Compared to traditional immunohistochemistry (IHC) and protein staining techniques, many pathologists prefer bright-field chromogenic or silver-enhanced in situ hybridization (ISH) staining more than fluorescence ISH, because it provides more stable results that can be reviewed over time without fears of degradation.

In a recent webinar hosted by Roche Diagnostics Asia Pacific, two Australian pathologists discussed the latest ISH assays for HER2 testing and the role of image analysis algorithms in scoring them.

Why dual ISH for HER2 testing?

In Australia, Prof Nirmala Pathmanathan, an anatomical pathologist at Douglas Hanly Moir, says that a lot of pathologists still use HER2 fluorescence ISH (HER2 FISH), but she prefers HER2 dual ISH (HER2 DISH) because it’s easier to use and does not require any special equipment.

In her lab, less than 1% of cases are sent for HER2 FISH testing; a HER2 DISH approach is much preferred. Her team avoids IHC because its lab-to-lab variability is too high. ISH methods, on the other hand, have significantly higher concordance, she says.

How might automated biomarker scoring impact my role as pathologist?

While some pathologists may worry that an automated scoring approach could threaten their roles or jobs, or somehow remove their expertise from the analysis, those who have used automated scoring or seen it in action say that it actually enhances what the pathologist can do.

“It gives you that additional layer of confidence to identify those small areas of heterogeneity,” says Prof Pathmanathan. “It really does seem to make things a lot easier.”

Automated scoring does not change the rest of the workflow, points out Dr Cameron Snell, an anatomical pathologist at Mater Pathology in Australia. He thinks of the approach as “computer-assisted scoring,” but notes that the onus is still on the pathologist to confirm results.

Dr Snell’s lab has been evaluating automated scoring, and has now compared it to traditional methods for nearly 100 cases. So far, concordance has been excellent.

“It’s a real time saver,” he says. “[Image analysis] algorithms give very useful information to guide treatment decisions more accurately.”

To discuss these trends further or access the full webinar, please contact Dr Richie Jara-Lazaro, Regional Pathologist in the Medical & Scientific Affairs division at Roche Diagnostics Asia Pacific, at [email protected].