Medicine 2.0 in action: Her2 testing errors

I wanted to call y’all’s attention to this website:

Her2 testing errors

Seems Seattle Breast Pathology Consultants have a website where patients can ask questions.  Anyone can answer, moderated by the site operators.  So you end up with an open discussion about a patient’s case.  For example, this patient asked:

Question: My pathology results showed my cancer was 3+ but FISH was done too and it showed a 1.7 so my doctor said I am not positive and therefore don’t qualify for Herceptin. From what I read 3+ is positive.

Pretty good question, right?  From what I know, disagreement between IHC and FISH isn’t uncommon.  Here’s the site's reply:

Answer: You are correct—a 3+ result by immunohistochemistry (IHC) is positive. If the laboratory that did your test is following the new rules for HER2 testing then there was no need to go to FISH. There is usually an outstanding correlation with 3+ by IHC and amplification by FISH so I am concerned maybe the lab over-called the IHC and you were really a 2+. Most cancers that are 2+ are not amplified by FISH which your cancer wasn’t with a ratio of 1.7. I would ask your doctor to check into why FISH was done and to see if the pathology lab that ran your IHC test really called it 3+ and maybe ask to have it repeated or performed at another laboratory.

So that’s a good answer, getting a second opinion seems warranted.  But what is cool is that I was able to post my own answer:

Definitely, get a second opinion from another pathology lab. Scoring Her2 is difficult and subjective, and it isn’t unusual for two pathologists to disagree on the same case. This is important enough to get right; you want to take Herceptin if it can help you, but you don’t want to expose yourself to the side effects and expense if it can’t.

So now this patient is getting the benefit of a reply from some guy who has nothing to do with this case – happens to the CTO of a digital pathology company, but could be Joe the Plumber – and anyone else could comment too.

This is Medicine 2.0, and it will be an interesting trend.  You can see digital pathology right in the middle of this, in future the patient would post a link to her slides, and I could read them.  Heck, I could even perform IHC Quantification on them, and post the results!

 

Comments

[Keith Kaplan]

Ole,

Excellent post. I think this is a reality pathology and pathologists are going to have to get accustomed to. More transparency of our interpretations and reports as patients seek and share information utilizing Web 2.0 technologies. If personal health records become a reality this will add another layer of opportunities for additional opinions much more seamlessly for patients.