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A MedPage Today interview with Cleveland Clinic breast oncologist Megan Kruse describes how pathology results guide treatment decisions for early HER2-positive breast cancer. She explains when additional testing or a tumor-board review may be used and says HER2-low and HER2-ultralow labels do not change upfront treatment for stage I through III disease.
A MedPage Today interview with Megan Kruse, MD, a Cleveland Clinic breast oncologist, describes how pathology findings help determine treatment for early HER2-positive breast cancer. Kruse said HER2 immunohistochemistry, follow-up testing when results are equivocal, and hormone-receptor status all inform care, while HER2-low labels do not change upfront treatment for stage I through III disease.
Kruse described a pathology report as a roadmap to care, pointing to estrogen and progesterone receptors as well as HER2 results. HER2 immunohistochemistry (IHC) is graded from 0 to 3. In the interview, she said IHC scores of 0 and 1+ are negative, while 3+ is definitively positive. A 2+ result is equivocal and prompts fluorescence in situ hybridization, or FISH, as a secondary test to clarify HER2 status.
Some cases remain unclear after the initial tests. Kruse said clinicians may test another area of the original biopsy, ask another pathologist to review it, or obtain a new biopsy. Such cases are discussed at a multidisciplinary tumor board, which may include pathologists, medical oncologists, surgeons and radiation oncologists. She said the team weighs the findings when deciding whether HER2-targeted treatment is appropriate.
Kruse also addressed hormone-receptor status and emerging HER2 labels. For tumors that are both hormone-receptor-positive and HER2-positive, endocrine therapy is part of the treatment discussion. She said HER2-low and HER2-ultralow categories matter mainly in metastatic breast cancer; they do not function as separate classifications that change upfront staging, prognosis or treatment patterns for stage I through III disease. The source interview does not provide a full treatment protocol or patient-specific recommendations.
How Pathology Shapes Treatment Choices
The distinction between HER2-positive and HER2-negative disease can affect whether a patient is considered for HER2-targeted therapy, alongside chemotherapy. When a result is equivocal, further review or testing can help clinicians avoid basing a treatment plan on an unresolved finding. Kruse emphasized that the decision depends on the pathology picture, not on a single label alone.
The interview also addresses a source of potential confusion for patients reading about newer HER2 categories. A low or ultralow result may have relevance in metastatic disease, but Kruse said it does not by itself change the upfront approach for early-stage disease. That distinction can help patients understand why information about advanced cancer treatment may not apply to their own diagnosis.
These points matter because pathology terminology can be technical while treatment decisions are consequential. The discussion offers a description of how one specialist approaches interpretation and shared decision-making; it is not a guideline or a substitute for reviewing an individual report with the treating team.
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Reading HER2 Test Results
The MedPage Today item is the first installment in a series called Beyond Diagnosis: Early HER2-Positive Breast Cancer, produced in partnership with the program’s sponsor. Host John Mangels spoke with Kruse about pathology, treatment choices and communication with patients. The series is intended to examine several parts of early HER2-positive care, including evolving therapies, individualized decisions and shared decision-making.
In the interview, IHC is presented as the initial assessment of HER2 protein expression, with FISH used to clarify an equivocal IHC result. Kruse said the degree of protein expression helps clinicians consider sensitivity to HER2-directed medications and treatment intensity. The discussion focuses on clinical interpretation and does not include study data, a new drug announcement or a change to treatment guidelines.
Kruse also cautioned against treating HER2-low and HER2-ultralow as new early-stage disease subtypes. She said those terms can appear on pathology reports, but their treatment relevance is primarily in metastatic breast cancer. The interview does not detail specific tests used to define every category or address how all laboratories report results.
“Their pathology report is the roadmap to their care.”
— Megan Kruse, MD, Cleveland Clinic breast oncologist
When HER2 Findings Stay Equivocal
The interview does not report how often HER2 tests remain equivocal, how frequently repeat biopsies change a diagnosis, or what criteria individual tumor boards use to resolve difficult cases. It describes possible next steps but does not establish a single approach for every patient. The source also does not give a publication date, outcome data, or a complete account of how hormone-receptor status affects expected treatment results.
Kruse said that when HER2 findings are unclear, clinicians may review additional tissue, seek another pathologist’s opinion or repeat testing with a new biopsy. The interview does not specify which option is chosen in a particular case or how the balance of benefit and risk is assessed for an individual patient. Readers should not infer a treatment decision from a score without clinical review.
Further Episodes And Individual Care
The source presents this conversation as the first episode of a series, with later installments planned to address evolving therapies, individualized treatment and patient support. It does not give dates for those episodes or announce a forthcoming guideline or clinical milestone.
For patients facing an early breast cancer diagnosis, the practical next step described in the interview is to review the pathology findings with their oncology team. Where results are equivocal, the team may consider additional testing or multidisciplinary review. The specific plan depends on the full pathology and clinical picture, and the source does not offer a one-size-fits-all recommendation.
Key Questions
What do HER2 IHC scores mean in the interview?
Kruse said 0 and 1+ are considered negative, 3+ is definitively positive, and 2+ is equivocal. She described FISH as a secondary test used to clarify an equivocal IHC result.
What may clinicians do if HER2 results remain unclear?
According to Kruse, clinicians may test another part of the original biopsy, request another pathologist’s review, or obtain a new biopsy. Unclear cases may also be discussed by a multidisciplinary tumor board.
Do HER2-low and HER2-ultralow change early-stage treatment?
Kruse said those labels are mainly relevant to treatment considerations in metastatic breast cancer. In her account, they do not create separate classifications that change upfront treatment patterns for stage I through III disease.
How does hormone-receptor status affect care?
For a cancer that is both hormone-receptor-positive and HER2-positive, Kruse said endocrine, or anti-estrogen, therapy is also part of the treatment discussion. The interview does not specify a regimen for individual patients.
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