HER-2/neu assessment in breast cancer by immunohistochemistry and fluorescence in situ hybridization:: Comparison of results and correlation with survival

Background: HER-2/neu immunohistochemistry (MC) and fluorescence in situ hybridization (FISH) results guide breast cancer therapy; however, few studies compared the results and no published studies have correlated them with patient outcome. Methods and Results: We compared results, cost, and turnaround time in 117 archival, invasive breast carcinomas and compared 50-month survival in 65 of these cases using commercial HER-2/neu MC and FISH assays. Twenty-one of 112 FISH (19%) and 33 of 117 IHC cases (28%) were positive. Concordance was high overall (88%; 98 of 112 cases) and in IHC 3+ cases (88%; 14 of 16 cases) but low in IHC 2+ cases (35%; six of 17 cases). Survival correlated with IHC results in 3+ cases (P = .02) and FISH cases with signal ratio greater than 4.0 (P = .03), but not in IHC 2+ cases (P = .7). Cost and turnaround time were greater for FISH. Conclusion: IHC is appropriate for initial HER-2/neu assessment; however, patients with tumors scored less than 3+, particularly those interpreted as 2+, would benefit from FISH to more accurately assess HER-2/neu status and avoid inaccurate prognostication and inappropriate treatment.