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Abstracts & Presentations

 

Abstracts will continue to be received and published until the workshop program is set.


Christopher Andry (view biography)
Biobanking and quality assurance management relevant to immunohistochemistry: a North American perspective.
Specimen quality and the impact of pre-analytic variables.

Nathan Acott (view biography)
Standardization and optimization of antibodies in gastrointestinal cancer diagnosis.
Standardization and optimization of antibodies in breast cancer diagnosis
Standardization and optimization of antibodies in lung cancer diagnosis

John Garratt (view biography)
The International Quality Network for Pathology (IQN-Path) update
TMA based external quality assurance, the cIQc programme
Doing it right – MMR for determining eligibility for immuno-modulator therapy
Standardization and optimization of B-Raf v600e
From the Newfoundland scandal to present day: Optimization of breast biomarker testing in Canada
Introducing iCAPCs (Immunohistochemistry Critical Assay Performance Controls)

Emiel Janssen (view biography)
Digital and quantitative immunohistochemistry in Bladder cancer.
The role of IHC in breast cancer diagnosis and optimization of patient management.
Digital Immunohistochemistry and Personalized Medicine in Norway.

Julia Pagliuso (view biography)
RCPAQAP Update and the Challenges of implementing PD-L1 EQA

Kieran Sheahan (view biography)
A panel of Immunohistochemical stains in colorectal cancer biopsies optimises patient management.
The Detection of Tumor Budding by H&E or Immunohistochemistry improves patient stratification in Colorectal Cancer.

Niall Swan (view biography) Ann Treacy, Sine Phelan, Julie McCarthy, Kieran Sheahan, and Conor O’Keane.
A National Population-based Approach to Laboratory Quality Improvement.
Immunohistochemistry in Endocrine Tumours, a Diagnostic and Theranostic Role.

 

Complete abstract content below

Digital and quantitative immunohistochemistry in Bladder cancer.
Emiel Janssen (view biography)
BSc, PhD
Stavanger University Hospital, Norway.

Bladder cancer is the cancer type for which cost per patient is highest in the US, not only because of its mortality but mostly because of the longitude of treatment, as the current grading system has very low prognostic value. High recurrence rate vs the low progression rate and the additional problem with the mediocre reproducibility of grading calls for improvement of the grading system and a need for new biomarkers. In Stavanger we have tried to improve the grading system by taking it apart and investigate which of the different features is the most reproducible and contains the most prognostic value. An image atlas has been developed to aid pathologists in grading, structure analysis and deep learning has been applied to improve grading. On the other hand several markers for immune cells have been investigated and measured by quantitative image analysis to analyze their prognostic and predictive value.
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The role of IHC in breast cancer diagnosis and optimization of patient management.
Emiel Janssen (view biography)
BSc, PhD
Stavanger University Hospital, Norway.

Breast cancer is the most frequent female malignancy in the Western world. Over the past decades a substantial effort has been made to improve breast cancer therapy. Still,
breast cancer remains a leading cause of death among women in the western world. Due to the potential systemic spread of cancer cells from the primary tumor, treatment
algorithms include surgery and combined adjuvant systemic treatment such as chemotherapy, endocrine and targeted biological modalities. Despite this strategy both
early and late relapses (more than 10 years later) still occur, the latter being more or less a hallmark for this disease. A special challenge for clinicians is patients with triple negative breast cancers (TNBC). They have the worst prognosis and they lack reliable predictive markers for various treatment options and monitoring of the disease. Therefore new IHC biomarkers will be presented that can help to personalize treatment and to monitor individual treatment response especially in these TNBC-patients.
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Digital Immunohistochemistry and Personalized Medicine in Norway.
Emiel Janssen (view biography)
BSc, PhD
Stavanger University Hospital, Norway.

