Leica HER2 FISH System - 30 Test
Instructions For Use
For use on Leica Biosystems’ BOND-MAX and BOND-III System.
TA9217 is a fluorescence in situ hybridization product designed to stain 30 tests (30 slides
stained with LSI HER2/CEP17 Dual Probe).
IVD
Leica Biosystems Newcastle Ltd
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United Kingdom
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Leica Biosystems Canada
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Concord, Ontario L4K 4V8
Canada
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( +61 2 8870 3500
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Intended Use
For in vitro diagnostic use
The Leica HER2 FISH System - 30 Test is designed to detect amplification of the HER2/neu
gene via fluorescence in situ hybridization (FISH) in formalin-fixed, paraffin-embedded human
breast cancer tissue specimens. The Leica HER2 FISH System - 30 Test is indicated as an aid
in the assessment of patients for whom Herceptin®* (trastuzumab) treatment is being considered
(see Herceptinpackage insert). The Leica HER2 FISH System - 30 Test is not intended for use
to screen for or diagnose breast cancer. All other available clinical information should also be
taken into consideration, such as tumor size, number of involved lymph nodes, and steroid
receptor status. No treatment decision for breast cancer patients should be based on HER2
gene amplification status alone.
Note: All of the patients in the Herceptin clinical trials were selected using an investigational
immunocytochemical Clinical Trial Assay (CTA). None of the patients in those trials were
selected using the Leica HER2 FISH System - 30 Test. The Leica HER2 FISH System - 30 Test
has been compared to the Abbott Molecular PathVysion®* HER-2 DNA Probe Kit assay on an
independent set of samples and found to provide acceptably concordant results, as indicated
in the Clinical Concordance Summary. The actual correlation of the results of the Leica HER2
FISH System - 30 Test to clinical outcome has not been established.
* Herceptin® is a trademark of Genentech, Inc. and F. Hoffmann-La Roche Ltd. PathVysion® is a trademark of Abbott Molecular
Inc. All Rights Reserved. Used under License.
Required training
Leica Biosystems will provide training in specimen preparation, assay procedure, and
interpretation of FISH testing of the HER2 gene for all users.
Summary and Explanation
Background
The HER2 gene, alternatively known as neu or c-erbB2, is located on the long arm of
chromosome 17 at position 17q11-12 (1). Both the HER2 gene and its 185 kD encoded protein
have been shown to play a major role in malignant transformation and tumor progression of
breast cancer (2).
HER2 functions as a prognostic marker, with gene amplification and protein over expression
being linked to an increased rate of disease recurrence and higher mortality. HER2
also functions as a predictive marker for selected systemic chemotherapy and targeted
treatments (3). Specifically, amplification of the HER2 gene has been shown to be an indicator
of poor prognosis in node-positive breast cancer (4-8). Furthermore, one study indicates
the prognostic value of HER2 to be stronger among patients treated with chemotherapy (7).
However, in predicting disease-free and overall survival in individual patients, other established
prognostic factors such as tumor size, number of positive lymph nodes and steroid receptor
status must also be taken into consideration.
Overexpression of the HER2 oncoprotein, as a result of gene amplification found in breast cancer
cells, suggests HER2 as a target for an antibody-based therapy (3). Herceptin (trastuzumab),
a humanized monoclonal antibody (9) that binds with high affinity to the HER2 oncoprotein has
been shown to inhibit the proliferation of human tumor cells that overexpress HER2 oncoprotein
both in vitro and in vivo (10–12). Since the development of Herceptin, the detection of both
the HER2 gene and protein have become essential tools in the assessment of breast tumors,
directing both therapy selection and subsequent patient management (13,14).
In both interphase and metaphase cells derived from human breast carcinoma cell lines, FISH
has been used to show HER2 gene amplification (15-18). For quantification of HER2 gene
amplification, FISH assesses the level of HER2 gene amplification directly in the tumor cells.
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
The characteristic morphology of the tissue and the spatial distribution of oncogene copies in
individual uncultured primary breast carcinomas are retained. Aberrations in chromosome 17
copy number (aneusomy) are also commonly found in breast tumors. These may present as
chromosome deletions or gains (polysomy). This chromosomal variation has critical impact on
the interpretation and reporting of HER2 gene amplification status. Therefore, measurement of
chromosome 17 copy number in conjunction with HER2 is critically important (4).
The Leica HER2 FISH System - 30 Test contains the LSI HER2 DNA probe, a 226 Kb
SpectrumOrange™ directly labeled fluorescent DNA probe specific for the HER2 gene
locus (17q11.2-q12) and the CEP17 DNA probe, a 5.4 Kb SpectrumGreen™ directly labeled
fluorescent DNA probe specific for the alpha satellite DNA sequence at the centromeric region
of chromosome 17 (17p11.1-q11.1). The probe solution has been specially formulated and
validated for use on the Leica BOND-MAX and BOND-III System and should not be modified
or used in a manual setting.
Clinical Concordance Summary Leica BOND-MAX System
The Leica HER2 FISH System - 30 Test was developed to provide a fully automated alternative
to current methodologies used to determine HER2 gene amplification status. The performance
of the Leica HER2 FISH System - 30 Test on the Leica BOND-MAX System was evaluated in an
independent study comparing the results of the Leica HER2 FISH System - 30 Test to the Abbott
Molecular PathVysion HER-2 DNA Probe Kit Assay on 300 breast tumor specimens. None of
these tumor specimens were obtained from patients in the Herceptin clinical studies. The results
indicated a 99.33% concordance in a 2x2 analysis (95% confidence intervals of 97.61–99.92%).
The concordance data also indicates that a positive result with the Leica HER2 FISH System -
30 Test is highly likely to correspond with a positive result on the Abbott Molecular PathVysion
HER-2 DNA Probe Kit assay. The Leica HER2 FISH System - 30 Test is interpreted as negative
for HER2 gene amplification when the HER2:CEP17 gene ratio is less than 2.0 and positive
when the HER2:CEP17 gene ratio is greater than or equal to 2.0. Equivocal (borderline) results,
where the HER2:CEP17 gene ratio is between or equal to 1.8-2.2, should be interpreted with
caution. Count an additional 20 nuclei and recalculate the ratio.
Clinical Concordance Summary Leica BOND-III System
The Leica HER2 FISH System - 30 Test was developed to provide a fully automated alternative
to current methodologies used to determine HER2 gene amplification status. The performance
of the Leica HER2 FISH System - 30 Test on the Leica BOND-III System was evaluated in an
independent study comparing the results of the Leica HER2 FISH System - 30 Test to the Abbott
Molecular PathVysion HER-2 DNA Probe Kit Assay on 300 breast tumor specimens. None of
these tumor specimens were obtained from patients in the Herceptin clinical studies. The results
indicated a 99.67% concordance in a 2x2 analysis (95% confidence intervals of 98.16–99.99%).
