.

Methods To determine whether short fixation time frustrates assessment of ER, PR and E-cadherin immunohistochemistry (IHC) and HER2 fluorescence in situ hybridisation (FISH), 69 consecutive patients with 70 invasive breast carcinomas were included through the same-day diagnostics programme of breast lesions of the Radboud university medical center and the hospital Pantein. IHC for ER, PR and E-cadherin and HER2 FISH were compared between CNBs fixed for approximately 60–90 min and traditionally fixed resection specimens.

Results Overall agreement between CNBs and resection specimens was 98.6% for ER (p<0.001; κ=0.93), 90.0% for PR (p<0.001; κ=0.75), 100% for E-cadherin (p<0001; κ=1.00) and 98.6% (p<0.001; κ=0.94) for HER2 FISH. Positive and negative predictive values were respectively 98.4% and 100% for ER, 95.9% and 76.2% for PR, 100% and 100% for E-cadherin and 90% and 100% for HER2 FISH.

Conclusions Hormone receptors and E-cadherin IHC and HER2 FISH are highly comparable between briefly fixed CNBs and the corresponding traditionally fixed resection specimens, and can therefore reliably be used in the daily clinical practice of same-day diagnostics of breast cancer.


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  • An abstract of this manuscript has been published earlier as a preliminary report at a scientific meeting.[36]

  • Handling editor Runjan Chetty

  • Contributors All authors contributed extensively to the work presented in this article. PB and JHWdW conceived the study and jointly designed the experiments with AH and JPB. Experiments were performed by AH, YHAJ, HB, PHJvC and PB. AH, JPB, PB, IDN, MS-V, JEMW and OBB performed data collection and analysis. AH, JPB and PB wrote the first concept of the manuscript. All authors discussed the results and implications, and commented on the manuscript at all stages.

  • Competing interests IN received a speaker’s fee from Sakura Finetek Europe BV.

  • Provenance and peer review Not commissioned; externally peer reviewed.