The specialism of Pathology is about to be revolutionized. Finally the days of millions of glass slides and microscopes is over and the start of a new era were pathologists will be surrounded by computer screens rather than a microscope and piles of glass slides.
Digitalization will not only change the work day of pathologists but the whole workflow of the department of pathology. Barcode or true positive identity will be used instead of hand written identification numbers. No more detective work for finding missing slides, preparation of clinical meetings will be more straightforward and teaching/training residents will be easier and more interactive. Digital pathology makes it also possible to write and store remarks/marking/measurements on the digital image. Thereby making it easier to understand and review a diagnosis, consultation will no longer require that the pathologists are at the same location/city/country. Measurements on the digital images will make the diagnostic procedures more reproducible, no more estimation but distances and sizes can be measured and quantification of immunohistochemistry will finally become science rather than an art. Results and the status for the local, regional and national implementation of digital and quantitative pathology in Norway will be presented.
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The International Quality Network for Pathology (IQN-Path) update
John Garratt (view biography)
RT (Cyto)
Canadian Immunohistochemistry Quality Control (cIQc), Vancouver
Canada

The mission, the history and the current activities of IQN-Path will be presented. An update on the PD-L1 self-assessment scheme for pathologists and laboratory scientists being developed by IQN-Path will be given.
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TMA based external quality assurance, the cIQc programme
John Garratt (view biography)
RT (Cyto)
Canadian Immunohistochemistry Quality Control (cIQc), Vancouver
Canada

Canadian Immunohistochemistry Quality Control (cIQc) external quality assurance is based on using multi-core tissue microarrays (TMAs) for challenges with scheme participants
entering their results and protocols in a web based system. The use of TMAs provides a massive number of data points that can be analysed and published. The design of the
scheme and the results from quality assurance challenges will be shared.
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Doing it right – MMR for determining eligibility for immuno-modulator therapy
John Garratt (view biography)
RT (Cyto)
Canadian Immunohistochemistry Quality Control (cIQc), Vancouver
Canada

cIQc have been monitoring the quality of Mismatch Repair IHC testing since 2011 and using the data gathered (both results and protocols) we can demonstrate that IHC provides a
robust platform for not only Lynch Syndrome screening but also for determining eligibility for anti-PD- L1 therapy. The presentation will highlight optimal staining protocols and pitfalls for the staining of MLH1, PMS2, MSH2 and MSH6.
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Standardization and optimization of B-Raf v600e
John Garratt (view biography)
RT (Cyto)
Canadian Immunohistochemistry Quality Control (cIQc), Vancouver
Canada

Using the example of B-Raf v600e (VE1) staining we will follow the work-up from verification and validation to the optimization of an antibody. The use of image analysis and cell lines for monitoring technical quality will also be discussed. Emphasis will be on the three tenets of verification, validation and vigilance ( 3V ).
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From the Newfoundland scandal to present day: Optimization of breast biomarker testing in Canada
John Garratt (view biography)
RT (Cyto)
Canadian Immunohistochemistry Quality Control (cIQc), Vancouver
Canada

In the Canadian province of Newfoundland, the hormone receptor status of 400 women were determined to be inaccurate which resulted in retesting and some women being informed
that they had not been receiving appropriate therapy for their cancer . Using lessons learnt from history we will explore what is required for optimal ER/PR and HER2 staining and review the current quality of ER, PR and HER2 testing in Canada.
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Introducing iCAPCs (Immunohistochemistry Critical Assay Performance Controls)
John Garratt (view biography)
RT (Cyto)
Canadian Immunohistochemistry Quality Control (cIQc), Vancouver
Canada

This is a brief overview of the concept of iCAPs that will also include discussion on alternative forms of IHC controls that are available. The concept of using image analysis for monitoring controls will also be discussed.
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Standardization and optimization of antibodies in gastrointestinal cancer diagnosis.
Nathan Acott (view biography)
B.Sc. (Medical Science).
PathWest Laboratory Medicine, Nedlands WA,
Australia

Immunohistochemistry is an important tool used routinely in the gastro-intestinal sub-specialty. It is used to determine and differentiate cancer types and origin (e.g.
adenocarcinoma v carcinoid; gastric carcinoma v metastatic carcinoma etc.), diagnose non-cancerous diseases and conditions (e.g. Hirschsprung’s disease, Inflammatory Bowel
Disease (IBD), viral infections etc.), determine treatment and prognosis for cancer patients, and help with family wellbeing through family surveillance programmes (e.g. Lynch
Syndrome). It is therefore critical that IHC laboratories meet the demands for accuracy and reproducibility of their IHC assays. This presentation will endeavour to show the most common assays used at PathWest in this sub-specialty of anatomical pathology, how we optimise and validate these assays, the importance of the proper use of both external and internal controls in the screening of IHC slides for quality assurance prior to release to the requesting pathologist and the issues we have encountered with different assays in this subspecialty and how we have tried to overcome them.
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Standardization and optimization of antibodies in breast cancer diagnosis
Nathan Acott (view biography)
B.Sc. (Medical Science).
PathWest Laboratory Medicine, Nedlands WA,
Australia