The concordance data also indicates that a positive result with the Leica HER2 FISH System -
30 Test is highly likely to correspond with a positive result on the Abbott Molecular PathVysion
HER-2 DNA Probe Kit assay. The Leica HER2 FISH System - 30 Test is interpreted as negative
for HER2 gene amplification when the HER2:CEP17 gene ratio is less than 2.0 and positive
when the HER2:CEP17 gene ratio is greater than or equal to 2.0. Equivocal (borderline) results,
where the HER2:CEP17 gene ratio is between or equal to 1.8-2.2, should be interpreted with
caution. Count an additional 20 nuclei and recalculate the ratio.
Principle of Procedure
TheLeicaHER2FISHSystem-30Testcontainscomponentsrequiredtocompleteafluorescence
in situ hybridization based staining procedure for formalin-fixed, paraffin-embedded tissues.
Following appropriate pretreatment, incubation with the ready-to-use LSI HER2/CEP17 Dual
Probe and appropriate stringency washing, tissue sections are then dehydrated and mounted
with DAPI. Results are interpreted by fluorescence microscopy using the recommended filters
at the appropriate wavelengths.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
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The Leica HER2 FISH System - 30 Test is for use only on the Leica BOND-MAX and BOND-III
System.
Components Provided
The materials listed below (Table 1) are sufficient to stain 30 tests (30 slides stained with LSI
HER2/CEP17 Dual Probe).
LSI HER2/CEP17 Probe
6.6 mL
Contains ready-to-use LSI HER2/CEP17 Dual Probe.
Contains <60% (v/v) formamide.
Post Hybridization Wash 2
9 mL
Contains ready-to-use post hybridization wash solution.
Contains <50% (v/v) formamide.
Leica BOND Enzyme
Concentrate 2
Contains Proteinase K solution at 1.7 mg/mL.
1 mL
Leica BOND Enzyme Diluent
65 mL
Contains Enzyme Diluent.
Leica BOND Open Container
3 x 7 mL
BOND Open Container used for Enzyme 5.
Table 1: Leica HER2 FISH System - 30 Test Components
Refer to individual MSDS for further product safety information, available from
www.LeicaBiosystems.com/TA9217-IFU
Directions For Use
All reagents supplied are formulated specifically for use with this assay and lot numbers are
specific for each Leica HER2 FISH System - 30 Test. For the assay to be valid, no substitutions
should be made.
Storage and Stability
Store at 2–8 °C. Do not freeze. Return to 2–8 °C immediately after use. Any deviation from these
conditions will invalidate the assay. Ensure the Leica HER2 FISH System - 30 Test is used within
its designated expiry date. The signs indicating contamination and/or instability of the Leica
HER2 FISH System - 30 Test are turbidity of the solutions (except for the probe solution) and
odor development. The user must verify storage conditions other than those specified above.
Specimen Preparation
Standard methods of tissue processing should be used for all specimens (19). It is recommended
that tissues are prepared in formalin-based fixatives and are routinely processed and paraffin-
embedded. For example, specimens should be sampled at a thickness of 3–4 mm and fixed
for 18–24 hours in 10% neutral-buffered formalin. The tissues should then be dehydrated in a
series of alcohols and cleared through xylene, followed by impregnation with molten paraffin
wax, held at no more than 60 °C. Tissue specimens should be sectioned between 4–6 µm.
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Tissue sections mounted on charged slides (Leica BOND Plus Slides S21.2113) can be held for
up to 12 months at 2–8 °C before staining. Following sectioning, it is recommended that slides
are incubated at 60 °C for one hour. Stained sections should be stored at -20 °C to preserve
fluorescent signal and prevent fading. Allow stored slides to reach room temperature prior to
reading.
Warnings and Precautions
For professional users only.
One or more components in the product are hazardous and may cause harm to the unborn
child.
As a rule, persons under 18 years of age are not allowed to work with this product. Users must
be carefully instructed in the proper work procedure, the hazardous properties of the product
and the necessary safety instructions.
Specimens, before and after fixation, and all materials exposed to them, should be handled as
if capable of transmitting infection and disposed of with proper precautions.
Never pipette reagents by mouth and avoid contacting the skin and mucous membranes with
reagents and specimens. If reagents or specimens come into contact with sensitive areas, wash
with copious amounts of water. Seek medical advice. Consult federal, state or local regulations
for disposal of any potentially toxic components.
Minimize microbial contamination of reagents or an increase in nonspecific staining may occur.
Procedure
A. Reagents required but not supplied
•
•
•
•
Leica BOND Dewax Solution (AR9222)
Leica BOND Epitope Retrieval Solution 1 (AR9961)
Leica BOND Wash Solution x10 Concentrate (AR9590)
Standard solvents used in fluorescence in situ hybridization based assays (eg ethanol,
absolute and graded)
•
•
•
•
Distilled or de-ionized water
DAPI Counterstain
Leica HER2 FISH Control Slides (TA9123)
Leica BOND Aspirating Probe Cleaning System (CS9100)
B. Equipment required but not supplied
•
•
•
•
•
•
•
•
•
Pipettes (capable of measuring 1-20 µL and 100 – 1000 µL volumes)
Charged slides (Leica BOND Plus Slides – S21.2113)
Leica BOND-MAX (21.0051) or Leica BOND-III (21.2201)
Leica BOND Universal Covertiles™ (S21.2001)
Leica BOND Mixing Stations (S21.1971)
Leica BOND Slide Label & Print Ribbon (S21.4564)
Coverslips
Drying oven (capable of maintaining 60 °C)
Fluorescence Microscope (60–100x objective) with appropriate light source. Record the
number of hours that the bulb has been used and replace the bulb before it exceeds the
rated time. Ensure that the lamp is properly aligned.
•
Appropriate Fluorescence Filter Set (SpectrumOrange™ – Excitation Peak at 559nm,
Emission Peak at 588nm, SpectrumGreen™ – Excitation Peak at 497nm, Emission
Peak at 524nm and DAPI – Excitation Peak at 367nm, Emission Peak at 452nm). Multi-
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
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bandpass fluorescence microscope filter sets optimized for use with the Leica HER2 FISH
System - 30 Test are available for most microscope models. The recommended filter sets
for the Leica HER2 FISH System - 30 Test are the DAPI/9-Orange dual bandpass, DAPI/
Green dual bandpass, Green/Orange(V.2) dual bandpass and the DAPI/Green/Orange
(V.2) triple bandpass.
C. Methodology
•
Prior to undertaking this methodology, users are required to be suitably trained in the
automated in situ fluorescence technique.
•
Each test section stained with the LSI HER2/CEP17 Dual Probe enables same cell
analysis of both HER2 and centromeric chromosome 17 signals. A subsequent ratio of
HER2 to chromosome 17 signals will enable a quantitative value to be assigned to the
sample, indicating a negative (non-amplified) or positive (amplified) result. Equivocal
(borderline) results (1.8-2.2) should be interpreted with caution. Count an additional 20
nuclei and recalculate the ratio.
