Novel quantitative immunohistochemistry method using histone H3, family 3B as the internal reference standard for measuring human epidermal growth factor receptor 2 expression in breast cancer

Abstract Background Immunohistochemistry (IHC) is an essential technique in surgical and clinical pathology for detecting diagnostic, prognostic, and predictive biomarkers for personalized cancer therapy. However, the lack of standardization and reference controls results in poor reproducibility, and a reliable tool for IHC quantification is urgently required. The objective of this study was to describe a novel approach in which H3F3B (histone H3, family 3B) can be used as an internal reference standard to quantify protein expression levels using IHC. Methods The authors enrolled 89 patients who had human epidermal growth factor receptor 2 (HER2)‐positive breast cancer (BC). They used a novel IHC‐based assay to measure protein expression using H3F3B as the internal reference standard. H3F3B was uniformly expressed at the protein level in all tumor regions in cancer tissues. HER2 expression levels were measured with the H‐score using HALO software. Results Kaplan–Meier analysis indicated that, among patients who had HER2‐positive BC in The Cancer Genome Atlas data set and the authors' data set, the subgroup with low HER2 expression had a significantly better prognosis than the subgroup with high HER2 expression. Furthermore, the authors observed that HER2 expression levels were precisely evaluated using the proposed method, which can classify patients who are at higher risk of HER2‐positive BC to receive trastuzumab‐based adjuvant therapy. Dual‐color IHC with H3F3B is an excellent tool for internal and external quality control of HER2 expression assays. Conclusions The proposed IHC‐based quantification method accurately assesses HER2 expression levels and provides insights for predicting clinical prognosis in patients with HER2‐positive BC who receive trastuzumab‐based adjuvant therapy.