Updated Guidelines Issued for ER, PgR Testing in Breast Cancer

Clinicians should be prepared to discuss limited data for benefit of endocrine tx in ER-low positive cases.

HealthDay News – In an American Society of Clinical Oncology/College of American Pathologists updated guideline, published online January 13 in the Archives of Pathology & Laboratory Medicine and the Journal of Clinical Oncology, recommendations are presented for estrogen and progesterone receptor (ER/PgR) testing in breast cancer.

Kimberly H. Allison, MD, from the Stanford University School of Medicine in California, and colleagues convened a multidisciplinary international expert panel to update the clinical practice guideline recommendations for ER and PgR testing in breast cancer.

The expert panel continues to recommend validated immunohistochemistry for ER testing of invasive breast cancers as the standard for predicting benefit from endocrine therapy. Samples with 1 to 100% of tumor nuclei positive should be considered ER-positive. However, limited data are available on the benefit of endocrine therapy for cancers with 1 to 10% of cells staining ER-positive, now described in a new reporting category called ER-low positive. A sample with <1 or 0% of tumor cell nuclei immunoreactive should be considered ER-negative. To promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result, additional strategies include establishing a laboratory specific standard operating procedure describing additional steps used to confirm/adjudicate results. PgR testing continues to be used primarily to help determine prognosis in ER-positive breast cancers. Testing ductal carcinoma in situ for ER is recommended while testing for PgR is considered optional.

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“The critical point for clinicians is that they need to be aware of and able to discuss with patients the implications of ER-low positive test results,” a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

Abstract/Full Text – Archives of Pathology & Laboratory Medicine

Abstract/Full Text – Journal of Clinical Oncology