D. BOND Enzyme Pretreatment
Prior to staining dilute supplied Leica BOND Enzyme Concentrate 2 at a 1:300 dilution
using supplied Leica BOND Enzyme Diluent in one of the Leica BOND Open Containers
provided. For example, to stain 10 slides prepare 3 mL of working enzyme solution by
diluting 10 µL of Leica BOND Enzyme Concentrate 2 in 2990 µL of Leica BOND Enzyme
Diluent. It is recommended that the enzyme is freshly prepared before each staining run
and that a minimum volume of 900 µL be used per run.
E. Default Staining Protocol
It is recommended that the Leica HER2 FISH System - 30 Test is used with the
recommended default staining protocol shown in Table 2 below.
Protocol Type
Staining
Protocol Name
*FISH Protocol A
*Dewax
Preparation
HIER
*HIER 25 min with ER1 (97)
*Enzyme 5 for 25 min
*D10
Enzyme
Denaturation
Hybridization
*ISH Hybridization (12Hr)
Table 2: Default Leica HER2 FISH System - 30 Test Staining Protocol
F. Procedure Steps
These instructions should be read in conjunction with the Leica BOND-MAX and BOND-III
System user manual. A new Leica BOND Universal Covertile should be used with each
slide.
The use of Leica BOND Universal Covertiles, which have previously been utilized for either
immunohistochemical or in situ hybridization staining have not been validated with this test.
1. On the Leica BOND-MAX and BOND-III System, ensure the bulk and hazardous waste
containers have enough capacity to perform the required staining runs.
2. Ensure there is adequate alcohol, distilled or de-ionized water, Leica BOND Dewax
Solution, Leica BOND Epitope Retrieval Solution 1 and Leica BOND Wash Solution
in the bulk reagent containers to perform the required staining runs.
3. Ensure that a clean Leica BOND Mixing Station is installed.
4. Turn on the Leica BOND-MAX and BOND-III System.
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
5. Turn on the PC attached to the Leica BOND-MAX and BOND-III System.
6. Open the Leica BOND software.
7. For a new Leica HER2 FISH System - 30 Test kit, scan the reagent tray barcode with
the handheld
scanner to enter the system into the Leica BOND reagent inventory (Single barcode
only).
8. Prepare Leica BOND Enzyme 5 in the supplied Leica BOND Open Container at a dilution
of 1:300. For example, for 10 slides add 10µL of Leica BOND Enzyme Concentrate 2 to
2990 µL of Leica BOND Enzyme Diluent.
9. Scan in supplied Leica BOND Open Container and register as Bond Enzyme 5.
10. Go to the Slide setup screen and click Add case.
11. Enter details for the first case. Ensure the dispense volume is set to 150 µL and the
preparation protocol is *Dewax. Click OK.
12. With the case highlighted in the Slide setup screen click Add slide.
13. First, add patient test slides. Ensure tissue type is set to Test tissue.
14. Select staining mode Single.
15. Select process ISH.
16. Select *LSI HER2/CEP17 Dual Probe – 30 Test from the probe list. The Protocols tab
defaults to the correct staining protocol (*FISH Protocol A), HIER protocol (*HIER 25
min with ER1 (97)), EIER protocol (*Enzyme 5 for 25 min), denaturation (*D10) and
hybridization (*ISH Hybridization (12Hr)).
17. Repeat steps 10 to 16 until patient test slides and controls (Leica HER2 FISH control
slides and/or in-house controls) have been created. Print slide labels.
18. Label slides appropriately.
19. Open the lids of all Leica HER2 FISH System - 30 Test containers and load the reagent
tray onto the Leica BOND-MAX and BOND-III System.
20. Apply new Covertiles to each slide.
21. Load the slide tray onto the Leica BOND-MAX and BOND-III System and press the
Load/Unload button.
22. Confirm that the slides have been scanned and click the Run (Play) button on the System
status screen to commence the run immediately (for the Leica HER2 FISH System -
30 Test it is recommended that this assay is run overnight utilizing the delayed start
functionality).
23. Ensure that the tray indicator field displays Proc (OK) and batch number and finish time
are displayed.
24. When the run is completed press the Load/Unload button and remove the slide tray from
the Leica BOND-MAX and BOND-III System.
25. Remove Covertiles and rinse the slides in de-ionized water.
26. Dehydrate rapidly in two changes of alcohol, air dry.
27. Dispense 20µL of DAPI directly onto the sample.
28. Apply coverslip and allow the solution to spread to its full extent, taking care to remove
any air bubbles.
29. Seal edge of coverslip with nail varnish, or similar sealant.
30. Place slides in dark to facilitate signal development before viewing under fluorescence
microscope.
31. To preserve signal intensity store stained slides at -20 °C.
G. Slide Storage
Store stained slides at -20 °C in the dark. Allow slides to reach room temperature prior to
viewing following removal from -20 °C.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 8 of 24
Signal Assessment and Enumeration
To assess the signal quality and enumerate the HER2 and CEP17 signals follow the process
below:
1. Assessment of Slide Quality
Evaluate slide quality using the following criteria:
1. Assess
•
Probe Signal Intensity: The signals should be bright and easy to
evaluate. Signals should be in either bright, compact oval shapes or
stringy, diffuse oval shapes.
Slide Quality
- Probe Signal
Intensity
•
Background: The background should be relatively free of fluorescent
- Background
particles, and appear dark or black.
Consult the troubleshooting guide (Table 6) if any of the above features are
unsatisfactory and repeat the assay if necessary.
2. Recognition of Target Signals
Ensure that the correct filters are used for analysis:
•
Tissue Overview: Hybridization signals should only be enumerated
among invasive tumor cells. Tumor cells can generally be distinguished
from normal cells by size: in general they are larger than normal cells,
lymphocytes, and epithelial cells. Identify and select target areas by
H & E stain and mark these areas on the coverslip after the FISH assay
is performed.
2. Recognise
Target Signals
- Tissue Overview
- Depth of Focus
•
Depth of Focus: Adjust the depth of the focus to determine focal plane
depth and become familiar with shape and size of the target signals and
noise (debris).
3. Nuclei Suitability
Overview the hybridized area using a 20X objective:
•
Nuclei Selection: Locate the target area of interest (tumor cells as
identified by H & E stain). Avoid areas where nuclear borders are unclear
or cells are necrotic.
3. Nuclei
Suitability
- Nuclei Selection
•
Additionally, signals with weak intensity and non-specific, noisy background,
or insufficient counterstain to determine the nuclear border should be
ignored. Only those nuclei with discrete signals should be enumerated.
4. Signal Enumeration
•
Tumor Overview: Scan several areas of tumor cells to account for
possible heterogeneity, using a 40X objective. Avoid areas of the target
where signals are weak and select an area of good nuclear distribution.
•
Counting: Begin analysis in the upper left quadrant of the selected area
and, scanning from left to right, count the number of signals within the
nuclear boundary, using a 100X objective, according to the guidelines
provided below and in Figure 1.
4. Signal
•
•
•
Locate all signals present in the nucleus by focusing up and down (Z
Enumeration
axis).
