would recommend that standardization Ibegin with identifying a reliable and trustworthy source ... Connection: What are the major benefits of EQC? Some of the major benefits of EQC are verification of the overall process and accuracy of your IHC stains. Applying the use of the double-blind format allows for unbiased and objective assessment of the procedures, fixation, antibody titration, and dilution to assure that the expected results are achieved. Connection: Would a template/procedure/scoring system for reporting IHC standardization assays be beneficial? Do you recommend it? I would endorse a scoring system for reporting immunohistochemistry assay results. Having seen the benefits of the quantification of HER2/ neu testing, similar standardization would objectify test results. Connection: What constitutes standardization of image analysis as applied to immunohistochemistry (IHC)? Can we have a standardized procedure to interpret IHC assays around the world? Image analysis is an excellent way to apply immunohistochemistry standards. Any time an instrument can be used to objectively quantify cellular staining intensity, it removes the human bias and preferences and, therefore, provides a more reliable and universal interpretation. I see no reason why a standardized procedure to interpret IHC assays around the world could not be attained. Connection: Why is standardization of image analysis in diagnostic pathology important? Standardization of image analysis in diagnostic pathology is important to remove human bias and preference from diagnoses. Connection: What are your recommendations for standardizing image analysis in an anatomic pathology laboratory? I would recommend that standardization begin with identifying a reliable and trustworthy source to be the authoritative source and convention for the staging and grading of tumors, perhaps the National Cancer Institutes TNM system http://www.cancer.gov/cancertopics/factsheet/ Detection/staging. Once the convention has been agreed upon, instrumentation can be tuned to that system and standardization can begin. Connection: Is a universal image analysis system feasible? I believe that not only is a universal analysis system feasible, its likely. Connection: In your opinion, what is the biggest hurdle for standardization in Image Analysis? I believe the biggest hurdle for standardization in Image Analysis is the coalescence and concordance of grading and staging of tumors into a system that can reliably quantify a tumor. Connection: With image analysis in mind, what is the minimum information needed to enable the interpretation of IHC results. The minimum information required to ensure accurate interpretation of IHC results are the following: Duration of time from specimen collection to its placement in fixative, duration of time spent in formalin, what antibody is used for the stain, in the case of an existing paraffin block, the age of the block, titration and dilution of the antibody, was antigen retrieval required to optimize the epitope, and the staining platform used to perform the assay. Connection: Is there a lot of variability in manual IHC testing? How do image analysis systems improve the scoring of IHC slides? As with any manual testing, variability is unavoidable. Image Analysis Systems improve the scoring of IHC slides by objectifying and eliminating human bias and preference. Connection: Where do you see IHC in 10 years? I imagine that the use of digital imaging and whole-slide imaging will be a large part of the future of immunohistochemistry. Teleradiology is commonplace today, and I envision a time in the not too distant future when telepathology will be equally as omnipresent. The digitalization and storage of histological slides on a server will allow pathologists to read and diagnose cases in the privacy of their own office while providing them with the opportunity to confer with colleagues down the hall or around the world. This flexibility will no doubt extend itself to immunohistochemistry slides as well. Connection: As a leader in the industry, how have you kept up with the changes occurring in IHC/ pathology? I try to attend specialty conferences and meetings several times each year. In addition, I receive and read numerous journals throughout the year. I receive many electronic communications from various on-line sources like the ASCP, USCAP, NSH and others. Connection 2008 | 30 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