The assessment of steroid hormone receptors in resected breast cancer tissues is essential to decide whether endocrine therapy is indicated and to select the best treatment for each patient on the basis of receptor status. Both enzyme immunoassay (EIA) and immunohistochemistry (IHC) have been generally used as methods for examination of estrogen receptor (ER) and progesterone receptor (PgR). In some patients, receptor status cannot be examined for various reasons. A questionnaire survey in Japan clarified that ER status is not examined in approximately 40% of patients receiving breast conserving surgery. To eliminate ‘receptor unknown’ cases, IHC examination on paraffin-embedded tissue is useful to assess thein situ receptor status. The concordance rate of ER and PgR status between EIA and IHC is very high and a study of 88 cases revealed a 97.7% concordance for ER and 92.0% for PgR at a cutoff point of 10%. The cutoff point of IHC is controversial and some studies demonstrated that patients showing 1% ER positive cancer cells would benefit from endocrine therapy. On the other hand, immunohistochemical expression of receptors is heterogeneous and some patients with ER negative invasive tumors have ER positive intraductal components. A study of 65 breast cancers demonstrated that ER positive intraductal components were detected in 3.1% cases of ER negative invasive lesions.
According to these results and the recommendation of the St. Gallen International Conference, IHC is thought to be more useful than EIA in the assessment of steroid hormone receptor status for breast cancer patients.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Group EBCTC: Tamoxifen for early breast cancer. An overview of the randomized trials.Lancet 351: 1451–1467, 1998.
Sonoo H, Kurebayashi J, Iino Y, Inaji H, Watanabe T, Toi M, Kobayashi S, Sato B, Yoshimoto M: Current status and controversial issues concerning endocrine therapy in patients with recurrent breast cancer in Japan.Breast Cancer 6: 344–350, 1999.
Bezwoda WR, Esser JD, Dansey R, Kessel I, Lange M: The value of estrogen and progesterone receptor determinations in advanced breast cancer.Cancer 68: 867–872, 1991.
Manni, A, Arafah B, Pearson OH: Estrogen and progesterone receptors in the prediction of response of breast cancer to endocrine therapy.Cancer 46: 2838–2841, 1980.
Robertson JF, Bates K, Pearson D, Blammy KW, Nicholsen RI: Comparison of two oestrogen receptor assays in the prediction of the clinical course of patients with advanced breast cancer.Br J Cancer 65: 727–730, 1992.
Ravdin PM, Green S, Dorr TM, McGuire WL, Fobian C, Pugh RP, Carlor RD, Rivkin SE, Borst JR, Bolt RJ: Prognostic significance of progesterone receptor levels in estrogen-positive patients with metastatic breast cancer treated with tamoxifen: results of a prospective Southwest Oncology Group study.J Clin Oncol 10: 1284–1291, 1992.
Dombernowsky P, Smith I, Falkson G, Leonard R, Panasci L, Bellmunt J, Bezwoda W, Gardin G, Gudgeon A, Morgan M, Fornasiero A, Hoffmann W, Michel J, Hatschek T, Tjabbes T, Chaudri HA, Horn-berger U, Trunet PF: Letrozole, a new oral aromatase inhibitor for advanced breast cancer: double-blind randomized trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate.J Clin Oncol 16: 453–456, 1998.
Butzdar A, Jonat W, Howell A, Blomqvist C, Vogel CL, Eiermann W, Wolter JM, Azab M, Webster A, Plourde PV: Anastrozole, a potent and selective aromatase inhibitor, versus megestrol acetate in postmenopausal woman with advanced breast cancer: results of overview analysis of two phase III trials.J Clin Oncol 14: 2000–2011, 1996.
Allegra JC, Lippan MC, Thompson EB, Simon R, Bar-lock A, Green L, Huff KK, Do HM, Aitken SC, Warren R: Estrogen receptor status: an important variable in predicting response to endocrine therapy in metastatic breast cancer.Eur J Cancer 16: 323–331, 1980.
Leclercq G, Bojar H, Goussard J, Nicholson RI, Pichon MF, Piffanelli A, Pousette A, Thorpe S, Lons-dorfer M: Abbott monoclonal enzyme immunoassay measurement of estrogen receptors in human breast cancer: a European multicenter study.Cancer Res 46: 4233s-4236s, 1986.
Taylor CR: The current role of immunohistochemistry in diagnostic pathology.Adv Pathol Lab Med 7: 59–105, 1994.
Greene GL, Sobel NB, King WJ, Jensen EV: Immunohistochemical studies of estrogen receptors.J Steroid Biochem 20: 51–56, 1984.
Layfield LJ, Gupta D, Mooney EE: Assessment of tissue estrogen and progesterone receptor levels: a survey of current practice, techniques, and quantitation methods.Breast J 6: 189–196, 2000.
Goldhirsch A, Glick JH, Gelber RD, Coates AS, Senn HJ: Meeting highlights: International consensus panel on the treatment of primary breast cancer.J Clin Oncol 19: 3817–3827, 2001.
Beatson GT: On the treatment of inoperable cases of carcinoma of the mamma: suggestions for a new method of treatment with illustrative cases.Lancet 2: 104, 1896.
Nomura Y: Recent Progress in endocrine therapy for breast cancer.Jpn J Cancer Clin 46: 693–700, 2000.
