Too Late for FISH Test?

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Hei
Hei Member Posts: 5
edited June 2014 in HER2+ (Positive) Breast Cancer

Hi,

My mom has removed her left breast entirely, and the tumor cell was sent in for FISH (Fluorescence in Situ Hybridization) test.

However, due to a human mistake (I blieve), the pathologist didn't perform the test until 12-14 days after the tumor cell was removed from the body.

Now, I wonder whether the FISH test is still valid because FISH test looks at HER2/CEP17 ratio.

Some articles mention the test is looking at HER2 gene and some looking at HER2 protien.

I wonder whether the HER2 gene or protien won't be preserved well enough for FISH test after 12-14 days.

I have been searching online for a long time but I can't find any article about it.

Anyone can share some insight?

Thanks in advance!

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  • Hei
    Hei Member Posts: 5
    edited August 2013

    After searching for awhile online, I found that the sample of tumor should be in 10% formalin for > 6 hours but less than 48 hours:

    http://www.healthcare.uiowa.edu/path_handbook/handbook/test2962.html

    Now, I am very concern that the sample has been there over 48 hours as the pathologist didn't receive it until day 10, and so the result isn't accurate anymore.

    Anyone has similar experience?  Or does anyone know how the sample is stored before it is reached the pathologist usually?

    Thanks in advance.

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  • Moderators
    Moderators Member Posts: 25,912
    edited August 2013

    Hi Hei!

    Sorry you didn´t get any real answer yet. You can read more about FISH test and how tissue is preserved following this link to our main site: http://www.breastcancer.org/symptoms/testing/types/fish

    Anyway, it would be great if you could ask the pathologist about the sample, just to make sure and release your concern.

    Let us know how you make out!

    ---The Mods

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  • Hei
    Hei Member Posts: 5
    edited August 2013

    Thanks for your reply, mod.

    I would like to talk to the pathologist but I am not sure whether he will tell me the truth in case there is any malpractice. Sigh. It is not about getting into law suit for any compensation but for my mom's life.

    Thanks for the link tho.

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  • rozem
    rozem Member Posts: 1,375
    edited August 2013

    hei - i had my tissue sample re-tested at another institution MONTHS after my biopsy and they were still able to test for the her2 protien (i was her2 positive)

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  • Hei
    Hei Member Posts: 5
    edited August 2013

    Thanks for sharing Rozem!

    Do you happen to know how your tissue sample was stored?  Paraffin processed?  Or Formalin fixed and paraffin processed?

    Thanks in advance.

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  • Hei
    Hei Member Posts: 5
    edited August 2013

    After reading a lot of medical journals, I found few things:

    1. CAP recommends 6-48 hours of fixation time for FISH test.

    2. The fixation time for IHC doesn't change even if the size of sample is smaller or thinner.

    And, my sister called the pathologist who did the IHC and sent my mom's sample (in paraffin block) to another lab.  The pathologist first tried to say that the sample was in NBF over 6 hours already, but then my sister pointed out the technician already pointed out he usually lets a sample in NBF for 2 hours, and then configured the machine to keep it in NBF for another 2 hours.  Then, the pathologist tried to argue that CAP recommends 6-48 hours but CAP never specifies whether the clock starts before slicing.

    Although he did have some sort of valid point, both my sister and I felt that he was just trying to get away from being sued.

    Now, we are looking for another alternative test that is hopefully as good as FISH test for HER2.  Anyone has any recommendation?

    The pathologist offered dissolving the paraffin block and then re-immersing the sample in NBF for another few hours to meet total of 6 hours and then redoing the FISH test.  I am not sure about the validity.  I have been searching for a long time but I have no result.  Anyone has similar experience?

    I also hope my findings above will help other avoid running into similar situation.  So carefully ask your pathologist BEFORE the surgery.

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