A modified approach for I-FISH evaluation of ERBB2 (HER-2) gene copy numbers in breast carcinomas: comparison with HER-2/CEP17 ratio system

The evaluation of ERBB2 gene copy numbers and ERBB-2 protein expression in invasive duct carcinomas of the mammary gland (IDC) has been introduced as a part of a regular investigation protocol. Amplification of the ERBB2 gene detected by fluorescence in situ hybridization on interphasic nuclei (I-FISH) is used as a criterion for Herceptin administration. To improve characterization of cases with a borderline ERBB2 gene amplification, we applied a modified evaluation of the ERBB2 gene copy numbers. The results were compared with a commonly used HER-2/CEP17 ratio calculation.

We investigated 175 patients with primary IDCs in histological sections from paraffin embedded tissue with PathVysion HER-2 DNA Probe Kit (Vysis). Tumor cells of each case were sorted according to the number of ERBB2 signals into groups of tumor cells without amplification, with moderate amplification (< or =10 signals) and with strong amplification (>10 signals). If >10% of tumor cells had moderate or strong amplification of the ERBB2 gene, the case was reported as "moderately" or "strongly" amplified.

The groups of patients classified by the proposed system as "without" and as with "strong" amplification had the HER-2/CEP17 ratio <1.91 (median 1.22, n = 33) and >2.3 (median 6.85, n = 115), respectively. Thus, the findings using the two systems of evaluation yielded similar results for these groups of patients. In cases, classified as with "moderate" amplification, the HER-2/CEP17 ratio varied from 1.3 to 4.77 (median 2.11, n = 27). Twelve of these 27 patients were according to the HER-2/CEP17 ratio system "not amplified" (1.3-1.93, median 1.72). Median percentage of the tumor cells with amplification of the ERBB2 gene was 14.5% in this subgroup. Of these 12 cases, 10 were ERBB-2 protein positive, and would be candidates for Herceptin therapy.

The criteria for evaluation of the ERBB2 gene copy number proposed for this study separate gray zone cases with a borderline HER-2/CEP17 finding. The proposed system is easy to apply and characterizes a heterogeneity of the ERBB2 gene copy number in IDC tumor cell population more precisely than the currently used HER-2/CEP17 ratio system.