- Tumor Overview
Count two signals, that are the same size and separated by a distance
equal or less than the diameter of the signal, as one signal.
- Counting
Nuclei with no signals or with signals of only one color should not be
scored. Only score those nuclei with one or more FISH signals of each
color.
•
Count the number of HER2 signals and the number of CEP17 signals
for each nucleus. Alternate between the orange (HER2), green (CEP17),
green/orange and the DAPI/green/orange filter sets to view both colors, as
necessary.
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Recommended Method for LSI HER2 to CEP17 Ratio Determination
To determine the LSI HER2 to CEP17 ratio, use the following method:
1. Record and determine the number of LSI HER2 and CEP17 signals in 20 nuclei (see
Figure 2 Leica HER2 FISH System - 30 Test score sheet below).
2. Total all of the LSI HER2 signals. This represents the total LSI HER2 signals for the count,
e.g. 143.
3. Total all of the CEP17 signals. This represents the total CEP17 signals for the count,
e.g. 48.
4. To calculate the final result, use the following calculation:
Total LSI HER2 signals divided by Total CEP17 signals,
e.g. 143/48 equals a ratio of 2.98, which is positive for HER2 amplification.
Important Note: If the LSI HER2 to CEP17 ratio is equivocal (1.80 - 2.20), count an
additional 20 nuclei and recalculate the ratio.
Results should be reported as follows:
1. If the ratio is <2, HER2 gene amplification was not observed
2. If the ratio is ≥2, HER2 gene amplification was observed
Important Note: A ratio at or near the cut-off (1.80 - 2.20) should be interpreted with
caution, as described above.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 10 of 24
Leica HER2 FISH System - 30 Test Interpretation Guide
Count as 2 orange signals and 1 green signal
Do not count. Nuclei with no signals or with signals of only 1 color
should not be scored. Only score those nuclei with one or more
FISH signals of each color
Count as 1 orange signal and 2 green signals
Count as 3 orange signals and 2 green signals
Count as 5 orange signals and 4 green signals. 1 orange signal is
diffuse and 1 green signal is diffuse
Count as 4 orange signals and 2 green signals. 1 orange signal is
diffuse. Count 2 signals that are the same size and separated by
a distance equal or less than the diameter of the signal, as one
signal
Count as 5 orange signals and 3 green signals. 1 orange signal is
diffuse
Countas2orangesignalsand2greensignals. 1orangesignaland
1 green signal are overlapping
Do not count. The nuclei are overlapping. It is too difficult to tell
which nuclei the signals are located in
Count as approximately 16 orange signals and 2 green signals
Figure 1: Interpretation Guide
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Leica HER2 FISH System - 30 Test Score Sheet
20 Nuclei Signal Count
HER2 Copy
Number
CEP17 Copy
Number
HER2 Copy
Number
CEP17 Copy
Number
Nucleus #
Nucleus #
1
11
2
12
3
13
4
14
5
15
6
16
7
17
8
18
9
19
10
20
Total 1-10
Total 11-20
HER2
CEP17
HER2:CEP17 Amplification ratio
Total Score 1-20
Average Per Cell
Figure 2: Sample Score Sheet
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 12 of 24
Quality Control
Use of Control Slides
It is recommended that a Leica HER2 FISH Control Slide is included in each test run to monitor
assay performance and to assess the accuracy of signal enumeration. Control slides should be
run for each staining batch on the Leica BOND-MAX and BOND-III System and with each new
reagent lot. In addition, individual users may choose to use their own control material.
Assess control slide quality and perform signal enumeration according to the instructions in the
Signal Assessment and Enumeration section. The criteria for slide quality must be satisfied
and the HER2:CEP17 ratio results should be within the established ranges for acceptable test
performance. See Table 3 for acceptance criteria of the Leica HER2 FISH Control Slides.
Leica HER2 FISH System - 30 Test
HER2:CEP17 Acceptance Criteria
Cell Line
Bond Oracle
HER2 IHC
HER2
ReceptorLoad
System Profile per cell*
3+
2+
4.3 x 105
HER2 amplification is observed
SKBr-3
HER2/CEP17 gene ratio should be between
1.5 – 2.5
1.4 x 105
MDA-MB-453
1+
0
6.3 x 104
9.3 x 103
HER2 amplification is not observed
HER2 amplification is not observed
MDA-MB-175
MDA-MB-231
*HER2 receptor load analysis as assessed by flow cytometry
Table 3: Leica HER2 FISH Control Slide Interpretation.
If assay controls fail, FISH results for that case should not be reported. If control slides fail to
meet the slide acceptance criteria, the Leica HER2 FISH System - 30 Test may have performed
inadequately. In this instance, a repeat test with fresh control slides and patient specimen
slide(s) will be required. If the results are outside of the specified range, but the control slides
meet the acceptance criteria for quality, repeat screening of the same slide may be appropriate
since the enumeration may not have been performed correctly. Consult the troubleshooting
guide (Table 6) in the event of hybridization failure, with either the specimen or control slide(s).
For clinical specimens, when interpretation of the hybridization signal is difficult and there is
insufficient specimen sample for re-assay, the test is uninformative. If there are insufficient cells
for analysis, the test is uninformative.
Patient specimens should be controlled according to standard laboratory operating procedures.
Signal quality and enumeration results should be documented on an appropriate report form.
Limitations
A. General Limitations
FISH is a technique that requires specialized training in all aspects of the procedure (including
the selection of appropriate reagents, tissue, fixation, processing and slide preparation) and
interpretation. Tissue staining is dependent on the handling, fixation and processing of the
tissue prior to staining. Improper fixation, freezing, thawing, washing, drying, heating, sectioning
or contamination with other tissues or fluids may produce morphological artifacts, nucleic acid
degradation, background fluorescence or false negative results. Inconsistent results may be
due to variations in fixation, embedding methods, or inherent irregularities within the tissue
(21). Excessive or incomplete counterstaining may also compromise correct interpretation of
the results.
Non-specific staining as a result of unbound probe has a scattered, granular appearance
and may be visualized at or distant from the expected hybridization site. Use intact cells for
interpretation of staining results. Necrotic or degenerated cells may stain non-specifically (22).
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Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Unexpected FISH staining, or variations in the staining, may be a result of alterations in the
expression levels of the encoding genes. Any change in expected staining patterns should be
interpreted in association with all other diagnostic investigations. Staining interpretation should
be complemented by morphological studies and the use of suitable control material, and should
be evaluated within the context of the patient’s clinical history and any other diagnostic tests, by
a qualified pathologist.
The performance of the assay (i.e. assessment of adequacy of control materials) and the
interpretation of any staining or its absence must be carried out in an appropriately accredited/
licensed laboratory under the supervision of a suitably qualified and experienced pathologist,
who is responsible for the overall assessment of the in situ hybridization assay and its
interpretation. False positive results in FISH may be due to cross-reactivity of the probe to other
nucleic acid sequences and/or nonspecific binding. Appropriate controls must be employed and
documented, and tests should take into account all relevant expiration dates.
