Immunohistochemical (IHC) study: diagnosis of the histogenesis of metastases in an unidentified primary focus (range of markers for identifying tissue belonging) (biomaterial fixed in a paraffin block). Immunohistochemical diagnosis of re

Oncological diseases are the most terrible reality for the vast majority of people. But in order to identify a serious problem in time and begin to effectively get rid of it, it is necessary to conduct special examinations. One of them is IGHstudy.

Genes, receptors and growth factors

The exact reasons that cause cells to actively divide, forming neoplasms, often with an oncological focus, are still unknown to science. But how cell growth occurs has already been studied quite well. Tissue cells have a complex structure. There are so-called HER-2 receptors on the cell surface. They serve as a kind of antennas that listen to the commands of the body. By the way, the abbreviation HER-2 originates from the English phrase human epidermal growth factor receptor 2, which literally means "human receptor. These are the receptors that make the cell divide, grow or self-repair.

Receptor activity and tumor

Unfortunately, the human body does not always work as it should ideally, without failures and diseases. While science does not know exactly why, it happens that HER-2 receptors begin to actively receive commands to "divide and multiply." And since these cellular elements are very executive, they force the cells to actively divide, forming a tumor. Only medical examinations, including IHC -research, allow you to determine the status of the neoplasm, as well as the prognosis for the treatment and life of the patient.

Tumor gene status

Oncological formations by modern medicine will be determined by the status of influence hormone therapy. can be negative (negative) and IHC- study. What does immunohistochemistry show? This study helps to establish the hormonal dependence of the neoplasm - hercept status, and therefore, to choose the right treatment method in order to get an effective result.

Negative and positive

The fact that the hormonal Hercept status of the tumor is called "positive" or "negative" will tell a lot to a competent doctor. But by themselves, these definitions do not apply to emotions, as a simple layman who first heard about the ICG study might think. The identified positive Hercept status indicates that this type of cancer is more aggressive, it develops faster, spreading throughout the body by metastasis. But at the same time, such a malignant tumor with a high level of probability will respond to certain types of medicines. A negative hercept status of the neoplasm will tell that the tumor develops slowly, but adequately. drug treatment not yet for her.

Immunohistochemistry - what is it?

One of the most common cancers among women is breast cancer. An IHC study helps to determine the type of neoplasm and select a treatment in accordance with the situation. Immunohistochemistry is a biopsy (a biomaterial taken during a biopsy) using a special staining substance. This substance stains HER-2 receptors, and the more receptors that affect the appearance and development of an "abnormal" cell, the brighter the color of the studied biomaterial will be.

How is neoplasm status determined?

Colored biomaterial during laboratory research to determine hercept status is subjected to visual examination. for this, a special scale is attached, which has a gradient color from 0 to 3+. This method allows us to distinguish 4 main thresholds, depending on which it is supposed to lead the patient further. It seems - what is easier? Stain the studied tissues with a special substance, place under a microscope, carefully examine, comparing what you see with color control samples, and establish the Hercept status of the tumor. But here a huge role is played by the human factor, lighting features and so on.

How an IHC study is carried out

If cancer is suspected, breast research. The decoding contains only four thresholds. But the problem is that the middle two values, which would be 1+ and 2+ on the scale, suggest an unclear result that requires further investigation by another method. That is, IHC research is the most controversial method for detecting the hercept status of a neoplasm. In addition, the result of the study is actively influenced, as already mentioned, by the human factor and external circumstances. The only thing that is most accurately determined are two extreme results - negative 0 (the neoplasm has a negative Hercept status) and 3+ (the hormonal status of the tumor is positive).

Female hormones and tumors

As he says modern medicine, most tumors of the female genital area are dependent on the hormonal level of the body. Their development is actively influenced by female sex hormones - progesterone and estrogen. Receptors for these hormones determine the formation and development of cancer. The established hormonal dependence makes it possible to clearly define the treatment regimen with subsequent life prognosis. In addition, these receptors play a role not only in oncological diseases of the mammary glands, but also in such serious problems as female infertility, endometriosis and cancers of the genital area - the uterus, ovaries, and cervix. Hercept-status of the tumor, which is established during IHC- the study of the endometrium, for example, will allow prescribing treatment with exactly those drugs that will help achieve an adequate result without unnecessary experiments with the selection medicines in each specific case.

