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The page below is a sample from the LabCE course HER2 Testing in Breast Cancer. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Fluorescence in Situ Hybridization (FISH) Versus Immunohistochemistry (IHC)

IHC is a surrogate marker for gene amplification.
  • Patients with 0 to 1+ IHC staining are more than likely negative for HER2 gene amplification
  • Patients with 3+ IHC staining are more than likely positive for HER2 gene amplification
The benefits of IHC include low cost and rapid turnaround time.

Patients with 2+ IHC staining are not reliably negative or positive for HER2 gene amplification. Therefore, FISH testing must be performed for gene enumeration in 2+ cases. In 3% of cases, protein expression does not correlate with gene amplification.
The primary benefit of FISH is accuracy. Drawbacks of FISH methods include high complexity of test performance, cost of the test, storage/archival over any extended amount of time causes loss of signal and slides are interpretable, and need for a specialized microscope.