Technical and interpretational variation may also be seen when FISH is utilized on cell line
derived materials (23).
B. Product Specific Limitations
This product is not designed for use in any other DNA-based diagnostic assay.
Do not replace Leica HER2 FISH System - 30 Test reagents with any other components either
supplied by Leica Biosystems or by other manufacturers. To do so will invalidate the assay. The
user must validate any deviation from the recommended procedures.
It is recommended that tissues fixed only in formalin-based fixatives be used in the assay. The
use of any other type of fixative may invalidate the assay.
Tissue sections cut outside of the recommended thickness range have not been validated. The
use of any other section thickness may invalidate the assay.
Clinical Concordance of HER2 FISH System - 30 Test to Abbott
Molecular PathVysion HER-2 DNA Probe Kit
This study examined the suitability of the Leica HER2 FISH System - 30 Test for use as an aid
in determination of treatment for Herceptin (trastuzumab) therapy. The study was designed to
examine the concordance between the Leica HER2 FISH System - 30 Test and a previously
approved diagnostic device, theAbbott Molecular PathVysion HER-2 DNAProbe Kit, considered
as the ‘gold standard’ for this assay. The acceptance criterion for testing was that the lower limit
of the 95% one-sided confidence interval is above 90% between the Leica HER2 FISH System
- 30 Test and the manual Abbott Molecular PathVysion HER-2 DNA Probe Kit, between positive
(amplified) and negative (non-amplified) formalin-fixed, paraffin-embedded (FFPE) invasive
breast cancer cases.
The study was conducted as a three-site, masked evaluation of clinical invasive breast
carcinoma samples. Each of the investigational sites were supplied with archived formalin-fixed,
paraffin-embedded invasive breast carcinoma tissue blocks with known HER2 oncoprotein
expression levels. A cohort of 300 specimens consisting of 75, 0/1+ previously characterized
IHC cases; 150, 2+ previously characterised IHC cases; and 75, 3+ previously characterized
IHC cases were selected, and split equally across each of the three investigational trial sites.
All cases were stained with the manual Abbott Molecular PathVysion HER-2 DNA Probe Kit
Assay according to the manufacturer’s instructions for use, as specified in the package insert.
Sequential sections from each case were then stained with the Leica HER2 FISH System - 30
Test on the Leica BOND-MAX and BOND-III System.
All stained slides were masked and scored in a randomized fashion by a single trained
observer at each of the three investigational trial sites. Scores were interpreted as negative
with a calculated HER2/CEP17 gene ratio of <2.0 and positive with a calculated HER2/CEP17
gene ratio of ≥2.0. Data was then analyzed for concordance, positive staining agreement and
negative staining agreement.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 14 of 24
2x2 Concordance Results Leica BOND-MAX System
Data was grouped as negative (<2.00) or positive (≥2.00) for a 2x2 analysis The observed
agreement for 300 samples between the two tests in a 2x2 analysis show a concordance of
99.33% (298/300) with a 95% CI of 97.61–99.92% for the Leica BOND-MAX System
The percentage Positive Agreement (sensitivity) or the ability of the Leica HER2 FISH System
- 30 Test to correctly identify Abbott Molecular PathVysion HER-2 DNA Probe assay positive
cases (the percentage of specimens scored positive by both the Leica HER2 FISH System -
30 Test and manual Abbott Molecular PathVysion HER-2 DNA Probe Kit out of all the Abbott
Molecular PathVysion HER-2 DNA Probe Kit positive cases) was 99.03% (102/103).
The percentage Negative Agreement (specificity) or the ability of the test to correctly identify
Abbott Molecular PathVysion HER-2 DNA Probe Kit negative cases (the percentage of
specimens scored negative by the Leica HER2 FISH System - 30 Test and Abbott Molecular
PathVysionHER-2 DNA Probe Kit out of all the Abbott Molecular PathVysion HER-2 DNA Probe
Kit negative cases) was 99.49% (196/197). See Table 4.
Abbott Molecular PathVysion HER-2 DNA Probe Kit
Negative (<2.0)
Positive (≥2.0)
Totals
197
Leica HER2 FISH
System - 30 Test
Leica BOND-MAX
196
1
1
Negative (<2.0)
Positive (≥2.0)
Totals
102
103
103
197
300
Overall Concordance (95% CI) = 99.33% (97.61 – 99.92%)
Table 4. 2x2 concordance of Leica HER2 FISH System - 30 Test on the Leica BOND-MAX System with Abbott Molecular
PathVysion HER-2 DNA Probe Kit.
Page 15 of 24
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
2x2 Concordance Results Leica BOND-III System
Data was grouped as negative (<2.00) or positive (≥2.00) for a 2x2 analysis The observed
agreement for 300 samples between the two tests in a 2x2 analysis show a concordance of
99.67% (299/300) with a 95% CI of 98.16–99.99% for the Leica BOND-III System.
The percentage Positive Agreement (sensitivity) or the ability of the Leica HER2 FISH System
- 30 Test to correctly identify Abbott Molecular PathVysion HER-2 DNA Probe Kit assay positive
cases (the percentage of specimens scored positive by both the Leica HER2 FISH System -
30 Test and manual Abbott Molecular PathVysion HER-2 DNA Probe Kit out of all the Abbott
Molecular PathVysion HER-2 DNA Probe Kit positive cases) was 99.03% (102/103).
The percentage Negative Agreement (specificity) or the ability of the test to correctly identify
Abbott Molecular PathVysion HER-2 DNA Probe Kit negative cases (the percentage of
specimens scored negative by the Leica HER2 FISH System - 30 Test and Abbott Molecular
PathVysion HER-2 DNA Probe Kit out of all the Abbott Molecular PathVysion HER-2 DNA Probe
Kit negative cases) was 100% (197/197). See Table 5.
Abbott Molecular PathVysion HER-2 DNA Probe Kit
Negative (<2.0)
Positive (≥2.0)
Totals
Leica HER2 FISH
System - 30 Test
Leica BOND-III
197
1
198
Negative (<2.0)
Positive (≥2.0)
Totals
0
102
103
102
300
197
Overall Concordance (95% CI) = 99.67% (98.16 – 99.99%).
Table 5. 2x2 concordance of Leica HER2 FISH System - 30 Test on the Leica BOND-III System with Abbott Molecular
PathVysion HER-2 DNA Probe Kit.
In conclusion, the data generated in this study demonstrates that the Leica HER2 FISH System
- 30 Test can be used as an aid in the assessment of patients for whom Herceptin (trastuzumab)
treatment is being considered, based upon its high concordance with Abbott Molecular
PathVysion HER-2 DNA Probe Kit, a previously approved diagnostic test for this indication.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 16 of 24
Precision Testing – Leica BOND-MAX System
A. Within Run Precision Study
The within run precision study was performed in a randomized and blinded fashion. Within
run precision testing of the Leica HER2 FISH System - 30 Test was evaluated at a single
investigational site on 540 previously HER2 characterized TMA samples containing formalin-
fixed paraffin-embedded breast cancer cases. The use of TMAs for the determination of
within run precision enabled a larger volume of cases covering a wider range of HER2
expression within a single run on a single instrument.