If infertility

Infertility is a huge problem for many modern families. Studies conducted by scientific medical institutions have shown that in a fairly large number of cases, infertility is due to a lack of hormonal levels of the endometrium - the epithelial layer lining the uterine cavity. It is the hercept status that makes it possible to identify IHC- study of endometrial receptivity. Female sex hormones are active parts of the process of egg formation, its fertilization, implantation of the embryo into the uterine cavity, as well as subsequent pregnancy and childbirth. ICG study of the endometrium, as we have already said, allows you to identify the Hercept status of endometrial cells to estrogen and progesterone and, in accordance with the results, select the right treatment for a woman.

Diagnosis of lymphoma

Oncological diseases are the misfortune of mankind. Although modern pharmacology and technical developments can cure these diseases. But here diagnostics is very important, especially on early stages diseases. Lymph cancer is a fairly common problem. An IHC study for lymphoma is one of the ways to make an accurate diagnosis in order to then prescribe adequate therapy. This study is performed on a biopsy of lymphatic fluid or tissue of the hematopoietic system. The material taken for research is stained with special substances that help determine tumor markers. Unfortunately, this type of research is imperfect and in most cases is supplemented by other diagnostic methods. In addition, it is often not the lymphatic system itself that causes the problem. This is what makes it possible to reveal the IHC study of the lymph.

IHC analysis - timely knowledge

Health problems should be detected and identified in time. For this, various methods of examinations and analyzes are needed. IGH-research is one of the most common methods for diagnosing neoplasms or other problems with the tissues of various organs. The study of IHC is carried out on the material taken to determine the problem - the so-called biopsy. The material is stained with special substances for each specific purpose, and with the help of a visual comparison conducted by a histologist, tumor markers are established that show a particular problem. The imperfection of the immunohistochemical study is that the material may not be enough, the human factor will play its role, or external causes will not allow you to establish an accurate picture of the problem. In any case, for an adequate diagnosis of a disease, especially oncological, it is necessary to conduct a whole range of examinations, where one of the steps will be IHC-study. What is it in cancer any organ, tissue? The biopsy specimen is examined for tumor markers, allowing to assess their presence in the sample. As an aid in making a diagnosis, the IHC study is indispensable, and it is also actively used in establishing the causes of female infertility.

Medicine, including diagnostic medicine, is constantly evolving. Perhaps, in the near future, immunohistochemical research will be brought to perfection and will allow many people to make an adequate diagnosis with the least amount of time and effort.

Standardized immunohistochemical study: receptor status in breast cancer (PR, ER, ki67, Her2 neu). It is performed only if there is a ready-made micropreparation on a slide and a tissue sample in a paraffin block.

Russian synonyms

IHC study (RE, RP, Her2/neu, Ki-67), immunohistochemical analysis of breast cancer receptor status.

English synonyms

IHC (ImmunoHistoChemistry) Test for Breast Cancer Receptor Status (ER, PR, HER2, Ki67), HER2 Overexpression by IHC, Estrogen Receptors, Progesterone Receptors, ER and PR Status, Estrogen and Progesterone Receptor Status.

Research method

Immunohistochemical method.

What biomaterial can be used for research?

Paraffin block with biopsy of breast formation. Primary tumor tissue can be obtained by core biopsy, as well as incisional and excisional surgery. To detect metastases, tissue from the wall can be taken for a biopsy chest, regional lymph nodes or distant organs.

General information about the study

Modern principles and strategies for the treatment of breast cancer are based, among other things, on the results of assessing the receptor status and proliferative potential of tumor cells. Tumor cells have the ability to produce and place on their surface special proteins - receptors, the stimulation of which leads to the launch of cell division and tumor growth. Such receptors are able to bind to substances that are normally present in the body and initially not associated with the development of a malignant neoplasm. According to current clinical guidelines, for breast cancer, the presence of the following receptors on tumor cells is important, various combinations of which are called receptor status:

    Receptors for the hormones estrogen and progesterone er,PR). A significant proportion of breast tumors are hormone-dependent, that is, their growth is supported and stimulated by estrogens and progesterone. Tumors with a positive hormonal receptor status respond well to therapy with hormone analogues (tamoxifen), which block the corresponding receptors - bind to them, but do not cause activation of intracellular processes and prevent the receptor from subsequently binding to the hormone. Thus, the study of tumor production of ER and PR makes it possible to determine its sensitivity to these drugs.

