FISH - Her2/neu Test: Booking, Price, and Results
About FISH - Her2/neu Test
| Field | Value |
|---|---|
| Also Known As | HER2 FISH Test, HER2/neu Gene Amplification by FISH, ERBB2 FISH, c-erbB-2 FISH, HER2 Fluorescence In Situ Hybridisation |
| Sample Type | Formalin-fixed, paraffin-embedded (FFPE) tumour tissue block |
| Fasting Required | No fasting required |
| Report Time | 6 days |
| Recommended For | Patients diagnosed with breast cancer or gastric/gastro-oesophageal cancer, particularly those with equivocal HER2 IHC (2+) results |
| Price | Starting at ₹10,500 |
What is a FISH - Her2/neu Test?
The FISH - Her2/neu Test uses a laboratory technique called fluorescence in situ hybridisation to check whether cancer cells contain extra copies of the HER2 gene. This gene controls how quickly cells grow and divide. Doctors order this test for patients with breast cancer or gastric cancer, especially when a prior protein test (IHC) gives an unclear result.
The test goes by several names, including the HER2 FISH Test, ERBB2 FISH, and HER2 Fluorescence In Situ Hybridisation. It uses a tumour tissue block prepared from a biopsy or surgical sample.
What Does a FISH - Her2/neu Test Measure?
The FISH - Her2/neu Test procedure analyses two key signals within tumour cells using fluorescent probes. Here is what each measurement tells us:
| Parameter | What It Measures |
|---|---|
| HER2 Gene Amplification | Whether extra copies of the HER2 gene are present in cancer cells |
| HER2-to-CEP17 Ratio | The number of HER2 gene signals compared to chromosome 17 centromere signals |
| Average HER2 Copy Number per Cell | The mean number of HER2 gene copies counted across tumour cells |
Together, these measurements allow a pathologist to classify the result as amplified (positive), not amplified (negative), or borderline (equivocal).
Why is a FISH - Her2/neu Test Done?
This test is a key step in understanding a cancer's biology and planning the right treatment. Below are the main reasons a doctor may request it.
Common Symptoms That May Require This Test
A doctor does not order this test based on symptoms alone. It is requested after a cancer diagnosis has already been made. However, the findings that typically lead to a cancer diagnosis include:
- A new lump or mass in the breast
- Change in breast size, shape, or contour
- Skin dimpling or puckering on the breast
- Nipple discharge or nipple turning inward
- Swelling of the lymph nodes in the armpit
- Newly confirmed breast or gastric cancer on biopsy
- Unexplained pain in the breast or nipple area
Conditions This Test Can Help Detect
This test helps characterise cancer biology rather than detect cancer itself. It can identify:
- HER2-positive breast cancer (found in roughly 15 to 20% of breast cancers)
- HER2 gene amplification, which is linked to faster tumour growth and higher grade
- HER2-positive gastric or gastro-oesophageal adenocarcinoma
- Eligibility for HER2-targeted treatments such as trastuzumab (Herceptin), pertuzumab, and lapatinib
How to Prepare and What to Expect
Because this test is performed on tissue already collected during a biopsy or surgery, there is very little the patient needs to do. The steps below explain what is involved.
Do You Need to Fast?
No fasting is required for this test. Since no fresh blood or fluid sample is collected from the patient, there are no dietary restrictions.
Practical Tips Before Your Test
- Bring a detailed clinical history, including your symptoms, previous test results, and family history, as this is required for the test
- Confirm with your surgeon or pathologist that the tissue block has been fixed in 10% neutral buffered formalin
- Ensure the tissue was placed in fixative within one hour of biopsy or surgery
- Avoid the use of strong acid-based decalcification solutions on the specimen
- Check that the block contains enough tumour cells for analysis
Step-by-Step Procedure
- Tumour tissue is obtained during a biopsy or surgical procedure and placed in fixative within one hour.
- Tissue is fixed in 10% neutral buffered formalin for a minimum of 6 hours and no more than 72 hours.
- The fixed tissue is embedded in paraffin wax to create an FFPE block.
- Very thin sections (4 to 5 microns thick) are cut from the block and mounted on glass slides.
- Fluorescent probes targeting the HER2 gene and chromosome 17 centromere are applied. The slide is then processed so the probes bind to their targets.
- A pathologist counts the fluorescent signals under a microscope and calculates the HER2-to-CEP17 ratio to determine amplification status.
