Hormone receptor expression in breast cancer: postanalytical issues

Hormone receptor expression is a critical part of the pathological evaluation of breast cancer. Underpinning not only therapeutic decisions and prognosis, oestrogen receptor (ER) and progesterone receptor (PR) have been a consistent thread in the expanding knowledge of breast cancer. Accurate laboratory testing requires care and precision in preanalytical, analytical and postanalytical processes. In this report, postanalytical issues of pathologist interpretation of ER and PR status in breast cancer are discussed. Apart from key elements of the actual pathological assessment, it is important to realise that there are additional factors that can impact on sensitivity, specificity and dynamic range of hormone receptor expression as rendered on pathology. These include tumour characteristics and heterogeneity, biological changes of tumour progression and interacting molecules, all of which can influence the degree of hormone responsiveness in a particular individual with hormone receptor-positive breast cancer. There is a need to ensure participation in quality assurance programmes and slide exchanges, as well as to constantly keep abreast of emerging data on clinical trials and outcomes of hormone receptor-positive breast cancer.