On enumeration of the slides stained in the Within Run Precision Study, 532/540 cases
evaluated demonstrated a concordant result giving an overall concordance of 98.52% with
a lower 95% CI of 97.10%.
B. Within Instrument Precision Study
The within instrument precision study was performed in a randomized and blinded fashion.
Within instrument precision testing of the Leica HER2 FISH System - 30 Test was evaluated
at a single investigational site on 1620 previously HER2 characterized TMA samples
containing formalin-fixed paraffin-embedded breast cancer cases. The use of TMAs for the
determination of within instrument precision enabled a larger volume of cases covering a
wider range of HER2 expression within multiple runs on a single instrument.
On enumeration of the slides stained in the Within Instrument Precision Study, 1620/1620
cases evaluated demonstrated a concordant result giving an overall concordance of 100%
with a lower 95% CI of 99.82%.
C. Between Run Precision Study
The between run precision study was performed in a randomized and blinded fashion.
Between run precision testing of the Leica HER2 FISH System - 30 Test was evaluated
at a single investigational site on 900 previously HER2 characterized TMA samples
containing formalin -fixed paraffin-embedded breast cancer cases. The use of TMAs for the
determination of between run, day-to-day precision testing enabled a larger volume of cases
covering a wider range of HER2 expression to be tested between runs on different days.
On enumeration of the slides stained in the Between Run Precision Study, 894/900 cases
evaluated demonstrated a concordant result giving an overall concordance of 99.33% with
a lower 95% CI of 98.55%.
D. Between Laboratory Precision Study
The between laboratory precision study was performed in a randomized and blinded
fashion. Between laboratory precision testing of the Leica HER2 FISH System - 30 Test
was evaluated between three investigational sites on 513 previously HER2 characterized
TMA samples containing formalin-fixed paraffin-embedded breast cancer cases. The use of
TMAs for the determination of between laboratory precision testing enabled a larger volume
of cases covering a wider range of HER2 expression to be tested between runs on multiple
instruments.
On enumeration of the slides stained in the Between Laboratory Precision Study, 510/513
cases evaluated demonstrated a concordant result giving an overall concordance of 99.42%
with a lower 95% CI of 98.30%.
E. Between Observer Precision Study
The between observer precision study was performed in a randomized and blinded fashion.
Between observer reproducibility testing of the Leica HER2 FISH System - 30 Test was
evaluated between three investigational sites. A single experienced observer at each
investigational site was used. Eighteen whole section breast cancer cases were used for
between observer precision, reflecting samples types used in the clinical setting.
On enumeration of the slides stained in the Between Observer Precision Study, 53/54 cases
evaluated demonstrated a concordant result giving an overall concordance of 98.15% with
a lower 95% CI of 90.11%
Page 17 of 24
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
F. Lot-to-Lot Precision Study
The lot-to-lot precision study was performed in a randomized and blinded fashion. Lot-to-Lot
precision was determined on three independently manufactured lots of the Leica HER2 FISH
System - 30 Test, manufactured under Good Manufacturing Practice (GMP). Each lot was
tested at a single investigational site on 540 previously HER2 characterized TMA samples
containing formalin-fixed paraffin-embedded breast cancer cases. The use of TMAs for the
determination of lot-to-lot reproducibility enables a larger volume of cases covering a wider
range of HER2 expression to be tested between lots.
On enumeration of the slides stained in the Lot-to-Lot Precision Study, 534/540 cases
evaluated demonstrated a concordant result giving an overall concordance of 98.89% with
a lower 95% CI of 97.60%.
Precision Testing – Leica BOND-III System
G. Within Run Precision Study
The within run precision study was performed in a randomized and blinded fashion. Within
run precision testing of the Leica HER2 FISH System - 30 Test was evaluated at a single
investigational site on 540 previously HER2 characterized TMA samples containing formalin-
fixed paraffin-embedded breast cancer cases. The use of TMAs for the determination of
within run precision enabled a larger volume of cases covering a wider range of HER2
expression within a single run on a single instrument.
On enumeration of the slides stained in the Within Run Precision Study, 540/540 cases
evaluated demonstrated a concordant result giving an overall concordance of 100% with a
lower 95% CI of 99.45%.
H. Within Instrument Precision Study
The within instrument precision study was performed in a randomized and blinded fashion.
Within instrument precision testing of the Leica HER2 FISH System - 30 Test was evaluated
at a single investigational site on 1620 previously HER2 characterized TMA samples
containing formalin-fixed paraffin-embedded breast cancer cases. The use of TMAs for the
determination of within instrument precision enabled a larger volume of cases covering a
wider range of HER2 expression within multiple runs on a single instrument.
On enumeration of the slides stained in the Within Run Precision Study, 1620/1620 cases
evaluated demonstrated a concordant result giving an overall concordance of 100% with a
lower 95% CI of 99.82%.
I. Between Run Precision Study
The between run precision study was performed in a randomized and blinded fashion.
Between run precision testing of the Leica HER2 FISH System - 30 Test was evaluated
at a single investigational site on 900 previously HER2 characterized TMA samples
containing formalin-fixed paraffin-embedded breast cancer cases. The use of TMAs for the
determination of between run, day-to day precision testing enabled a larger volume of cases
covering a wider range of HER2 expression to be tested between runs on different days.
On enumeration of the slides stained in the Between Run Precision Study, 891/900 cases
evaluated demonstrated a concordant result giving an overall concordance of 99.00% with
a lower 95% CI of 98.11%.
J. Between Laboratory Precision Study
The between laboratory precision study was performed in a randomized and blinded
fashion. Between laboratory precision testing of the Leica HER2 FISH System - 30 Test
was evaluated between three investigational sites on 513 previously HER2 characterized
TMA samples containing formalin-fixed paraffin-embedded breast cancer cases. The use of
TMAs for the determination of between laboratory precision testing enabled a larger volume
of cases covering a wider range of HER2 expression to be tested between runs on multiple
instruments.
On enumeration of the slides stained in the Between Laboratory Precision Study, 511/513
cases evaluated demonstrated a concordant result giving an overall concordance of 99.61%
with a lower 95% CI of 98.60%.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 18 of 24
K. Between Observer Precision Study
The between observer precision study was performed in a randomized and blinded fashion.
Between observer reproducibility testing of the Leica HER2 FISH System - 30 Test was
evaluated between three investigational sites. A single experienced observer at each
investigational site was used. Eighteen whole section breast cancer cases were used for
between observer precision, reflecting samples types used in the clinical setting.
On enumeration of the slides stained in the Between Observer Precision Study, 53/54 cases
evaluated demonstrated a concordant result giving an overall concordance of 98.15% with
a lower 95% CI of 90.11%.
