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Anne-Vibeke Lænkholm

Guidelines for hormone receptor analysis in breast carcinoma


The ASCO/CAP guidelines for immunohistochemical testing of ER recommend a cut-off value of ≥ 1% positive tumor cells for considering a tumor ER positive and as such eligible for endocrine treatment. Several scoring methods have been described for evaluation of ER e.g., the Allred score and the H-score.  These scoring methods include evaluation of staining intensity as well as percentage of positive tumor cells. The presentation will focus on guidelines for ER testing with emphasis on scoring methodology, cut-off values and reproducibility of test results.


Senior consultant at the Department of Pathology, Slagelse Hospital, Denmark. Main focus on diagnostic breast pathology and breast cancer research. Board member of the Danish Breast Cancer Cooperative Group and member of the NordiQC HER-2 ISH Assessor Group.

University degree:
M.D., from the faculty of Health Sciences Copenhagen 1989                 
Present Position:
2011-present Consultant, Department of Pathology, Slagelse Hospital, Region Zealand, Denmark
Teaching experience:
2008-2009 Associate professor, Institute of Clinical research, University of Southern
Denmark 2004 – present Board certification: Postgraduate teaching for MDs studying for their board
certification in Diagnostic Pathology and responsible for the course in diagnostic breast pathology.
Present professional memberships:
Board member of The Danish Breast Cancer Cooperative Group (DBCG)
Member of The Scientific Committee of Pathology (DBCG)
Member of the Scientific Committee of Translational Research (DBCG).

