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Logo of jclinpathJournal of Clinical PathologyCurrent TOCInstructions for authors
J Clin Pathol. Feb 2000; 53(2): 125–130.
PMCID: PMC1763294

Reliability of immunohistochemical demonstration of oestrogen receptors in routine practice: interlaboratory variance in the sensitivity of detection and evaluation of scoring systems

Abstract

Aims—To investigate interlaboratory variance in the immunohistochemical (IHC) detection of oestrogen receptors so as to determine the rate of false negatives, which could adversely influence the decision to give adjuvant tamoxifen treatment.

Methods—To ensure that similar results are obtained by different institutions, 200 laboratories from 26 countries have joined the UK national external quality assessment scheme for immunocytochemistry (NEQAS-ICC). Histological sections from breast cancers having low, medium, and high levels of oestrogen receptor expression were sent to each of the laboratories for immunohistochemical staining. The results obtained were evaluated for the sensitivity of detection, first by estimating threshold values of 1% and 10% of stained tumour cells, and second by the Quick score method, by a panel of four assessors judging individual sections independently on a single blind basis. The results were also evaluated using participants' own threshold values.

Results—Over 80% of laboratories were able to demonstrate oestrogen receptor positivity on the medium and high expressing tumours, but only 37% of laboratories scored adequately on the low expressing tumour. Approximately one third of laboratories failed to register any positive staining in this tumour, while one third showed only minimal positivity.

Conclusions—There is considerable interlaboratory variability, especially in relation to the detection of breast cancers with low oestrogen receptor positivity, with a false negative rate of between 30% and 60%. This variability appears to be caused by minor differences in methodology that may be rectified by fine adjustment of overall technique.

Key Words: immunohistochemistry • oestrogen receptors • interlaboratory variation

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Selected References

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Figures and Tables

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Figure 1 Distribution of the results of the "Quick" score evaluation conducted on the three infiltrating ductal carcinomas (IDC), X, Y, Z, used at assessment. The bold line represents the median score, the bottom and top of the boxes, the 1st and 3rd ...
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Figure 2 The proportion of laboratories from which immunohistochemistry reliably demonstrated the intraductal carcinomas X, Y, Z as being oestrogen receptor positive. χ2 values were as follows:
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Figure 3 The proportions of 200 laboratories from which immunohistochemistry demonstrated either no nuclei, some nuclei but less than 10%, and 10% of more, in the "low" oestrogen receptor expressing infiltrating ductal carcinoma.

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