PMID- 24614047
OWN - NLM
STAT- MEDLINE
DCOM- 20141030
LR  - 20211021
IS  - 1540-1413 (Electronic)
IS  - 1540-1405 (Print)
IS  - 1540-1405 (Linking)
VI  - 12 Suppl 1
IP  - 0 1
DP  - 2014 Feb
TI  - Optimizing the quality of breast cancer biomarker use at Duke Cancer Institute.
PG  - S21-4
AB  - Advances in identifying biomarker profiles in patients with early-stage breast 
      cancer have improved 5-year curative rates. Identification of the HER2 receptor 
      provides valuable information that has been shown to extend survival in adjuvant 
      and metastatic settings. Current clinical guidelines discuss when confirmatory 
      testing may be inappropriate. Using a quality improvement approach, the team at 
      Duke Cancer Institute determined HER2 ordering practices in a large academic 
      cancer center. HER2 ordering using immunohistochemistry (IHC) and fluorescence in 
      situ hybridization (FISH) was abstracted from the charts of 314 patients with 
      early-stage breast cancer. Qualitative responses to current clinical practices 
      were obtained from clinicians. Of the patients included, duplicate IHC was 
      performed for 36% and in triplicate for 6%; repeat testing resulted in clinically 
      significant change in HER2 status for approximately 20%. Repeat biomarker testing 
      on metastatic biopsy sites "all of the time" was favored by the surveyed 
      physicians. FISH was ordered for each grade of IHC: 0+ (>20% of cases), 1+ 
      (>20%), 2+ (99%), 3+ (54%). Most physicians "strongly" or "somewhat" favored 
      solutions that integrate order sets and care pathways into the electronic medical 
      record. This quality improvement project identified root causes and solutions to 
      practice variance in breast cancer biomarker ordering and interpretation. Further 
      investigations are planned to standardize best practices while appreciating the 
      clinical challenges posed by discordant test results.
FAU - Kamal, Arif H
AU  - Kamal AH
AD  - From Duke Cancer Institute, Duke University Medical Center, Durham, North 
      Carolina.
FAU - Power, Steve
AU  - Power S
FAU - Broadwater, Gloria
AU  - Broadwater G
FAU - Holland, Audrey R
AU  - Holland AR
FAU - Marcom, Paul K
AU  - Marcom PK
LA  - eng
GR  - P30 CA014236/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Natl Compr Canc Netw
JT  - Journal of the National Comprehensive Cancer Network : JNCCN
JID - 101162515
RN  - 0 (Biomarkers, Tumor)
RN  - EC 2.7.10.1 (Receptor, ErbB-2)
SB  - IM
MH  - Academic Medical Centers
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Biomarkers, Tumor/genetics/metabolism
MH  - Breast Neoplasms/*diagnosis
MH  - Cancer Care Facilities
MH  - Female
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - North Carolina
MH  - *Quality Assurance, Health Care
MH  - Receptor, ErbB-2/metabolism
MH  - Young Adult
PMC - PMC4517429
MID - NIHMS707775
EDAT- 2014/03/13 06:00
MHDA- 2014/10/31 06:00
PMCR- 2015/07/28
CRDT- 2014/03/12 06:00
PHST- 2014/03/12 06:00 [entrez]
PHST- 2014/03/13 06:00 [pubmed]
PHST- 2014/10/31 06:00 [medline]
PHST- 2015/07/28 00:00 [pmc-release]
AID - 12/suppl_1/S-21 [pii]
AID - 10.6004/jnccn.2014.0209 [doi]
PST - ppublish
SO  - J Natl Compr Canc Netw. 2014 Feb;12 Suppl 1(0 1):S21-4. doi: 
      10.6004/jnccn.2014.0209.