To the manufacturer’s protocol with minor modifications. For all probes, sequential digital images were captured by a stack motor (5 planes at 1.0 mm for each probe) using the Plan Apo VC 1006/1.40 oil objective (Nikon, Japan) using specific filters and the resulting images were reconstructed with the appropriate pseudo-colors using the XCyto-Gen software (ALPHELYS, Plaisir, France). For HER2/CEP17 status a minimum of 20 tumor cells were counted, whereas for the ESR1/CEP6 status, 40 to 60 cells 23 [16]. The HER2 gene was considered to be amplified when the ratio of the respective gene probe/centromere probe was .2.2 or the HER2 copy number was 15481974 .6 [17]. The cases were scored as ESR1 deleted when the ratio gene/CEP was ,0.8, normal between 0.8?1.0, gene gain .1.0?2.0, and amplified if the ratio was 2.0 or the gene copy number .6 [6,7,18,19]. ESR1 gene enumeration was performed using counting guides for other genes (HER2, TOP2A) with minor changes, as well as the probe manufacturer’s recommendations. The size of the ESR1 signals of the surroundingESR1 Gene Amplification in Early Breast CancerResults Patient and Tumor DemographicsA total of 1010 women with resected early breast adenocarcinoma, mostly .T1 (68.7 ), node-positive (99.6 , N2 in 60 ) and ER-positive (77 ) were managed with anthracycline and taxane-based chemotherapy (84.2 ) and hormonal therapy (78.3 ). Only 159 patients (15.9 ) did not receive paclitaxel. Basic patient and tumor characteristics are summarized in Table 1. There were no significant differences between patient and tumor characteristics of the two trials with those of our study cohort. At a median follow-up of 105.5 months, 303 (30 ) experienced tumor relapse and 262 (25.9 ) had died. The 5-year DFS and OS rates were 73.6 (70.9?6.3) and 86.5 (84.3?8.6) respectively. No statistically significant DFS or OS survival difference was seen between E-T-CMF, E-CMF, ET-CMF in the HeCOG trials (data published) nor in our patient cohort under study (data not shown) [12,13].Figure 2. Title Loaded From File Fluorescence in situ hybridization (FISH) in invasive breast carcinomas (IBC) using the ESR1/CEP6 dual color probe. ESR1 gene (green signals) in an IBC case with normal gene status is presented (A), IBC cases with gain of ESR1 gene (B ) and in the last panel (D), case with high amplification of ESR1 gene, accompanied by gain of CEP6. Magnification 61000. CEP6, centromere 6 enumeration probe. doi:10.1371/journal.pone.0070634.gTable 1. Patient and Tumor Demographics.Patient and Tumor DemographicsN = 1010 52.5 (22.4?9.3) N ( )normal cells was used to decide whether the ESR1 signal size was enlarged. In clusters, the number of ESR1 signals was estimated based on the diameter of the gene signal found in normal breast epithelium (Figure 2). The observers performed FISH analyses blinded to the results of the IHC and PCR assays.Median age (range)Randomization group E-T-CMF E-CMF ET-CMF Menopausal status Premenopausal Postmenopausal Tumor size (cm) #2 2? .5 Number of positive axillary lymph nodes 0?