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The Quantitative ER Immunohistochemical Analysis in Breast Cancer: Detecting the 3 + 0, 4 + 0, and 5 + 0 Allred Score Cases

1
Institute of Pathology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
2
Faculty of Medicine, University of Niš, 18000 Niš, Serbia
3
Department of Chemistry, Faculty of Sciences and Mathematics, University of Niš, 18000 Niš, Serbia
4
Department of Physiology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
5
Department of Histology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
6
Centre for Radiology, Clinical Center Niš, 18000 Niš, Serbia
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(8), 461; https://doi.org/10.3390/medicina55080461
Received: 12 April 2019 / Revised: 22 July 2019 / Accepted: 7 August 2019 / Published: 10 August 2019
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Abstract

Background and objectives: The currently used immunohistochemical approach in determining the estrogen receptor (ER) positivity of breast cancers (BCs) is inherently subjective and additionally limited by its semi-quantitative nature. The application of software in the analysis of digitized slide images may overcome some of these limitations. However, the utilization of such an approach requires that the entire staining procedure is standardized. Background and objectives: We aimed to establish a procedure for the photometric and morphometric analysis of BC immunohistochemical parameters that can possibly be used for a diagnostic purpose that is in line with the current semi-quantitative scoring system. Materials and Methods: Semi-quantitative analysis of ER-stained tissue sections was performed following the Allred scoring system guidelines. The quantitative analysis was performed in ImageJ software after color deconvolution. The quantitative analysis of 66 cases of invasive lobular BC included: Percent of ER-positive cells, average nuclear coloration intensity, and the quantitative ER score. The percent of ER-positive tumor cells was counted using a standard grid overlay, while optical density (0.0–1.0) was measured within each nucleus at the grid points. Results: A statistical analysis revealed a significant positive correlation (r = 0.886, p < 0.001) between the subjective semi-quantitative and quantitative ER scores, with a large effect size (d = 3.8215). We observed strong statistically significant correlations between individual parameters of the total ER score, percentage of ER-positive nuclei, and color intensity, obtained by the two independent methods. Conclusions: Additionally, besides excluding subjectivity, the up to now unreported cases of 3 + 0, 4 + 0, and 5 + 0 Allred scores were detected only by the application of the proposed quantitative approach. View Full-Text
Keywords: lobular breast cancer; Allred scoring system; estrogen immunopositivity; quantitative analysis lobular breast cancer; Allred scoring system; estrogen immunopositivity; quantitative analysis
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Ilić, I.R.; Stojanović, N.M.; Radulović, N.S.; Živković, V.V.; Randjelović, P.J.; Petrović, A.S.; Božić, M.; Ilić, R.S. The Quantitative ER Immunohistochemical Analysis in Breast Cancer: Detecting the 3 + 0, 4 + 0, and 5 + 0 Allred Score Cases. Medicina 2019, 55, 461.

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