Introduction to CISH <ul><li>Chromogenic In Situ Hybridization. </li></ul><ul><li>Uses chromogen(digoxigenin)-labeled DNA ...
Available  CISH  detection kits <ul><li>Gene amplification  </li></ul><ul><li>Chromosome translocations  </li></ul><ul><li...
Can be performed on: <ul><li>FFPE tissues  </li></ul><ul><li>Blood or bone marrow smears  </li></ul><ul><li>Metaphase chro...
Concordance between IHC, FISH and  CISH <ul><li>Most IHC/ CISH  studies show concordance between 80 and 100%. </li></ul><u...
What is HER2? <ul><li>HER2 (human epidermal growth factor receptor 2) is a protein that plays an important role in cell gr...
Why HER2 matters <ul><li>HER2+ cancers grow faster and spread faster than other cancer cells, and they need to be treated ...
Methods of HER2 Testing <ul><li>Immunohistochemistry (IHC)   </li></ul><ul><li>IHC detects the presence of the HER2 protei...
HER2  CISH  Kit <ul><li>Zymed's SPoT-light  HER2  CISH  Kit is a standardized kit for 20 tests. </li></ul><ul><li>HER2 pro...
HER2  CISH  Kit Additional Materials Required <ul><li>Super frost/ plus slides  </li></ul><ul><li>Positive tissue control:...
HER2  CISH  Kit: Equipment Required <ul><li>Timer  </li></ul><ul><li>Pipettes and pipette tips  </li></ul><ul><li>Slide ra...
CISH  step by step <ul><li>Specimen Preparation </li></ul><ul><li>Heat Pretreatment </li></ul><ul><li>Enzyme digestion </l...
Specimen Preparation for  CISH 1 <ul><li>Fixation and sectioning of tissue </li></ul><ul><li>Tissue should be fixed in 10%...
Heat Pretreatment 2 <ul><li>Coplin jar containing heat pretreatment buffer is heated to 98  oC-100  oC in the water bath  ...
Enzyme digestion 3 <ul><li>Tissue is digested with pepsin (provided in Zymed  CISH  kit)  </li></ul><ul><li>10 min digesti...
Denaturation and Hybridization 4 <ul><li>Denaturation of probe is performed at 94- 95 oC for 5 minutes in a PCR thermal cy...
Stringent Wash 5 <ul><li>Insufficient wash may lead to high DAB background  </li></ul><ul><li>Wash must be performed in SS...
Immunodetection 6 <ul><li>Between immunodetection steps, slides are washed with PBS , pH7.4  </li></ul><ul><li>Washes are ...
Counterstaining 7 <ul><li>Requires  1  dip only in Harris haemotoxylin  </li></ul><ul><li>Strong counterstaining is not re...
Evaluation of HER2 Gene Status by  CISH <ul><li>Normal </li></ul><ul><li>1-2 copies of the HER2 gene present per nucleus <...
Evaluation of HER2 Gene Status by  CISH <ul><li>Low Amplification </li></ul><ul><li>6-10 copies of the  HER2 gene or a sma...
FISH  disadvantages  advantages  CISH <ul><li>FISH </li></ul><ul><li>Modern expensive fluorescence microscope with filters...
Becoming a  CISH  Reference Laboratory <ul><li>Roche invited expression of interest from Labs with experience and/or inter...
 