L. Lot-to-Lot Precision Study
The lot-to-lot precision study was performed in a randomized and blinded fashion. Lot-to-Lot
precision was determined on three independently manufactured lots of Leica HER2 FISH
System - 30 Test, manufactured under Good Manufacturing Practice (GMP). Each lot was
tested at a single investigational site on 540 previously HER2 characterized TMA samples
containing formalin-fixed paraffin-embedded breast cancer cases. The use of TMAs for the
determination of lot-to-lot reproducibility enables a larger volume of cases covering a wider
range of HER2 expression to be tested between lots.
On enumeration of the slides stained in the Lot-to-Lot Precision Study, 540/540 cases
evaluated demonstrated a concordant result giving an overall concordance of 100% with a
lower 95% CI of 99.45%.
Assay Robustness
Robustness studies were performed on the Leica BOND-MAX and BOND-III System to determine
the assay tolerance range for heat retrieval time and temperature; enzyme retrieval
time, temperature and concentration; denaturation time and temperature; hybridization time and
temperature; and stringency wash time and temperature. Robustness studies using the default
Leica BOND-MAX and BOND-III System protocol were also performed outside the
recommended limits as defined in the FDA/ORA guidance document ORA LAB5.3 Rev1.7 for
temperature and humidity.
• No difference in amplification status was observed when the default temperature for each
heat dependent step was raised by 4 °C or decreased by 4 °C, when compared to the default
LeicaHER2FISHSystem-30Testprotocol.Highestqualityratingswereobservedatthedefault
temperatures and these temperatures are recommended.
• No difference in amplification status was observed when the heat induced epitope retrieval
(HIER) time was performed for 20 minutes and 30 minutes at 97 °C with Leica BOND ER1
solution, when compared to the default Leica HER2 FISH System - 30 Test protocol. Highest
quality ratings were observed at the default time of 25 minutes and this incubation time is
recommended.
• No difference in amplification status was observed when the enzyme induced epitope retrieval
(EIER) time was performed for 15 minutes and 35 minutes at 37 °C, when compared to the
default Leica HER2 FISH System - 30 Test protocol. Highest quality ratings were observed at
the default time of 25 minutes and this incubation time is recommended.
• No difference in amplification status was observed when the enzyme induced epitope retrieval
(EIER) enzyme concentration was performed with enzyme concentrate/enzyme diluent
ratios of 1:200 and 1:500 using the default Leica HER2 FISH System - 30 Test protocol.
Highest quality ratings were observed at the default concentration of 1:300 and this dilution
is recommended.
• No difference in amplification status was observed when the denaturation time was performed
for 5 minutes and 15 minutes, when compared to the default Leica HER2 FISH System - 30
Test protocol. Highest quality ratings were observed at the default time of 10 minutes and this
Page 19 of 24
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
denaturation time is recommended.
• No difference in amplification status was observed when the hybridization time was performed
for 9 hours and 15 hours when compared to the default Leica HER2 FISH System - 30
Test protocol. Highest quality ratings were observed at the default time of 12 hours and this
hybridization time is recommended.
• No difference in amplification status was observed when the post hybridization wash time
was performed for 2 minutes, 5 minutes, and 7 minutes, when compared to the default Leica
HER2 FISH System - 30 Test protocol. Highest quality ratings were observed at the default
time of 4 minutes and this post hybridization wash time is recommended.
• No difference in amplification status was observed when the Leica HER2 FISH System - 30
Test was performed at 28 °C and 30% relative humidity and 16 °C and 80% relative humidity,
when compared to the default Leica HER2 FISH System - 30 Test protocol performed at
ambient conditions.
Operations performed outside of the tested assay robustness recommended parameters have
not been validated. The use of any other testing parameter may invalidate the assay.
The above text describes the conditions tested and the results from the study. Note that Leica
did not test all possible combinations of conditions and does not recommend using non-default
ranges for all conditions. The default Leica HER2 FISH Staining Protocol is outlined in Table 2.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 20 of 24
Troubleshooting
Problem
Probable Cause
Remedial Action
No or weak
fluorescent
signal/staining
Inappropriate fixation or
processing of test specimen
Ensure a formalin-based fixative is used and
that processing schedules are suitable for
the specimen undergoing testing.
Leica HER2 FISH System - 30
Test is being used outside its
expiry date
Ensure the Leica HER2 FISH System - 30
Test used is within its specified expiry date.
Incorrect protocol selection
Ensureappropriatedefaultto*FISHProtocol
AinthestainingprotocolfieldoftheAddslide
dialog.
Inappropriate bulk reagents
dispensed
Ensure all Leica BOND reagents have been
allocated to appropriate bulk containers
andplacedintoappropriatepositionsonthe
instrument.
Inadequate deparaffinization
of slides
Ensure *Dewax mode is selected in the
Preparation field of the Add slide dialog.
Inappropriate pretreatment
Ensure default pretreatment (HIER and
EnzymaticDigestion)protocolsareselected.
Adjust pretreatment protocol (HIER or
Enzymatic Digestion) if required.
Inadequate denaturation
Inadequate hybridization
Ensureappropriatedefaultdenaturation*D10is
selected.
Ensureappropriatedefaulthybridization*H12is
selected.Extendhybridizationtimeifrequired.
Excess post hybridization
washing
Decreaseposthybridizationwashincubation
time.
Run aborted prior to
completion
Using Leica BOND software, confirm the
presence of any reportable errors during the
staining run and address as instructed by
the Leica BOND software.
Inappropriate fluorescence
microscopy equipment
Ensure that all fluorescence microscopy
equipment used is appropriate for the assay
being performed, confirm:
•
•
•
•
Inappropriate filter set
Incorrect lamp
•
•
•
•
Appropriate filter set
Appropriate lamp
Expired lamp
Good lamp strength
Incorrect oil type
Appropriate oil for use in oil immersion
microscopy
Over exposure to UV light
(photobleaching)
Store slides before and after assessment in
the dark to preserve fluorescent signals. To
maintain signal for long term storage store
slides at –20 ºC.
Page 21 of 24
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Problem
Probable Cause
Remedial Action
Nonspecific
background
fluorescent
Inadequateposthybridization
washing
Increaseposthybridizationwashincubation
time.
signal/staining
Inappropriate bulk reagents
dispensed
Ensure all Leica BOND reagents have been
allocated into appropriate bulk containers
andplacedintoappropriatepositionsonthe
instrument.
Inadequate deparaffinization
of slides
Ensure Dewax is selected in the Preparation
field of the Add slide dialog.
Nonspecific cross-reaction
with areas of tissue necrosis
Ensure a formalin-based fixative is used
and that processing schedules are suitable
for the specimen undergoing testing. If
possible, retest case using another block.
If this is not possible, assess in conjunction
with a corresponding H&E stained section,
and select areas which show best fixation
patterns.
Sections adhered to slides
using alternative adhesives
Use Leica BOND Plus Slides (S21.2113).
Poorpreservation
of tissue
morphology
Inadequate tissue fixation and
processing
Ensure a formalin-based fixative is used
and that processing schedules are suitable
for the specimen undergoing testing. If
possible, retest case using another block.