Chen YM, Gertz KR, Vaughn CB: Assay of ER and PgR in the presence of molybdate.Breast Cancer Res Treat 8: 87, 1986.
Sonoo H: Adjuvant hormone therapy for breast cancer.Jpn J Cancer Clin 46: 701–709, 2000.
Heuson JC, Longeval E, Mattheiem WH, Deboel MC, Syvester RJ, Leccclercq G: Significance of quantitative assessment of estrogen receptors for endocrine therapy in advanced brest cancer.Cancer 39: 1971–1977, 1977.
Campbell FC, Blarney RW, Elston CW, Morris AH, Nicholson RI, Griffiths K, Haybittle JL: Quantitative oestradiol receptor values in primary breast cancer and response of metastases to endocrine therapy.Lancet 2: 1317–1319, 1981.
Kurosumi M, Kusawake T, Takeo K, Suemasu K, Higashi Y: Assessment of estrogen receptor (ER) by immunohistochemistry in resected breast cancer tissues after breast-conserving surgery.Kitakanto Med J 48: 244, 1998 (Proceeding of 23th Saitama and Gunma Conference of Breast Disease, in Japanese).
Shi S-R, Cote RJ, Taylor CR: Antigen retrieval immunohistochemistry: past, present, and future.J Histochem Cytochem 45: 327–343, 1997.
Suemasu K, Kurosumi M, Sakamoto G: Risk factors for local recurrence (especially inflammatory recurrence) of breast cancer after breast-conserving surgery.Jpn J Breast Cancer 15: 558–566, 2000.
Andersen J, Bentzen SM, Poulsen HS: Relationship between radioligand binding assay, immunoenzyme assay and immunohistochemical assay for estrogen receptors in human breast cancer and association with tumor differentiation.Eur J Cancer Clin Oncol 24: 377–384, 1988.
McCarty KS Jr, Miller LS, Cox EB, Konrath J, McCarty KS: Estrogen receptor analysis. Correlation of biochemical and immunohistochemical methods using monoclonal immunohistochemical and biochemical methods.Arch Pathol Lab Med 109: 716–721, 1985.
Sondergaard G, Pedersen KO, Paulsen SM: Estrogen receptor analyses in breast cancer: comparison of monoclonal immunohistochemical and biochemical methods.Eur J Cancer Clin Oncol 25: 1425–1429, 1989.
Kinsel LB, Szabo E, Greene GL, Konrath J, Leight GS, McCarry KS: Immunocytochemical analysis of estrogen receptors as a predictor of prognosis in breast cancer patients: comparison with quantitative biochemical methods.Cancer Res 49: 1052–1056, 1989.
Pertschuk LP, Kim DS, Nayer K, Feldman JG, Eisen-berg KB, Carter AC, Rong ZT, Thelmo WL, Fleisher J, Greene GL: Immnocytochemical estrogen and progesterone receptor assays in breast cancer with monoclonal antibodies: histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival.Cancer 66: 1663–1670, 1990.
Kell DL, Kamel OW, Rouse RV: Immunohistochemical analysis of breast carcinoma estrogen and progesterone receptors in paraffin-embedded tissue. Correlation of clones ERID5 and IA6 with a cytosol-based hormone receptor assay.Appl Immunobiochem 1: 275–281, 1993.
Esteban JM, Kandalaft PL, Mehta P, Odem-Maryon TL, Bacus S, Battifora H: Improvement on the quantification of estrogen and progesterone receptors on paraffin-embedded tumors by image analysis.Am J Clin Pathol 99: 32–38, 1993.
Elledge, RM, Clark GM, Fuqua SAW, Allred DC:P53 protein accumulation detected by five different abtibodies: relationship to prognosis and heat shock protein 70 in breast cancer.Cancer Res 54: 3752–3757, 1994.
Harvey JM, Clark GM, Osborne CK, Allred DC: Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer.J Clin Oncol 17: 1474–1481, 1999.
Kurosumi M, Kishi K, Takayama S, Kano T, Kurihara T, Suemasu K, Higashi Y: Histopathological examination of carcinoma involvement around surgical margins in the resected specimen of breast conservative surgery.Jpn J Breast Cancer 8: 581–586, 1993.
Dixon JM, Love CDB, Renshaw L, Cameron DA, Miller WR, Leonard RC: Lessons from the use of aromatase inhibitors in the neoadjuvant setting.Endocrine-Related Cancer 6: 227–230, 1999.
Dixon JM, Renshaw L, Bellamy C, Stuart M, Hoctin-Boes G, Miller WR: The effects of neoadjuvant anastrozole (Arimidex) on tumor volume in postmenopausal women with breast cancer: a randomized, double-blind, single-center study.Clin Cancer Res 6: 2229–2235, 2000.
Reprint requests to Masafumi Kurosumi, Department of Pathology, Saitama Cancer Center, 818 Komuro, Ina-machi, Kitaadachi-gun, Saitama 362-0806, Japan.
About this article
Cite this article
Kurosumi, M. Significance of immunohistochemical assessment of steroid hormone receptor status for breast cancer patients. Breast Cancer 10, 97–104 (2003). https://doi.org/10.1007/BF02967633
- Breast cancer
- Hormone receptor
- Hormone therapy