Immunohistochemistry is an important diagnostic as well as predictive and prognostic tool used routinely in the area breast cancer. It is not only used by Pathologists to determine if a carcinoma is of breast origin, but also by other clinicians to determine treatment modalities for patients with primary breast carcinoma and other primary female genital sex hormone related carcinomas. Most recently, IHC is being used in the area of personalized medicine, involving the quantification of positive staining cells/cellular components to determine the use of specific therapies. It is therefore critical for patient wellbeing, and ultimately outcome, that IHC laboratories meet the increased demands for accuracy and reproducibility of their IHC assays. This presentation will endeavor to show the most common assays used at PathWest in this sub-specialty of anatomical pathology, how we optimize and validate these assays, the importance of the proper use of both external and internal controls in the screening of IHC slides for quality assurance prior to release to the requesting pathologist and the issues we have encountered with different assays in this subspecialty and how we have tried to overcome them.
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Standardization and optimization of antibodies in lung cancer diagnosis
Nathan Acott (view biography)
B.Sc. (Medical Science).
PathWest Laboratory Medicine, Nedlands WA,
Australia

Immunohistochemistry is an important diagnostic, prognostic and predictive tool used routinely in the respiratory pathology sub-specialty. It is primarily used to determine and differentiate between cancer types and origin (e.g. adenocarcinoma v squamous cell carcinoma; primary lung carcinoma v metastatic carcinoma etc.). With the advent of personalised medicine, immunohistochemistry is now used as both a primary companion and complementary diagnostic tool, so is determining treatment regimens for patients with non-small cell lung cancer. It is therefore critical that IHC laboratories meet the increased demands for accuracy and reproducibility of their IHC assays. This presentation will endeavor to show the most common assays used at PathWest in this sub-specialty of anatomical pathology, how we optimize and validate these assays, the importance of the proper use of both external and internal controls in the screening of IHC slides for quality assurance prior to release to the requesting pathologist and the issues we have encountered with different assays in this subspecialty and how we have tried to overcome them.
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Biobanking and quality assurance management relevant to immunohistochemistry: a North American perspective.
Christopher Andry (view biography)
MPhil, PhD.
Boston University Medical Center, Boston, USA

Establishing a Quality Management Program (QMP) to provide governance over a bioarchive is a key step to a successful service. Integration of the QMP with existing quality programs in the surgical processing room, histology and immunohistochemistry laboratory allows for careful control of pre-analytic variables that may impact assay quality and reported results in the analytic phase. Our medical center has a high percentage (71%) of ethnically diverse patients. Cancer biospecimens from these populations are under-represented in national biospecimen collections. We worked with the U.S. National Cancer Institute (NCI), Biorepositories and Biospecimen Research Branch (BBRB) and Leidos Biomedical, Inc. to collect biospecimens for NCI’s Biospecimen Preanalytical Variables (BPV) Program whose goal was to systematically evaluate the effects of biospecimen preanalytical factors on detection of cancer biomarkers with an aim to contribute towards development of best practices for collection, processing, storage, and utilization of biospecimens. We collected renal, serous ovarian carcinoma, colon, and lung adenocarcinoma samples, with matched blood and clinical history. In collaboration with NCI and Leidos we developed 31 standard operating procedures (SOPs) to guide the project including: the patient consent process, timely collection of biospecimen samples, processing and fixation, clinical information annotation and quality control monitoring. Eligible tumor biospecimens (1cm3) were divided and fixed for variable times. Macroscopic examination was performed by a resident and the attending pathologist managed sample dissection. High consent rate and standardized specimen collection, from a diverse patient population, is possible at a safety net academic medical center. Rigorous adherence to SOPs allowed us to accomplish high quality biospecimen collection, processing and fixation in a timely manner. Funded by NCI Contract No. HHSN261200800001E
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Specimen quality and the impact of pre-analytic variables
Christopher Andry (view biography)
MPhil, PhD.
Boston University Medical Center, Boston, USA