    Type 2 receptor for human epidermal growth factor receptor 2 HER2/neu). In the cells of some breast tumors, there is an increased production of this receptor protein, which, when combined with a natural growth factor, starts the process of division in the tumor cell. Total number of patients with HER2-positive breast cancer is from 15% to 20%. The determination of HER2/neu is not only of prognostic value (such tumors usually progress faster and have a more aggressive clinical development), but also allows you to evaluate the possibility of using targeted drugs - monoclonal antibodies to the HER2 receptor - trastuzumab (Herceptin), lapatinib, pertuzumab. In addition, HER2-positive tumors are resistant to tamoxifen.

Proliferative activity is an indicator of the ability of tumor cells to divide indefinitely, which is the main factor in the biological aggressiveness of a tumor. The process of division is accompanied by the appearance in the cell of certain proteins, one of which is Ki-67. It is not produced in cells at rest, which allows it to be used as a marker of tumor proliferative activity. Determining the level of Ki-67 has an important prognostic value, since tumors from the least mature and differentiated cells have the highest proliferative activity.

All of the above markers can be detected by immunohistochemical examination of the biopsy or surgical material of the tumor. For analysis, the thinnest sections are cut from the finished paraffin block using a special microknife, which are then attached to glass slides and stained with routine dyes so that it is possible to distinguish cells from each other and from intercellular substance. Then the sections on the slides are stained with solutions of antibodies labeled with fluorescent labels specific to one of the studied receptors. If the desired receptor is present in the tumor cell, the antibodies bind to it, and when viewing the glass under a special microscope, fluorescence can be seen, which will indicate a positive test result. In addition, when viewing a section, a morphologist will be able to see that the stained marker is located in the nucleus, cellular substance, or on the membrane of tumor cells. The number of antibody solutions used corresponds to the number of markers that are examined in the sample. The degree of fluorescence and the percentage of cells in which it is present underlie the interpretation of the results of immunohistochemical analysis and are described in more detail in the corresponding section.

What is research used for?

  • To determine the hormone receptor status and the degree of proliferative activity of breast cancer to assess the prognosis and individualization of treatment, including determining indications for the appointment of targeted therapy.
  • Based on the results of the detection of hormonal receptors, the expediency of using antiestrogen is determined, and the HER2 receptor is determined by targeted anti-HER2 drugs. The revealed absence of these markers makes it possible to avoid prescribing obviously ineffective therapy. A high index of proliferative activity, as well as a negative receptor status, for the most part, is an indication for adding cytostatic drugs to the treatment.

When is the study scheduled?

  • In the presence of histologically verified breast cancer - newly diagnosed, recurrent and metastatic tumors.

What do the results mean?

When interpreting the results of immunohistochemical determination receptor status of steroid hormones(estrogens and progesterone) in breast tumors, it is necessary to evaluate not only the percentage of cells stained with antibodies, but also the intensity of staining. Both of these parameters are taken into account in the Allred scale, where the percentage of positive cells is estimated from 0 to 5 points, and the intensity of staining is from 0 to 3. The sum of the two indicators is the final score, which determines the positivity of the tumor by receptor status: 0-2 negative, 3- 8 positive. An overall score of 3 on this scale corresponds to 1-10% of stained cells and is the minimum positive result when hormonal therapy can be effective.

Sometimes the receptor status is determined solely by the percentage of cells with stained nuclei. In such cases, NCCN recommends that all tumors with more than 1% positive cells be considered positive.

When interpreting color on receptorHER2/neu only membrane staining (staining of the cell membrane) is taken into account, which is evaluated on a scale from 0 to +3:

    a result of 0 and +1 is considered HER2-negative;

    2 - borderline result, with which, according to the immunohistochemical study, it is impossible to judge the presence of the HER2-neu receptor on the cell surface, a FISH or CISH study is necessary;

    3 - positive result - targeted therapy with anti-HER2 drugs will be effective.

According to the classification of St. Gallen Consensus (2009), a low index of proliferative activity is considered level Ki-67 less than 15%, medium - 16-30%, and high - more than 30%.

What can influence the result?

