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July 21, 2004

HER-2 and Fluorescent In Situ Hybridization to Evaluate Breast Cancer

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292(3):328. doi:10.1001/jama.292.3.328-a

To the Editor: Dr Yaziji and colleagues1 compared immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) tests for overexpression of human epidermal growth factor receptor-2 (HER-2). Based on the inconvenience and higher cost of FISH, they concluded that HER-2 determination was most "efficient" by using IHC, with FISH performed for tumors with an IHC score of 2+. FISH was not recommended in tumors with an IHC score of 3+. Although I agree that FISH should be performed if the IHC score is 2+, the omission of confirmatory FISH when the IHC score is 3+ could lead to several adverse financial and ethical consequences.