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Technical Advances

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Technical Advances

  1. 2. Introduction to CISH <ul><li>Chromogenic In Situ Hybridization. </li></ul><ul><li>Uses chromogen(digoxigenin)-labeled DNA Probes. </li></ul><ul><li>Allows visualization of cellular DNA and can be performed on a tissue section. </li></ul><ul><li>Used to quantify the number of gene copies in cells in a tissue section and demonstrates gene status in tumors. </li></ul>
  2. 3. Available CISH detection kits <ul><li>Gene amplification </li></ul><ul><li>Chromosome translocations </li></ul><ul><li>Deletions </li></ul><ul><li>Aneuploidy </li></ul>
  3. 4. Can be performed on: <ul><li>FFPE tissues </li></ul><ul><li>Blood or bone marrow smears </li></ul><ul><li>Metaphase chromosome spreads </li></ul><ul><li>Fixed cells </li></ul>
  4. 5. Concordance between IHC, FISH and CISH <ul><li>Most IHC/ CISH studies show concordance between 80 and 100%. </li></ul><ul><li>FISH/ CISH concordance rates between 90 and 100%. </li></ul><ul><li>Generally most IHC/ CISH and FISH/ CISH studies demonstrate concordance data above 80%. </li></ul>
  5. 6. What is HER2? <ul><li>HER2 (human epidermal growth factor receptor 2) is a protein that plays an important role in cell growth, multiplication, and survival. </li></ul><ul><li>Normal cells contain two copies of the HER2 gene and make amounts of HER2 to allow normal cell growth and division. </li></ul><ul><li>Some cancer cells, however, contain many more copies of the HER2 gene and in turn produce too much HER2 protein. </li></ul><ul><li>This “over expression” of HER2 receptors results in a cancer that is “HER2+.” About 20% to 25% of breast cancer tumors are HER2+ (HER2-positive). </li></ul>
  6. 7. Why HER2 matters <ul><li>HER2+ cancers grow faster and spread faster than other cancer cells, and they need to be treated differently .. </li></ul>
  7. 8. Methods of HER2 Testing <ul><li>Immunohistochemistry (IHC) </li></ul><ul><li>IHC detects the presence of the HER2 protein in tissue samples </li></ul><ul><li>Fluorescence in situ hybridization (FISH) Uses fluorescent DNA probes to identify increased copies of the HER2 gene Chromogenic in situ hybridization </li></ul><ul><li>( CISH ) Allows detection of gene amplification using conventional peroxidase on FFPE tissues </li></ul>
  8. 9. HER2 CISH Kit <ul><li>Zymed's SPoT-light  HER2 CISH Kit is a standardized kit for 20 tests. </li></ul><ul><li>HER2 probe purchased separately </li></ul><ul><li>SPoT-light  HER2 probes are stored at -20oC. </li></ul>
  9. 10. HER2 CISH Kit Additional Materials Required <ul><li>Super frost/ plus slides </li></ul><ul><li>Positive tissue control: FFPE tissue section with HER2 gene amplification </li></ul><ul><li>Distilled water </li></ul><ul><li>Xylene </li></ul><ul><li>70%, 85%, 95% and 100% ethanol and 100% methanol. </li></ul><ul><li>30% hydrogen peroxide. </li></ul><ul><li>Cover slips and rubber cement </li></ul>
  10. 11. HER2 CISH Kit: Equipment Required <ul><li>Timer </li></ul><ul><li>Pipettes and pipette tips </li></ul><ul><li>Slide rack </li></ul><ul><li>Slide warmer oven </li></ul><ul><li>37 oC incubator </li></ul><ul><li>Coplin jars and staining jars </li></ul><ul><li>PCR thermal cycler with a slide block </li></ul><ul><li>Water bath (capable of reaching 100 oC) </li></ul><ul><li>Bright field microscope </li></ul>
  11. 12. CISH step by step <ul><li>Specimen Preparation </li></ul><ul><li>Heat Pretreatment </li></ul><ul><li>Enzyme digestion </li></ul><ul><li>Denaturation and Hybridization </li></ul><ul><li>Overnight Incubation </li></ul><ul><li>Stringent Wash </li></ul><ul><li>Immunodetection </li></ul><ul><li>Counterstaining </li></ul>
  12. 13. Specimen Preparation for CISH 1 <ul><li>Fixation and sectioning of tissue </li></ul><ul><li>Tissue should be fixed in 10% neutral buffered formalin for 12-24 hours prior to paraffin embedding </li></ul><ul><li>Tissue sections should be 4-5mm thick and mounted on Super frost/Plus microscope slides </li></ul><ul><li>Baking and deparaffinisation </li></ul><ul><li>Sections should be baked at 60 oC for 15 minutes prior to deparaffinisation or overnight at 37 oC. </li></ul>
  13. 14. Heat Pretreatment 2 <ul><li>Coplin jar containing heat pretreatment buffer is heated to 98 oC-100 oC in the water bath </li></ul><ul><li>Slides are then placed in the coplin jar and heated at 100 oC for 15 minutes </li></ul><ul><li>Slides are then placed in distilled water at Room Temperature </li></ul>
  14. 15. Enzyme digestion 3 <ul><li>Tissue is digested with pepsin (provided in Zymed CISH kit) </li></ul><ul><li>10 min digestion recommended for most tissues However, </li></ul><ul><li>Digestion depends on tissue fixation, type of tissue, decalcification </li></ul>
  15. 16. Denaturation and Hybridization 4 <ul><li>Denaturation of probe is performed at 94- 95 oC for 5 minutes in a PCR thermal cycler with slide block </li></ul><ul><li>Hybridization must be for at least 12 hours to a maximum of 72 hours at 37 oC </li></ul>
  16. 17. Stringent Wash 5 <ul><li>Insufficient wash may lead to high DAB background </li></ul><ul><li>Wash must be performed in SSC buffer at 75-80C for 5 min. Do not exceed 80C. </li></ul><ul><li>Washes performed at higher temperatures than recommended may result in a complete loss of CISH signal </li></ul>
  17. 18. Immunodetection 6 <ul><li>Between immunodetection steps, slides are washed with PBS , pH7.4 </li></ul><ul><li>Washes are 3 x 2 minutes </li></ul><ul><li>Important to keep pH range between pH 7.0-7.5, otherwise may affect staining </li></ul><ul><li>Insufficient or lack of washing may lead to high DAB background </li></ul>
  18. 19. Counterstaining 7 <ul><li>Requires 1 dip only in Harris haemotoxylin </li></ul><ul><li>Strong counterstaining is not recommended as it may mask HER2 signals in nucleus </li></ul>
  19. 20. Evaluation of HER2 Gene Status by CISH <ul><li>Normal </li></ul><ul><li>1-2 copies of the HER2 gene present per nucleus </li></ul>
  20. 21. Evaluation of HER2 Gene Status by CISH <ul><li>Low Amplification </li></ul><ul><li>6-10 copies of the HER2 gene or a small HER2 gene cluster, present per nucleus in >50% cancer cells. </li></ul><ul><li>Amplification </li></ul><ul><li>>10 copies, or large clusters of the HER2 gene present in >50% cancer cells </li></ul>
  21. 22. FISH disadvantages advantages CISH <ul><li>FISH </li></ul><ul><li>Modern expensive fluorescence microscope with filters </li></ul><ul><li>Fluroscence fades quickly (photographic record required ) </li></ul><ul><li>Morphological features difficult to visualize </li></ul><ul><li>CISH </li></ul><ul><li>Bright field microscope used </li></ul><ul><li>Permanent record </li></ul><ul><li>Histological analysis similar to immunohistochemistry </li></ul>
  22. 23. Becoming a CISH Reference Laboratory <ul><li>Roche invited expression of interest from Labs with experience and/or interest to set-up a CISH service. </li></ul><ul><li>Before engaging in a contract with Roche, a certification process was compulsory to be completed by Pathologist(s) and Scientist(s) </li></ul>
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