  • The quality of the paraffin blocks provided, the experience and qualifications of the pathologist, since the immunohistochemical method is not fully standardized and the evaluation of its results is somewhat subjective.
  • The interpretation of the results of the study should be carried out exclusively by a doctor of the relevant specialty, the data on the effectiveness and expediency of prescribing certain drugs, depending on the results of the study, are purely advisory in nature and can be revised taking into account the individual characteristics of the patient.


Important Notes

  • In case of indeterminate HER2/neu-receptor status (the result of an immunohistochemical study is 2+), it is recommended to perform a FISH or CISH study, which will reveal hyperactivation of the gene encoding this receptor. If these studies are unavailable, a second immunohistochemical study is allowed, but on a different sample of tumor tissue.
  • There are several scales for assessing the receptor status of breast cancer, the laboratory report should indicate which one was used to evaluate the positivity of the tumor in this study, as well as a descriptive characteristic of the number of positive cells, staining features of cellular structures and morphological features of cells.

    Histological examination of the biopsy material of the formation of the mammary gland

    Cytological examination of breast punctures

    Determination of HER2 tumor status by FISH

    Determination of HER2 tumor status by CISH

Who orders the study?

Oncologist, mammologist, oncogynecologist.

Literature

    Dana Carmen Zaha. Significance of immunohistochemistry in breast cancer. World Journal of Clinical Oncology, 2014; 5(3): 382-392.

    NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 3.2017 – November 10, 2017. Available at www.nccn.org.

    Clinical laboratory diagnostics: national leadership: in 2 volumes - T. I / Ed. V. V. Dolgova, V. V. Menshikov. - M.: GEOTAR-Media, 2012. S. 658-660.

    V. F. Semiglazov, R. M. Paltuev, V. V. Semiglazov, G. A. Dashyan, T. Yu. Semiglazova, P. V. Krivorotko, K. S. Nikolaev. General recommendations for the treatment of early breast cancer Galle-2015, adapted by the experts of the Russian Society of Mammary Oncologists. Tumors of the female reproductive system, 2015; 3:43-60.

Immunohistochemistry is a technique for detecting the presence of an oncological process in the body by assessing the content of antigens. With its help, it is possible not only to diagnose a cancer at an early stage, but also to predict the further course. Used as a cancer diagnosis and evaluation of the effectiveness of the chosen treatment method

In the presence of an oncological process in the body, antigens enter the bloodstream. Their presence indicates a pathology, and a specific type indicates the location of the neoplasm. With its help, you can more accurately diagnose and determine the effectiveness of treatment.

The essence of the study is to identify antigens, which is possible through a series of tests. Reagents are used, which include "labeled" antibodies. These protein structures have a specific color, which is given to them by specialized dyes.

Antibodies are able to seek out antigens and interact with them. A similar reaction is called "antigen-antibody", when using labeled cells it is possible to determine the presence of antigens that indicate the presence of a malignant tumor process.

With the help of immunohistochemical studies, it is possible to detect not only the presence of oncogenic markers, but also to determine some hormone receptors, which is effective in the hormone-dependent type of tumor or progressive endocrine diseases.

The results of the study show:

  1. The histological affiliation of the tumor, which confirms or refutes the presence of cancer.
  2. Localization of the tumor process and target organs that will suffer in the future - this allows you to maximally direct all methods of treatment to suppress the pathological process in a particular area of ​​the body.
  3. A possible method of treatment and resistance of cells to certain types of medicines. A doctor can predict how effective a particular drug will be for a particular patient. It minimizes development risks side effects and lack of therapeutic effect.

Immunohistochemistry is the most reliable study that helps determine the type cancer cells. The level of error is minimal, which indicates the high accuracy of the results.

Immunohistochemistry very accurately determines the type of cancer cells

The indisputable advantage of immunohistochemistry is the exact identification of the type of cancer and its location (center). It is impossible to reveal this by any other ultra-precise methods. It is the staining of the biomaterial sample that shows which cells are present in the tumor, how they behave, and how they will behave when exposed to certain methods of treatment.

Diagnosis based on a chemical reaction helps to identify the tumor process at the earliest stages. This increases the chances of a favorable outcome.

Several external factors affect the accuracy of the results, including reception hormonal drugs. A few days before the biopsy, the refusal of all drugs, diet and lack of physical activity is indicated. Failure to follow these recommendations increases the risk of inaccuracies in the results of the study. If desired, the analysis can be taken in two laboratories at the same time, which will reduce the likelihood of error.

