Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update
Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update
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DOI：
10.1200/jco.19.02309
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发表时间：
2020-04-20
影响因子：
45.3
通讯作者：
Wolff, Antonio C.
中科院分区：
文献类型：
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作者：
Allison, Kimberly H.;Hammond, M. Elizabeth H.;Wolff, Antonio C.
更新美国临床肿瘤学会/美国病理学家学会雌激素（ER）和孕激素受体（PgR）的关键建议乳腺癌指南中的ER检测。METHODSA多学科国际专家小组召开会议，通过对医学文献的系统回顾，更新临床实践指南的建议。免疫组织化学作为预测哪些患者可能受益于内分泌治疗的标准，并且不推荐用于此目的的其他测定。1%-100%肿瘤细胞核阳性的乳腺癌样本应解释为ER阳性。然而，专家小组承认，关于内分泌治疗对1%至10% ER阳性细胞的癌症的益处的数据有限。具有这些结果的样本应使用新的报告类别（ER低阳性）报告，并附有建议的注释。如果< 1%或0%的肿瘤细胞核是免疫反应性的，则认为样品是ER阴性的。为促进最佳性能、解释和报告初始ER染色结果低至无结果的病例，建议采用的其他策略包括建立实验室特定的标准操作规程，描述实验室用于确认/裁定结果的其他步骤。对于0%至10%染色的病例，应报告对照状态。类似的原则适用于PgR测试，主要用于ER阳性癌症的预后目的。乳腺导管原位癌（DCIS）的ER检测被推荐用于确定内分泌治疗的潜在益处，以降低未来乳腺癌的风险，而DCIS的PgR检测被认为是可选的。更多信息可以在www.asco.org/breast-cancer-guidelines上找到。
PURPOSETo update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen (ER) and progesterone receptor (PgR) testing in breast cancer guideline.METHODSA multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature.RECOMMENDATIONSThe Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines.