Connection: In your opinion, what is the biggest hurdle for standardization? The biggest hurdle for standardization is considered to lie in the development of a nationwide system to manage the process. There is also a limited budget for employing people for quality control and managing the process of standardization. The Japanese Society of Pathology has just started this process. Connection: United Kingdom National External Quality Assessment Service (UK NEQAS) helps to ensure that clinical laboratory test results are accurate, reliable and comparable wherever they are produced. Similarly, Nordic Immunohistochemical Quality Control (NordiQC) - an independent, scientific, non-profit organization is dedicated in the quality assessment of IHC in Northern Europe. What is the equivalent of UK NEQAS and NordiQC in Japan? There is no homemade system like this in Japan, but CAP QA/QC has been known among the Japanese pathologists for a while. Connection: How well is the pre-fixation process standardized? Is it at all possible to standardize this process? This area is the least standardized. I consider it critical and important to make it possible. Connection: The Members of the Ad-Hoc Committee on Immunohistochemistry Standardization (Appl Immunohistochem Mol Morphol 2007;15:124­133) strongly discourage non-formalin fixatives and encourage formaldehyde as the fixative of choice. What fixatives are used in your laboratory, and at what concentration? In my laboratory, 10% neutral non-buffered formalin is used. Connection: Is it true that a particular histology feature may be better demonstrated by other fixatives, such as Glyo-Fixx for nuclear features and lymphocyte appearance and Omnifix for cytoplasmic detail (Arch Pathol Lab Med 2005;129:502-506)? Would you recommend these fixatives in the future? Are these fixatives used in Japan? It is not widely used in Japan. Connection: The American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) convened an expert panel to develop a US guideline to improve the accuracy of HER2 testing in invasive breast cancer. The ASCO/CAP Guideline is also followed by Canadian pathologists with some modifications (Hanna W, et al. Curr Oncol. 2007 August; (4):149­153). Can you explain the guideline followed in Japan for HER2 testing? In Japan, the guideline for HER2 testing is studied and determined by the Japanese Pathology Board for Optimal Use of Trastuzumab (JPBOT) Study Group, which is supported by Chugai Pharmaceutical Co. Ltd. and consists of seven pathologists and three clinicians specialized in breast cancers. (Editor note: Prof. Osamura is the representative of JPBOT.) http://www.her2.org/hc/her2net. As to the new ASCO/CAP Guideline for HER2 testing, there is no sufficient supporting data. Therefore, it has not been integrated into the Japanese guideline yet, although the new guideline has been advertised to the clinicians and the pathologists to discuss its feasibility in Japan. Connection: How about estrogen and progesterone receptor biomarker tests? The J-Score is recommended as a more conventional scoring standard, which is supported by the findings of a pathology study group of the Japanese Society of Breast Cancer. For some laboratories, clinical doctors introduce Allred Score following the recommendation. For more information please refer to the following articles: ·Kurosumi M: Immunohistochemical Assessment of Hormone Receptor Status Using a New Scoring System (J-Score) in Breast Cancer. Breast Cancer 14:189-193, 2007. in Standardizationand IHC should be nationwide comparable to global standards. Connection: How many labs in Japan follow an external quality assessment (EQA) scheme? There is no established EQA organization in Japan, and there are few laboratories which participate in the CAP survey. Connection: What are the main functions of your external quality assessment (EQA) scheme? Is EQA involved in collaborations with other countries (US, UK, Australia, etc.)? The independent organization, the External Quality Assessment (EQA), should be involved in objectively recommending the standards for diagnosis and staining techniques. From a global point of view, I think it would be better, if EQA in Japan synchronized its activities with other countries to a certain advisable extent. Connection: How would you like to standardize IHC in Japan? Standardization in IHC should be nationwide and comparable to global standards. It would be desirable, if the Japanese Society of Pathology (JSP) could play a leading role in this very important task. The JSP has a quality control subcommittee, which has just started IHC standardization for HER2 testing. http://jsp.umin.ac.jp/english/mis_and_act.html Connection 2008 | 24 April 2008, VOL 11 Connection IHC STANDARDIZATION AROUND THE WORLD In this issue Q&A with Patho Contents APRIL 2008, VOL 11 2 3 4 Editorial George L. Kumar, PhD Featured Laboratory The Osamura Editorial Immunohistochemistry (IHC) Standardization Around the World George L. Kumar, PhD Managing Featured Laboratory The Osamura Laboratory Laboratory headed by Prof. Robert Yoshiyuki Osamura, MD, Q&A Ask the Experts: On Immunohistochemistry (IHC) Standardization Professor Leong is Medical Di time interval between removal of tissue and immersion in fixative, the temperature of tissue storage Connection: How would you like to standardize IHC in Australia? As discussed above, standardization Connection: Antigen retrieval is essential in immunohistochemistry (IHC) in order to restore epitope Connection: Is a universal image analysis system feasible? No, not until we standardize the all impo Q&A Fernando Soares, MD, PhD University of São Paulo, São Paulo, Brazil Dr. Fernando Soares is F Connection: In your opinion, what is the biggest hurdle for standardization? Probably education in l There are no standards in Latin America. We always follow the manufacturers protocol during our firs Q&A Bryan R. Hewlett, ART, MLT Consultant Technologist to the Anatomic Pathology EQA program of There is no standardization of AR steps circumstances, it would be impossible toand, undera the pre Connection: How would you rate European (UK NEQAS, NordiQC) and US IHC standards to Canadian IHC sta Q&A Prof. Chen Jie Prof. Cui Quancai Peking Union Mediacl College Hospital, Beijing, China Prof. Connection: According to Goldstein et al. Appl Immunohistochem Mol Morphol 2007;15:124­133 Immunohis Connection: Is it true that a particular histology feature may be better demonstrated by other fixat Connection: What constitutes standardization of image analysis as applied to immunohistochemistry (I Q&A Dr. Tanuja Manjanath Shet Dr. Vani Parmar Tata Memorial Hospital, Mumbai, India Tanuja Manj ... the biggest hurdle in India is suboptimal fixation and processing of tissues. Though I agree th Connection: Is it true that a particular histology feature may be better demonstrated by other fixat Connection: Can you comment on the internal and external quality control (EQC) procedures followed i Q&A Prof. Robert Yoshiyuki Osamura Department of Pathology, Tokai University School of Medicine Connection: In your opinion, what is the biggest hurdle for standardization? The biggest hurdle for the standardization of image ... appropriate for pre-screeninganalysis is of the staining quality. Connection: Why is standardization of image analysis in diagnostic pathology important? Because the Q&A James F. Happel, DLM (ASCP), HTL Technical Director of Surgical Pathology, Research and Deve Connection: United Kingdom National External Quality Assessment Service (UK NEQAS) helps to ensure t Connection: The American Society of Clinical Oncology (ASCO) and the College of American Pathologist would recommend that standardization Ibegin with identifying a reliable and trustworthy source ... Interview Immunohistochemistry for Oestrogen and Progesterone Receptors Dr. Andrew Lee Consultant H Connection: What is the difference between the H score and the Allred score? Which is better? What d Connection: Can you comment on the burden in the laboratory, if one changes from a current ER/PR ass Opinion & Interview IHC Standardization: A Dako Perspective Dr. Ole Rasmussen R&D Director, Connection: Dako has developed Readyto-Use Antibodies for in vitro diagnostic applications. How is t Articles UK NEQAS-ICC & ISH: Historical perspective, current role, future directions Andy Dodso UK NEQAS-ICC in the 1990s In his first year as Scheme Organiser, Keith oversaw the transition to sub The application could be argued to represent a field change in terms of the rigour with which the an Assessment teams consist of four assessors, who view slides around a multi-headed microscope and sco The archive which UK NEQAS holds, both in terms of stained slides and methodological data, must sure For Immunocytochemistry and FISH RESULT: RUN 80L SLIDE: NEQAS Laboratory No: XXX Mr. A. Scientist De Figure 6. Feedback on results has always been given high priority, and for many years this has been a b c d Figure 7. The antigen chosen by Gerry Reynolds for his very first assessment run was kap Bibliography Selected UK NEQAS-ICC & ISH papers. Ibrahim M, Dodson AR, Barnett S, Fish D, Jasani Articles Nordic Immunohistochemical Quality Control (NordiQC) An Organization for External Quality A parameters (i.e. results interpretation and reporting) (4, 5). In an EQA setting, by circulating ser CD79a (Fig. 2) Among 112 laboratories submitting stains in the latest run, most used mAb clone JCB11 References 1. Rhodes A, Jasani B, Barnes DM, Bobrow LG, Miller KD. Reliability of immuno-histochemic Fig. 2. CD79a A. Optimal CD79a staining of the tonsil using the monoclonal antibody (mAb) clone JCB Standardization of Ki-67 Immunohistochemical Staining for Diagnosing Grade of Gastrointestinal Strom was conducted in 49 GIST cases. The concordance rate for the evaluation results at three laboratorie CB pH6 a b c d TE pH9 e f g h Autoclave 121° C/10 min Water bath 95° C/40 min Microwave 50 Table 1. Correlation between NCC and STD methods R2=0.9483 Categories of proportion NCC Method 3 Opinions Importance of Standardization for Predictive Prognosis David J. Dabbs, MD Chief of Pathol is documented and serves as a surrogate marker for the initial exposure to formalin. Since the first Opinions The New Era for ER and PRIts time to Standardize! Dr. Ian Ellis, B.Med.Sci. BM, MS, FRCpa et al 2001). The main reason for false-negative results is due to inefficient heat-induced epitope ( Standardization of HER2 TestingInconsistency Raises Questions Opinions Sunil S. Badve, MD, FRCPath rence seen in these trials is in the order of 50%. This is the major reason for all the excitement a which now requires expression of HER2 by at least 30% of tumor cells (instead of 10%). It has also r IHC CONSENSUS MEETING, JANUARY 27 2008, SANTA BARBARA, CA, USA , IHC CONSENSUS MEETING, JANUARY 27, Richard Cartun, PhD, Sunil Badve, MD Jon Askaa, PhD Søren Nielsen, HT, CT, Mogens Vyberg, MD Elizab Dako Abstracts Abstracts presented at the 30th Annual San Antonio Breast Cancer Symposium December Dako Abstracts Amplification of ESR1 may predict resistance to adjuvant tamoxifen in postmenopausal Dako Abstracts Abstracts presented at the United States and Canadian Academy of Pathology (USCAP) A Dako Abstracts Metastatic Pancreatic Endocrine Tumors in the Liver Express KOC Briones AJ, Bourne P Dako Abstracts Merkel Cell Carcinomas Express K Homology Domain Containing Protein Overexpressed in Dako Abstracts Immunohistochemical Analysis of KOC/IMP3 in Malignant Pleural Mesothelioma Xu H, Sim Dako Abstracts KOC, TTF-1 and CDX2 Discriminate Small-Cell Carcinoma from Carcinoid and Pancreatic Dako Publications Publications Co-authored by Dako: In Press Li L, Xu H, Spaulding B, Cheng L, Si Dako Meetings 2007 - National Society for Histotechnology Meeting. Denver, CO NSH workshop attend New Premium Quality Concentrated Antibodies New Products Your current and future needs drive the c Targeting Colorectal Adenocarcinomas, Anti-TIMP-1 and Anti-Villin Monoclonal Mouse Anti-Human Tissue Dakos FLEX Ready-to-Use Concept Enhance performance of your laboratory by running FLEX Ready-to-Use 2008 Product Catalog Available Now! The catalog features more than 170 new products, including the A