Indications for immunohistochemistry

Research is necessary in the following situations:

  1. In the presence of a tumor that gives fuzzy echo signs, which requires the establishment of its nature.
  2. If there are metastases to identify their locations, which helps to stage the cancer.
  3. Making a forecast and the rate of spread of the tumor process.
  4. If it is necessary to study the sensitivity of receptors to certain types of hormones, if a person has disorders in the endocrine system.
  5. If the doctor doubts the method of conducting the selected type of drug treatment or there is no therapeutic effect.

The indication is a pronounced tumor process in any part of the body. Immunohistochemistry shows the degree of its malignancy, possible forecast and drug tolerance.

The study is effective in diagnosing pathologies of the reproductive system when it is impossible to become pregnant and bear a child. The indications are:

  • chronic diseases of the uterus and ovaries;
  • infertility and spontaneous miscarriages in the early stages;
  • pathological growth of the endometrium.

The technique helps to determine whether there are cells in a woman's body that prevent pregnancy.

Methodology

The research takes place in four stages:

  1. Pre-laboratory sample preparation - obtaining the desired sample is carried out using a biopsy. The choice of method depends on the location of the tumor, its shape and the prevalence of the tumor process. Part of the excised tissue is placed in a formalin solution, after which the sample is transferred to the laboratory. Another advantage of immunohistochemistry is the ability to study after a certain time. There is no need to process the sample immediately after the biopsy is taken. Samples are well stored and show results no worse than on the day they were taken.
  2. Preparation of the sample for the study - the biomaterial is injected into paraffin, which is necessary for complete fixation of the sample. The thinnest sections are prepared from the obtained tissue elements, which is possible with the help of high-precision equipment. The thinner the cut, the easier it is to trace the chemical reaction. Sections are placed on a special panel, on which the reagent will be applied in the future.
  3. Staining of sections by injection of antigens - several samples are prepared, which are affected by various antibodies. The result obtained is fixed by the degree of staining of a particular section of the cut. Up to 10 types of antigens can be detected simultaneously, which makes it possible to determine the exact nature of the tumor.
  4. Evaluation of the results - after a certain time (7-10 days), using high-precision equipment, the degree of coloring of the samples is assessed, making a conclusion. All the data obtained is entered into a special decoding form, which helps in making an accurate diagnosis. It is passed to the attending physician, after which the appropriate treatment is selected.

The sampling of biomaterial is carried out before the start of treatment in order to assess the true state of affairs. If medications were used, these results will be somewhat different from the true ones.

For the study, a part of the biomaterial is used. The second part can be stored in the laboratory. This will reduce the number of interventions in the body, especially when choosing a treatment method. There is no need to take a biopsy again to establish which medication will be effective in a given situation.

The advantage is given to those laboratories in which staining of samples is carried out automatically. Minimizing human intervention in the process allows you to get the most accurate results.

Contraindications

There are no contraindications to immunohistochemistry in principle. The impossibility of the study is due to the impossibility of taking a biopsy, which is possible when the tumor is located in the deep layers of tissues and organs, when introduced into which there is a risk of developing deadly complications. This applies to tumors of the brain, internal parts of organs.

Interpretation of results

In the course of the study, the type of oncogenic cells and their number are revealed, which further contributes to the preparation of an accurate prognosis. Attention is paid to the Ki-67 indicator. It is this marker that shows the degree of malignancy of the process. If its percentage is more than 85%, then this indicates a running oncological process with the presence of metastases, which will eventually provoke sudden death.

When the tumor percentage is less than 10%, the prognosis is favorable. With the right choice complex treatment there is a 95% chance of going into lifelong remission with the preservation of health.

The higher the percentage of oncogenicity, the worse the prognosis and the less chance of life.

The resulting transcript is passed to the attending oncologist, under whose guidance the treatment will be carried out. A detailed answer to the question of interest will allow you to choose the most optimal medicines, which will increase the chances of a full recovery.

After the course of treatment, immunohistochemistry is repeated. Based on the assessment of the quantitative and qualitative composition of cells, it is possible to trace the dynamics and effectiveness of treatment. The absence of a therapeutic effect may be a reason for re-conducting the study, but in a different laboratory.