Factors That Can Affect Accuracy
The following factors can influence how reliable the result is:
- Delayed fixation (more than one hour between surgery and placing tissue in formalin)
- Fixation time outside the 6 to 72-hour window
- Use of fixatives other than 10% neutral buffered formalin
- Decalcified tissue, which may not be suitable for FISH analysis
- Insufficient tumour cells in the tissue block
- Chromosome 17 polysomy (extra copies of the entire chromosome), which can complicate interpretation
Understanding Your FISH - Her2/neu Test Results
Results are classified into five groups based on ASCO/CAP 2018 guidelines. Your treating doctor will review these findings alongside your full clinical picture. The table below gives a general overview.
| Group | HER2/CEP17 Ratio | Average HER2 Copies per Cell | Classification |
|---|---|---|---|
| Group 1 | >= 2.0 | >= 4.0 | HER2 Positive (Amplified) |
| Group 2 | >= 2.0 | < 4.0 | Requires correlation with IHC; often considered HER2 Negative if IHC is not 3+ |
| Group 3 | < 2.0 | >= 6.0 | HER2 Positive (Amplified) |
| Group 4 | < 2.0 | >= 4.0 to < 6.0 | Requires correlation with IHC |
| Group 5 | < 2.0 | < 4.0 | HER2 Negative (Not Amplified) |
These ranges are general guidelines. Your doctor will interpret your results based on your age, health history, and other factors. Always consult a qualified healthcare professional for personalised medical advice.
Results During Special Conditions
Certain circumstances can make results harder to interpret. These are worth knowing:
- Tissue left unfixed for more than 6 hours before being placed in formalin may show reduced FISH signals, affecting the final score.
- Specimens treated with fixatives other than 10% neutral buffered formalin may produce unreliable results.
- Decalcified tissues are generally unsuitable for FISH analysis and may yield invalid findings.
- Chromosome 17 polysomy can raise the CEP17 count and make the HER2/CEP17 ratio appear falsely low, requiring careful expert interpretation.
How to Maintain Healthy Levels
While this test is not a routine wellness check, these general steps support breast health and early detection:
- Perform regular breast self-examinations and attend screening mammograms as advised by your doctor.
- Maintain a balanced diet, a healthy body weight, and regular physical activity to reduce overall cancer risk.
- Discuss your family history of breast or gastric cancer with your doctor so they can recommend the right screening schedule for you.
Lupin Diagnostics FISH - Her2/neu Test Price
The FISH - Her2/neu Test starts at ₹10,500 at Lupin Diagnostics. This test requires a visit to a Lupin Diagnostics centre or submission of the FFPE tissue block directly; home collection is not available for this test.
| City | Approximate Price (₹) |
|---|---|
| BHOPAL | 10500 |
| CHENNAI | 10500 |
| HYDERABAD | 10500 |
| KOLKATA | 10500 |
| NAVI MUMBAI | 10500 |
| PUNE | 10500 |
Prices are indicative and may vary by location. Please confirm the current price at the time of booking.
How to Book
Follow these steps to book your FISH - Her2/neu Test online or at a centre:
- Select the test on the Lupin Diagnostics website.
- Choose your city and preferred centre location.
- Visit the centre at your scheduled time to submit your FFPE tissue block.
- Receive your report via email or WhatsApp within the stipulated turnaround time.
Frequently Asked Questions
The FISH - Her2/neu Test checks whether cancer cells contain extra copies of the HER2 gene. This result tells doctors whether the cancer is likely to behave aggressively and whether HER2-targeted treatments may be suitable for the patient.
When an immunohistochemistry (IHC) test returns an equivocal result, scored as 2+, it cannot confirm whether the HER2 gene is truly amplified. The HER2 FISH Test provides a more precise measurement at the gene level and is used to clarify that borderline result.
No separate sample collection is needed at the time of testing. The test is performed on tumour tissue that was already obtained during a biopsy or surgery. The preserved tissue block from that procedure is sent directly to the laboratory.
A positive (amplified) result means the cancer cells carry extra copies of the HER2 gene. This is associated with faster tumour growth, but it also means the patient may be a candidate for specific HER2-targeted therapies. Your oncologist will explain what this means for your treatment plan.
At Lupin Diagnostics, results are delivered within 6 days. The FISH - Her2/neu Test procedure involves multiple laboratory steps, including tissue processing, probe hybridisation, and expert microscopic analysis, which is why it takes longer than routine blood tests.
No special preparation is needed from the patient. The main requirements relate to how the tissue specimen was handled after surgery, such as the correct fixation time and the type of fixative used. Your surgeon and pathologist manage these steps.
No. The FISH - Her2/neu Test cannot be done at home. It requires a formalin-fixed, paraffin-embedded tissue block from a prior biopsy or surgical procedure. This block must be submitted to a specialised laboratory for analysis.
FISH - Her2/neu Test: Booking, Price, and Results