If this is not possible, assess in conjunction
with a corresponding H&E stained section,
and select areas which show best fixation
patterns.
Inappropriate pretreatment
Adjust pretreatment protocol (HIER or
Enzymatic Digestion).
Tissue detached
from patient/
control slide(s)
Use of incorrect type of slides
or inadequate draining of
section
Ensureappropriateslidesareusedforpatient/
control sections (e.g. Leica BOND Plus Slides
S21.2113). Ensure slides receive adequate
drainingandareincubatedfor1hourat60°C.
Table 6. Leica HER2 FISH System - 30 Test Troubleshooting Guide.
If any problems associated with the Leica HER2 FISH System - 30 Test fall outside the scope
of the troubleshooting guide please contact your local Leica Biosystems Technical Services
Department or Distributor for assistance.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 22 of 24
References
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related protein. Nature 1986;319:226–30.
2. Lonardo F, Di Marco E, King CR, Pierce JH, Segatto O, Aaronson SA, et al. The normal erbB-
2 product is an atypical receptor-like tyrosine kinase with constitutive activity in the absence of
ligand. New Biologist 1990; 2: 992–1003.
3. Wolff A.C., Hammond E.H., Schwartz J.N., et al. American Society of Clinical Oncology/College of
American Pathologists Guideline recommendations for human epidermal growth factor receptor 2
testing in breast cancer. Journal of Clinical Oncology 25, 1-28, 2007.Slamon DJ, Clark GM,
4. Wong SG, et al. Human breast cancer: correlation of relapse and survival with amplification of the
HER-2/neu oncogene. Science 1987;235:177-182.
5. Gusterson BA, Gelber RD, Goldhirsch A, et al. Prognostic importance of c-erbB-2 expression in
breast cancer. Journal of Clinical Oncology 1992;10:7:1049-1056.
6. Gullick WJ, Love SB, Wright C, et al. c-erbB-2 protein overexpression in breast cancer is a risk
factor in patients with involved and uninvolved lymph nodes. British Journal of Cancer 1991;63:434-
438.
7. Borg A, Tandon AK, Sigurdsson H, et al. HER-2/neu amplification predicts poor survival in node-
positive breast cancer. Cancer Research 1990;50:4332-4337.
8. Tandon AK, Clark GM, Chamness AU, et al. HER-2/neu oncogene protein and prognosis in breast
cancer. Journal of Clinical Oncology 1989; 7:1120-1128.
9. Carter P, Presta L, Gorman CM, Ridgway JBB, Henner D, Wong WLT, et al. Humanization of an
anti-p185HER2 antibody for human cancer therapy. Proceedings of the National Academy of Science
USA 1992; 89: 4285–9.
10.Hudziak RM, Lewis GD, Winget M, Fendly BM, Shepard HM, Ullrich A. p185HER2 monoclonal
antibody has antiproliferative effects in vitro and sensitizes human breast tumor cells to tumor
necrosis factor. Molecular & Cell Biology 1989; 9: 1165–72.
11.Lewis GD, Figari I, Fendly B, Wong WL, Carter P, Gorman C, et al. Differential responses of human
tumor cell lines to anti-p185HER2 monoclonal antibodies. Cancer Immunology and Immunotherapy
1993; 37: 255–63.
12.Baselga J, Norton L, Albanell J, Kim Y-M, Mendelsohn J. Recombinant humanized anti-HER2
antibody (Herceptin) enhances the antitumor activity of paclitaxel and doxorubicin against HER2/
neu overexpressing human breast cancer xenografts. Cancer Research 1998; 58: 2825–31.
13.Ellis I.O., Bartlett J., Dowsett M., Humphreys S., Jasani B., Miller K., Pinder S.E., Rhodes A. and
Walker R. Best practise No. 176: Updated recommendations for Her-2 testing in the UK. Journal of
Clinical Pathology 57; 233-237, 2004.
14.Walker R.A, Bartlett, J., Dowsett, M., Ellis, I., Hanby, A., Jasani, Miller, K., Pinder, S. HER2 Testing
in the UK – further update to recommendations. Journal of Clinical Pathology 2007.054866
15.Press MF, Zhou JY, Ma Y, et al. Evaluation of HER-2/neu gene amplification by fluorescence in
situ hybridization in invasive breast carcinoma. In: FISH: Clinical Applications in Cancer and Genetics
February 8-11, 1994; Lake Tahoe, CA.
16.Pauletti G, Singh R, Press MF, et al. HER-2/neu gene amplification detected by fluorescence in situ
hybridization:Acomparative study with other techniques.Abstract 3247, Proceedings of the American
Association for Cancer Research 1994 35:545.
17.Szöllösi J, Balázs M, Feuerstein BG, et al. Phenotype genotype relationship in erbB-2 amplification.
International Society for Analytical Cytology 1994 Abstracts. 92. Abstract 536D.
18.Kallioniemi O, Kallioniemi A, Kurisu W, et al. ERBB2 amplification in breast cancer analyzed by
fluorescence in situ hybridization. Proceedings of the National Academy of Sciences 1992;89:5321-
5325.
19.The National Committee for Clinical Laboratory Standards (NCCLS). Quality assurance for
immunocytochemistry; Approved guideline. NCCLS document MM4-A (1-56238-396-5) NCCLS,
940 West Valley Road, Suite 1400, Wayne, Pennsylvania 1999; 19087–1898: USA
20.Elias JM, Gown AM, Nakamura RM, Wilbur DC, Herman GE, Jaffe ES, et al. Special Report:
Quality control in immunohistochemistry. American Journal of Clinical Pathology 1989 ;92: 836–43.
21.Nadji, M. and Morales, A. R. Immunoperoxidase, part I: the techniques and its pitfalls. Laboratory
Medicine 1983; 14: 767.
22.Jackson P. 2007. Quality Assurance in Immunohistochemistry. In: Immunohistochemistry, 2007 (ed.
Renshaw S), PP 205–237. Scion Publishing Ltd.
23.Bartlet JMS, Ibrahim M, et al External Quality Assurance of HER2 FISH Testing: Results of a UK
NEQAS Pilot Scheme. Journal of Clinical Pathology. 2006.
Page 23 of 24
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
License Agreement
This product contains PathVysion FISH probes supplied by Abbott Molecular Inc.
PathVysion, LSI and CEP are a trademark of Abbott Molecular Inc. All Rights Reserved. Used
under License.
Amendments to Previous Issue
Product name, Sponsor information, Summary and Explanation, Procedure.
Date of Issue
08 April 2013
Symbol Identification
LOT
REF
Batch Code
Storage
Catalog number
Serial Number
In vitro diagnostic
medical device
IVD
SN
Manufacturer
Consult
Contains
instructions for
use
sufficient for <n>
tests
Use by YYYY-MM-DD
Herceptin is a trademark of Genentech, Inc. and F. Hoffmann-La Roche Ltd.
Leica Biosystems Leica HER2 FISH System - 30 Test Instructions for Use TA9217 EN-CE-Rev_D 08/04/2013
Page 24 of 24
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