Despite the high accuracy of the results obtained, the diagnosis is made on the basis of a comprehensive examination. Very rarely, there are cases when the data of immunohistochemistry and histological examination the same sample gave different values.

Oncological diseases of the mammary glands are diagnosed in women quite often. Therefore, diagnostic measures to detect dangerous tumor do not lose their relevance. Immunohistochemical study in breast cancer is designed to determine the susceptibility of malignant cells to specific substances. Through the study, it is found out whether the treatment being carried out is correct.

IHC - what is this study?

Immunohistochemical research used in oncology makes it possible to detect the relationship between proteins synthesized by malignant cells and antigens. Having identified this connection, specialists establish the type and structure of the neoplasm.

Purpose of the study

IHC in oncological pathologies of the mammary glands is carried out in order to:

  • establish the type of disease susceptible to a particular therapy;
  • , launched by the tumor, and the degree of their spread;
  • find the source of metastases;
  • establish the stage of development of the detected tumor;
  • evaluate the effectiveness of therapy;
  • find out the rate of spread of metastases;
  • identify the sensitivity of blood cells to specific medicinal substances to screen out ineffective drugs.

Indications for IHC

Diagnostic testing is used to determine the condition of any part human body. The procedure is prescribed not only for breast cancer, but also for any neoplasms that are presumably malignant. IHC determines the state of the endometrium at:

  • the appearance of metastases;
  • pathologies of the uterus;
  • infertility;
  • unsuccessful IVF procedures;
  • diseases of the pelvic organs with different etiologies;
  • constant spontaneous abortion.

There are no contraindications to the procedure. They refuse to study only if for some reason it is impossible to take a biomaterial from a patient.

Study preparation

Before the procedure, the patient:

  • should not take hormonal drugs (one week before taking the biomaterial);
  • should not take medication to stop bleeding;
  • should carry out thorough hygiene procedures.

The study is carried out on specific days of the menstrual cycle:

  • on the 5th - 7th day they study pathological changes endometrium;
  • on days 20-24, secretory and receptor activity is assessed.

Research progress

To conduct an immunohistochemical test, a certain amount of tumor tissue of the breast is taken by biopsy. The fence is carried out at the site where the specialist suspects the accumulation of malignant cells.

Before the procedure, the physician marks the selected point on the patient's chest. Also pieces of the tumor can be taken for analysis cut during surgery.

  1. The collected biomaterial is taken to the laboratory.
  2. Tumor samples are lowered into a container with formalin.
  3. The biomaterial is degreased.
  4. Paraffin liquid is poured in, which makes it possible to determine the structure and type of tumor tissues.
  5. Cut off a piece of the tumor 1 mm thick.
  6. Place on laboratory glass.
  7. Chemical reagents and antibodies are used as dyes.
  8. The results of the test are ready after two weeks.

Different markers are used to detect breast cancer. If the test results revealed the presence of a significant amount of female sex hormones in the tumor tissues, then the tumor is actively developing. It is even possible that metastases have already begun. If the accumulation of hormones is average, then malignant cells multiply inactively. So, with proper and timely treatment, the patient has the opportunity to restore health.

positive result hormonal treatment possible if the Ki-67 marker in a malignant breast tumor does not exceed 15-17%. The neoplasm grows rapidly if the marker reaches 35%. In this situation, chemotherapy is immediately carried out, which allows to slow down the reproduction of malignant cells. If the marker is above 85%, then it is too late to treat, death is inevitable.

Deciphering the results

Deciphering the results, look at the progesterone (PR) and estrogen (ER) receptors. IHC also determines the amount of the human epidermal growth factor receptor (HER-2 protein) in the biomaterial taken from the patient. In breast cancer, HER-2 is elevated.

With increased ER and PR in tumor tissues, it can be said that the malignant formation grows under the influence of hormones. If the concentration of ER and PR does not go beyond the norm or goes slightly, then the patient can hope for successful treatment.

The IHC indicators are deciphered according to a special color scale, correlating the colors on the scale with the shades of the biomaterial.

  1. 0 and +1. The protein concentration is normal. Therapeutic measures are not needed.
  2. +2. The protein concentration is average. There is a malignant tumor in the breast. Usually, an additional study is carried out to confirm the correct result of the first test. An additional study called FISH allows you to find out the protein content in each cell. If HER-2 is normal, then the FISH test will give a positive result, if it is elevated, then it will be negative.
  3. +3. The protein concentration is much higher than the normal value. Definitely there is a malignant neoplasm in the breast.

