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To the Editor: Dr Yaziji and colleagues¹ compared immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) tests for overexpression of human epidermal growth factor receptor-2 (HER-2). Based on the inconvenience and higher cost of FISH, they concluded that HER-2 determination was most "efficient" by using IHC, with FISH performed for tumors with an IHC score of 2+. FISH was not recommended in tumors with an IHC score of 3+. Although I agree that FISH should be performed if the IHC score is 2+, the omission of confirmatory FISH when the IHC score is 3+ could lead to several adverse financial and ethical consequences.

First, HER-2 status determines if a woman should receive trastuzumab, an antibody specifically targeting tumor cells overexpressing HER-2 gene. The FISH test is currently the most predictive of tumor response.² Indeed, Yaziji et al found 8.4% of the tumors with an IHC score of 3+ were, in . . . [Full Text of this Article]

Tawee Tanvetyanon, MD
ttanve@lumc.edu
Loyola University Chicago Stritch School of Medicine
Cardinal Bernardin Cancer Center
Maywood, Ill

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