Alfred score Er 6

hi...i don't know if I was her positive. I do know I am an 8 on the Allred score. And ER and PR positive. I only tolerated 1 yr of tamoxifen. I' almost 7yr since diagnosis of my dcis. I often worry that I am not on a hormone blocker. If you find out more about this Allred score I'd love to know.

Hi Manc:

There are a variety of validated immunohistochemistry ("IHC") methods for reporting ER status in current clinical use. ASCO/CAP guidelines (2010) for ER and PR testing recommend "that ER and PgR assays be considered positive if there are at least 1% positive tumor nuclei in the sample on testing in the presence of expected reactivity of internal (normal epithelial elements) and external controls."

Thus, "the Panel recommended that the cutoff to distinguish ''positive'' from ''negative'' cases should be ≥ 1% ER-positive tumor cells. The Panel recommended considering endocrine therapy in patients whose breast tumors show at least 1% ER-positive cells and withholding endocrine therapy if less than 1%."

As advised by your team, it appears that an Allred Score of 6 is within the positive range, which includes Allred Scores from 3 to 8.

The Allred scoring system is a semi-quantitative measurement in which the pathologist assesses:

(a) the proportion of cells with nuclei that stain positively for receptor, assigning a "proportion score" on a scale from 0 to 5 (See Table 2 below, left columns); and

(b) the intensity or brightness of the nuclear staining, assigning an "intensity score" on a scale from 0 to 3 (See Table 2 below, right columns);

These two scores are added together to give an overall "Allred Score":

[Proportion Score] + [Intensity Score] = Allred Score (maximum possible Allred Score is 8).

Fitzgibbons (2014), "Template for Reporting Results of Biomarker Testing of Specimens From Patients With Carcinoma of the Breast"

Please correct me if I am missing a possibility, but from Table 2, it appears that to obtain a overall Allred Score of 6, the various possibilities for Proportion Score + Intensity Score include:

3 + 3 (corresponding to 11-33% cells positive for nuclear staining, with strong intensity of staining)

4 + 2 (corresponding to 34-66% cells positive for nuclear staining, with intermediate intensity of staining)

5 + 1 (corresponding to ≥ 67% cells positive for nuclear staining, with weak intensity of staining)

You can see from the above, that to obtain an Allred Score of 6, requires a Proportion Score of 3 or higher, corresponding to at least 11% positive staining (or above), which is above the 1% threshold for positivity.

===> You can check your pathology report to see if the Proportion Score and Intensity Score were separately reported.

BarredOwl