An expanding data base of literature recognizes the impact of pre-analytic variables on important biomarkers for cancer. Development of biospecimen science regarding collection, fixation, processing, storage and management of tissues, blood and other body fluids is key.
This will ensure accurate translational studies for biomarker development, including application in the diagnostic setting and guidance for personalized medicine. Particular
attention is now being paid to small biopsy management. This presentation will review current literature and developing fields in biospecimen science and how it pertains to
immunohistochemistry staining and interpretation.
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RCPAQAP Update and the Challenges of implementing PD-L1 EQA
Julia Pagliuso (view biography)
BSc, CT (ASC), MBA(UTS)
The Royal College of Pathologists of Australasia Quality Assurance
Programs (RCPAQAP), Anatomical Pathology, St Leonards, NSW, 2065, Australia

The RCPAQAP has undergone a number of changes over the last couple of years and is continuing to evolve. These changes will be communicated, along with a summary of the future directions and projects for Immunohistochemistry within the Anatomical Pathology discipline.
Changes discussed include informatics, nomenclature, ongoing competency program, and the online product catalogue. One important initiative that commenced in 2017 was collaboration with UK NEQAS for the challenging implementation of a PD-L1 proficiency testing program for non-small cell lung carcinoma. Challenges of assessment included standardising the scoring criteria for each commercial assay interpretation in addition to laboratory developed tests (LDTs) and using appropriate tissue to cover the critical interpretation points for each assay. The findings of the pre-Pilot suggest that the use of a clinically validated PD-L1 IHC assay performs better during assessment than adopting an LDT. It was acknowledged that participants are limited by the platforms they have available and so it was suggested that validating an optimal method against the clinical assay and continual verification of the test may produce the expected result.
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A National Population-based Approach to Laboratory Quality Improvement.
Niall Swan (view biography) Ann Treacy, Sine Phelan, Julie McCarthy, Kieran Sheahan, and Conor O’Keane.
Faculty of Pathology, Royal College of Physicians of Ireland,
Dublin, Ireland.

On the background of several highly publicised pathologist errors in Ireland a national quality improvement (QI) program for histopathology was initiated in 2009 with a vision of a patient-centred pathologist-led framework that would enhance the quality of patient care with timely, accurate and complete pathological diagnoses and reporting. External laboratory accreditation to ISO 15189 standards is undertaken by the majority of the 34 histopathology laboratories in Ireland but the pathologist community had concerns that diagnostic interpretive elements were not covered adequately by this process. Currently all 25-government funded histopathology laboratories and 7 private laboratories participate in the program which is based on national QI guidelines that consist of 17 key quality activities generating 51 Key Quality Indicators (KQI). Participation in external quality assessment is one of the key quality activities of the program with laboratories enrolled in both UK NEQAS and NordiQC immunohistochemistry (IHC) schemes. Each laboratory submits QI data to a central database managed by a novel information technology system, the National Quality Assurance Intelligence System (NQAIS)-Histopathology, that allows individual laboratories to compare their own performance to the national average for various KQI’s. Workload statistics generated for 2016 reveal IHC was performed in 12% of cases nationally with an 11% increase in IHC activity over the past 4 years.
Based on national data and international benchmarks 18 QI targets are established and 4 annual reports have been published, enabling Ireland to be the first country to publicly report national metrics on the quality of their histopathology services.
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Immunohistochemistry in Endocrine Tumours, a Diagnostic and Theranostic Role.
Niall Swan (view biography) Ann Treacy, Sine Phelan, Julie McCarthy, Kieran Sheahan, and Conor O’Keane.
Faculty of Pathology, Royal College of Physicians of Ireland,
Dublin, Ireland.