If the test showed a high concentration of protein, then the tumor is of an aggressive type, it grows intensively.

According to the results of IHC, 4 types of breast cancer are distinguished:

  • – ER receptors are positive, protein receptors are negative, Ki-67 is below 14%;
  • B-luminal - ER and HER-2 receptors are negative, Ki-67 is above 15%;
  • overexpressing - ER and PR receptors are negative, protein receptors are positive;
  • basal-like - all receptors are negative.

Prognostic markers

They determine the most likely behavior of the neoplasm at the time of the test. There is no effect of therapy on the study. The test allows you to determine the aggressiveness of the tumor. The prognosis is important for the selection of the most appropriate medications and treatment procedures.

Diagnostic markers

The study shows the effectiveness of the treatment. If the presence of aggressive cancer is detected, then chemotherapy is prescribed.

IHC is a complex test that uses a large number of markers. The more markers are tested, the higher the cost of the study. The test is effective in determining the type of cancer, helps to prescribe optimal therapy.

At present, a qualitative diagnosis of many oncological diseases is impossible without immunohistochemical studies. This is a highly accurate and informative method that allows not only to identify a neoplasm, but also to develop optimal treatment tactics.

IHC is mandatory prescribed for cancer of the lymphatic system, when The lymph nodes or internal organs

IHC research - what is it

IHC is a technique used in pathological anatomy to diagnose cancer and benign tumors. It is prescribed when it is impossible to establish an accurate diagnosis using a standard histological method or when it is necessary to detail the clinically significant parameters of neoplasms at the molecular level.

Very often, histology is not enough. In most cases, the reason for this is the extremely atypical structure of the pathological formation, which makes it difficult to make an accurate diagnosis. In particular, with lymphoma and leukemia, IHC is almost always done.

It should be noted that in total there are about 70 varieties of leukemia and lymphomas. It is possible to verify some of them only through several studies - histological, immunohistochemical and molecular genetic.

Another diagnosis - "small round cell tumor" - can mean 13 malignant tumors with different course and prognosis. In addition, each of them requires the development of a special scheme of chemotherapy and radiotherapy. Differentiation of such tumors helps the only method - immunohistochemistry.

The essence of the technique

With the development of any tumor process, proteins alien to the body are formed - antigens, in contrast to which the immune system Humans produce antibodies called immunoglobulins. They attach to antigens and bind to epitopes, the main parts of antigenic macromolecules. Antibodies perform two functions at once: binding and effector. Simply put, they directly prevent antigens from doing harm and at the same time activate complement, triggering an immune response.

The role of antigens in this case belongs to atypical tumor cells. Before conducting an immunohistochemical study, sections of the biomaterial are labeled with specific antibodies to them. For further visualization, these antibodies are stained with enzymes. Further, using high-precision optics, the behavior of the tested cells is observed.

If protein compounds labeled as antibodies bind to tumor cells, a glow will be seen - fluorescence, indicating the presence of the desired substances. So, for example, hormone receptors and tumor markers are detected. If breast cancer is suspected, estrogen and progesterone receptors are thus detected.

Who is shown

The main indication for the appointment of immunohistochemistry are malignant neoplasms. In oncology, this method is used to search for metastases and pathological microorganisms, determine the type and localization of the tumor, and also to assess the activity of the pathological process. With the help of IHC, it is possible to establish a final or, less often, an intermediate diagnosis in skin cancer (melanoma), sarcoma, lymphogranulomatosis, lymphocytic leukemia, and leukemia, and to type the degree of malignancy of the process. The latter is extremely important in neuroendocrine formations, which are also called "hidden killers" due to the fact that they are very difficult to recognize in the early stages.


Immunohistochemical testing is often done to avoid aggressive treatment with toxic drugs.

In some cases, immunohistochemical analysis makes it possible to establish the source of metastases, when the localization of the primary focus is unknown, and also to carry out differential diagnosis with several neoplasms of different origin.

IHC can be prescribed for infertility, chronic pathologies of the endometrium, uterus and ovaries, habitual miscarriages. It is also advisable to do it if pregnancy does not occur after several IVF procedures.

Immunohistochemistry will help detect the presence of cells that prevent conception, and determine further tactics for the treatment of infertility.