/ 4 Tumor grade I I/III V Histology classification Invasive ductal Invasive lobular Mixed Other Estrogen Receptor Status Negative/Positive HER2 IHC3+ and/or FISH+ Ki67 (n = 987) Low (,14 ) High (.14 ) Hormonal therapy Nder extreme acidic conditions (pH 4.0) all enzymes experienced a significant loss Tamoxifen/Aromatase inhibitors doi:10.1371/journal.pone.0070634.t001 312 (31.6) 675 (68.4) 791 (78.3) 696 (68.9)/153 (15.1) 227 (22.5)/778 (77.0) 247 (24.5) 788 (78.0) 100 (9.9) 73 (7.2) 49 (4.9) 499 (49.4)/511 (50.6) 400 (39.6)/610 (60.4) 316.To the manufacturer’s protocol with minor modifications. For all probes, sequential digital images were captured by a stack motor (5 planes at 1.0 mm for each probe) using the Plan Apo VC 1006/1.40 oil objective (Nikon, Japan) using specific filters and the resulting images were reconstructed with the appropriate pseudo-colors using the XCyto-Gen software (ALPHELYS, Plaisir, France). For HER2/CEP17 status a minimum of 20 tumor cells were counted, whereas for the ESR1/CEP6 status, 40 to 60 cells 23 [16]. The HER2 gene was considered to be amplified when the ratio of the respective gene probe/centromere probe was .2.2 or the HER2 copy number was 15481974 .6 [17]. The cases were scored as ESR1 deleted when the ratio gene/CEP was ,0.8, normal between 0.8?1.0, gene gain .1.0?2.0, and amplified if the ratio was 2.0 or the gene copy number .6 [6,7,18,19]. ESR1 gene enumeration was performed using counting guides for other genes (HER2, TOP2A) with minor changes, as well as the probe manufacturer’s recommendations. The size of the ESR1 signals of the surroundingESR1 Gene Amplification in Early Breast CancerResults Patient and Tumor DemographicsA total of 1010 women with resected early breast adenocarcinoma, mostly .T1 (68.7 ), node-positive (99.6 , N2 in 60 ) and ER-positive (77 ) were managed with anthracycline and taxane-based chemotherapy (84.2 ) and hormonal therapy (78.3 ). Only 159 patients (15.9 ) did not receive paclitaxel. Basic patient and tumor characteristics are summarized in Table 1. There were no significant differences between patient and tumor characteristics of the two trials with those of our study cohort. At a median follow-up of 105.5 months, 303 (30 ) experienced tumor relapse and 262 (25.9 ) had died. The 5-year DFS and OS rates were 73.6 (70.9?6.3) and 86.5 (84.3?8.6) respectively. No statistically significant DFS or OS survival difference was seen between E-T-CMF, E-CMF, ET-CMF in the HeCOG trials (data published) nor in our patient cohort under study (data not shown) [12,13].Figure 2. Fluorescence in situ hybridization (FISH) in invasive breast carcinomas (IBC) using the ESR1/CEP6 dual color probe. ESR1 gene (green signals) in an IBC case with normal gene status is presented (A), IBC cases with gain of ESR1 gene (B ) and in the last panel (D), case with high amplification of ESR1 gene, accompanied by gain of CEP6. Magnification 61000. CEP6, centromere 6 enumeration probe. doi:10.1371/journal.pone.0070634.gTable 1. Patient and Tumor Demographics.Patient and Tumor DemographicsN = 1010 52.5 (22.4?9.3) N ( )normal cells was used to decide whether the ESR1 signal size was enlarged. In clusters, the number of ESR1 signals was estimated based on the diameter of the gene signal found in normal breast epithelium (Figure 2). The observers performed FISH analyses blinded to the results of the IHC and PCR assays.Median age (range)Randomization group E-T-CMF E-CMF ET-CMF Menopausal status Premenopausal Postmenopausal Tumor size (cm) #2 2? .5 Number of positive axillary lymph nodes 0?/ 4 Tumor grade I I/III V Histology classification Invasive ductal Invasive lobular Mixed Other Estrogen Receptor Status Negative/Positive HER2 IHC3+ and/or FISH+ Ki67 (n = 987) Low (,14 ) High (.14 ) Hormonal therapy Tamoxifen/Aromatase inhibitors doi:10.1371/journal.pone.0070634.t001 312 (31.6) 675 (68.4) 791 (78.3) 696 (68.9)/153 (15.1) 227 (22.5)/778 (77.0) 247 (24.5) 788 (78.0) 100 (9.9) 73 (7.2) 49 (4.9) 499 (49.4)/511 (50.6) 400 (39.6)/610 (60.4) 316.
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