Immunohistochemistry (IHC) for endocrine tumours has evolved over the past decade from a purely diagnostic purpose to now playing a key role in predicting treatment response and providing prognostic information. Despite being rare tumours pathologists will likely encounter neuroendocrine tumours (NET’s) of the gastrointestinal tract, pancreas or lung in routine practice and the expectation from pathological analysis has progressed from diagnosis to now providing comprehensive theranostic information. Demonstration of neuroendocrine differentiation with both chromogranin A and synaptophysin is recommended in most situations as location and differentiation can influence their expression. Ki67 IHC to establish proliferative index for grade assignment in well differentiated NET has largely replaced mitotic index but controversy exists on the best method to be
employed for accurate quantification and where casual “eyeballing” is no longer an option for grade 2/3 well differentiated NET’s given the impact on treatment decisions. A low threshold to perform Ki67 IHC is also suggested in material where crush artefact impedes assessment of differentiation. Peptide hormone IHC assessment is rarely necessary as functional syndromes are diagnosed clinically but can be useful in the setting of metastatic disease for primary site identification as are markers such as CDX2 and TTF-1. Therapies based on somatostatin receptor (SSTR) status are indicated for metastatic NET with IHC for SSTR 2A now a useful marker of treatment response. Finally, IHC can be used to predict familial endocrine tumours with IHC for succinate dehydrogenase mutations in phaeochromocytoma / paraganglioma allowing pathologists to triage patients for genetic testing.
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A panel of Immunohistochemical stains in colorectal cancer biopsies optimises patient management.
Kieran Sheahan (view biography)
Department of Pathology, St. Vincent’s University Hospital,
University College Dublin School of Medicine, Dublin, Ireland.

HER-2, ER & PR testing in breast cancer guidelines recommend testing in biopsy specimens, to ensure timely availability of results at multidisciplinary team (MDT) treatment
planning and to enable consideration for neoadjuvant treatment. Re-testing in the resection is only considered in non-responding, stable, or progressive HER2-negative tumours. A similar approach to the immunohistochemical assessment of prognostic and predictive biomarkers in colorectal cancer (CRC) is advocated. Recent NICE guidelines in the UK for mismatch repair (MMR) testing in CRC state PCR for MSI or IHC may be performed on the “biopsy or the resection tissue”. Testing for MMR status , BRAF mutation status, PD-L1 and CDX2 status is now possible in pre-operative biopsies and may become standard of care in CRC in the near future for prognostic and predictive purposes. Also IHC markers are now available that stratify CRC into their consensus molecular (CSM) subtypes. Such a strategy has the potential to be practice changing. From a patient perspective, there is the potential to exclude the most common genetic cause for CRC (Lynch syndrome), & have extremely useful pre-operative prognostic information. Also tailored approaches to chemotherapy and/or novel immunotherapies can be discussed at MDT prior to surgery.
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The Detection of Tumor Budding by H&E or Immunohistochemistry improves patient stratification in Colorectal Cancer.
Kieran Sheahan (view biography)
Department of Pathology, St. Vincent’s University Hospital,
University College Dublin School of Medicine, Dublin, Ireland.

Most studies advocate the identification of tumor budding using standard pathological processing methods (H/E, light microscopy), with no additional staining or pathological processing required. A recent International Tumor Budding Consensus Conference advocated analysis by H/E while stating that immunohistochemistry required additional
studies. However, tumor budding may be difficult to detect in an inflammatory/desmoplastic stroma. Immunohistochemistry using cytokeratin antibody staining assists tumor budding detection. Although studies vary in their definition of how many cells constitute a tumor bud, and how many buds represent budding, most studies demonstrate that the finding is a strong negative prognostic marker in colorectal cancer. A recent meta-analysis in over six thousand patients, despite a lack of standardization of tumor budding between studies, demonstrated that tumor budding in CRC is strongly predictive of lymph node metastasis, recurrence and cancer-related death. While H&E has been increasingly adopted, there has been a reluctance to use IHC routinely, due to cost & because the majority of original prognostic studies were performed using H&E. The cut-off for clinically significant tumor budding has also been a source of debate. More studies are needed (a) to assess the relationship between tumor bud counts assessed by H/E and IHC and (b) to determine optimal cut-offs for clinically actionable decision making. The potential advantages of IHC are the ability to more readily reproduce, quantify and perform image analysis of tumor budding. Clinical trials stratifying patients according to tumor budding status determined both by H/E and by IHC are urgently required.
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Last update on: 2017/09/12 09:28:48 UTC/GMT time.