34 peer-reviewed publications.
Selected publications from 2013-2011

  1. Lyng MB, Lænkholm AV, Tan Q, Vach W, Gravgaard KH, Knoop A, Ditzel HJ. Gene Expression Signatures That Predict Outcome of Tamoxifen-Treated Estrogen Receptor-Positive, High-Risk, Primary Breast Cancer Patients: A DBCG Study. PLoS One. 2013;8(1):e54078. Epub 2013 Jan 16.
  1. Bjerre C, Knoop A, Bjerre K, Larsen MS, Henriksen KL, Lyng MB, Ditzel HJ, Rasmussen BB, Brünner N, Ejlertsen B, Laenkholm AV. Association of tissue inhibitor of metalloproteinases-1 and Ki67 in estrogen receptor positive breast cancer. Acta Oncol. 2013 Jan;52(1):82-90.
  1. Larsen MS, Bjerre K, Lykkesfeldt AE, Giobbie-Hurder A, Lænkholm AV, Henriksen KL, Ejlertsen B, Rasmussen BB. Activated HER-receptors in predicting outcome of ER-positive breast cancer patients treated with adjuvant endocrine therapy. Breast. 2012 oct:21(5):662-8.
  2. Laenkholm AV, Knoop A, Ejlertsen B, Rudbeck T, Jensen MB, Müller S, Lykkesfeldt AE, Rasmussen BB, Nielsen KV. ESR1 gene status correlates with estrogen receptor protein levels measured by ligand binding assay and immunohistochemistry. Mol Oncol. 2012 Aug;6(4):428-36.
  3. RR Lund, MG Terp, AV Lænkholm, ON Jensen, R Leth-Larsen, and HJ Ditzel. Quantitative Proteomics of Primary Tumors with Varying Metastatic Capabilities using Stable Isotope-labeled Proteins of Multiple Histogenic Origins. Proteomics. 2012 Jul;12(13):2139-48.
  4. Mathilde S. Larsen, Karsten Bjerre, Anita Giobbie-Hurder, Anne-Vibeke Lænkholm, Katrine L. Henriksen, Bent Ejlertsen, Anne E. Lykkesfeldt, Birgitte B. Rasmussen. Prognostic value of Bcl-2 in two independent populations of estrogen receptor positive breast cancer patients treated with adjuvant endocrine therapy. Acta Oncologica. 2012 Acta Oncol. 2012 Jul;51(6):781-9.
  5. Lyng MB, Lænkholm AV, Søkilde R, Gravgaard KH, Litman T, Ditzel HJ. Global MicroRNA Expression Profiling of High-Risk ER+ Breast Cancers from Patients Receiving Adjuvant Tamoxifen Mono-Therapy: A DBCG Study. PLoS One. 2012;7(5):e36170. Epub 2012 May 18.
  6. Stovgaard ES, Tvedskov TF, Lænkholm AV, Balslev E. Cytokeratin on frozen sections of sentinel node may spare breast cancer patients secondary axillary surgery. Patholog Res Int. 2012;2012:802184. Epub 2012 May 9.
  7. Rossing HH, Talman ML, Laenkholm AV, Wielenga VT. Implementation of TMA and digitalization in routine diagnostics of breast pathology. APMIS. 2012 Apr;120(4):341-7.
  8. Gravgaard KH, Lyng MB, Laenkholm AV, Søkilde R, Nielsen BS, Litman T, Ditzel    HJ. The miRNA-200 family and miRNA-9 exhibit differential expression in primary versus corresponding metastatic tissue in breast cancer. Breast Cancer Res Treat. 2012 Jul:134(1):217-17.
  9. Jensen JD, Knoop A, Laenkholm AV, Grauslund M, Jensen MB, Santoni-Rugiu E, Andersson M, Ewertz M. PIK3CA mutations, PTEN, and pHER2 expression and impact on outcome in HER2-positive early-stage breast cancer patients treated with adjuvant chemotherapy and trastuzumab. Ann Oncol. 2012 Aug;23(8):2034-42.
  10. Jensen JD, Knoop A, Ewertz M, Laenkholm AV. ER, HER2, and TOP2A expression in primary tumor, synchronous axillary nodes, and asynchronous metastases in breast cancer.Breast Cancer Res Treat. 2012 Apr;132(2):511-21.
  11. Christiansen P, Bjerre K, Ejlertsen B, Jensen MB, Rasmussen BB, Lænkholm AV, Kroman N, Ewertz M, Offersen B, Toftdahl DB, Møller S, Mouridsen HT; Danish Breast Cancer Cooperative Group. Mortality rates among early-stage hormone receptor-positive breast cancer patients: a population-based cohort study in Denmark.. J Natl Cancer Inst. 2011 Sep 21;103(18):1363-72.
  12.  Skytte AB, Crüger D, Gerster M, Laenkholm AV, Lang C, Brøndum-Nielsen K, Andersen MK, Sunde L, Kølvraa S, Gerdes AM. Breast cancer after bilateral risk-reducing mastectomy.Clin Genet. 2011 May;79(5):431-7.
  13. PIK3CA mutations may be discordant between primary and corresponding metastatic disease in Breast Cancer.Dupont Jensen J, Laenkholm AV, Knoop A, Ewertz M, Bandaru R, Weihua L, Hackl W, Barrett JC, Gardner H. Clin Cancer Res. 2011 Feb 15;17(4):667-77.
  14. Nielsen KV, Ejlertsen B, Müller S, Møller S, Rasmussen BB, Balslev E, Lænkholm AV, Christiansen P, Mouridsen HT. Amplification of ESR1 may predict resistance to adjuvant tamoxifen in postmenopausal patients with hormone receptor positive breast cancer. Breast Cancer Res Treat. 2011 Jun;127(2):345-55.
  15. Atkinson R, Mollerup J, Laenkholm AV, Verardo M, Hawes D, Commins D, Engvad B, Correa A, Ehlers CC, Nielsen KV. Effects of the change in cutoff values for human epidermal growth factor receptor 2 status by immunohistochemistry and fluorescence in situ hybridization: a study comparing conventional brightfield microscopy, image analysis-assisted microscopy, and interobserver variation. Arch Pathol Lab Med. 2011 Aug;135(8):1010-6.
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