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Zhou JY, Pan CG, Ye Y, Li ZW, Fu WD, Jiang BH. Development and Validation of a Prognostic Nomogram for HR+ HER- Breast Cancer. Cancer Manag Res 2024; 16:491-505. [PMID: 38800665 PMCID: PMC11127650 DOI: 10.2147/cmar.s459714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose We aimed to develop a nomogram to predict prognosis of HR+ HER2- breast cancer patients and guide the application of postoperative adjuvant chemotherapy. Methods We identified 310 eligible HR+ HER- breast cancer patients and randomly divided the database into a training group and a validation group. The endpoint was disease free survival (DFS). Concordance index (C-index), area under the curve (AUC) and calibration curves were used to evaluate predictive accuracy and discriminative ability of the nomogram. We also compared the predictive accuracy and discriminative ability of our nomogram with the eighth AJCC staging system using overall data. Results According to the training group, platelet-to-lymphocyte ratio (PLR), tumor size, positive lymph nodes and Ki-67 index were used to construct the nomogram of DFS. The C-index of DFS was 0.708 (95% CI: 0.623-0.793) in the training group and 0.67 (95% CI: 0.544-0.796) in the validation group. The calibration curves revealed great consistencies in both groups. Conclusion We have developed and validated a novel and practical nomogram that can provide individual prediction of DFS for patients with HR+ HER- breast cancer. This nomogram may help clinicians in risk consulting and guiding the application of postoperative adjuvant chemotherapy.
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Affiliation(s)
- Jie-Yu Zhou
- Department of Thyroid and Breast Surgery, The Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Cheng-Geng Pan
- Department of Thyroid and Breast Surgery, The Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Yang Ye
- Department of Thyroid and Breast Surgery, The Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Zhi-Wei Li
- Department of Thyroid and Breast Surgery, The Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Wei-Da Fu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Bin-Hao Jiang
- Department of Urinary Surgery, Yueqing People’s Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
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Wu P, Wu SG, He ZY. Nomogram Update to Predict the High Genomic Risk Breast Cancer by Different Races. Clin Breast Cancer 2024; 24:e61-e70.e3. [PMID: 38007348 DOI: 10.1016/j.clbc.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To develop a nomogram to predict the high-risk recurrence score (RS) and to customize the nomogram for different races in early-stage hormone receptor (HoR)-positive, human epidermal growth factor receptor-2 (HER2)-negative breast cancer. METHODS Patients diagnosed between 2010 and 2015 were included from the surveillance, epidemiology, and end results oncotype DX database. The nomogram was assessed with a receiver operating characteristic curve to measure the area under the curve (AUC) with a 95% confidence interval (95% CI). The nomogram was developed and internally validated for discrimination and calibration, and then validated in different races. RESULTS A total of 48,464 patients were included and randomly assigned to the training cohort (n = 36370, 75.0%) and validation cohort (n = 12,094, 25.0%). Patients in the training cohort were identified to develop the nomogram, including 32,683 (89.9%) White women, 3135 (8.6%) Black women, and 552 (1.5%) Chinese women. Five independent predictive factors for high-risk RS were included to develop the nomogram, including tumor grade, progesterone receptor status, histological subtype, race, and tumor stage. The AUC was 0.696 (95% CI, 0.682-0.710) in the training cohort and 0.700 (95% CI, 0.676-0.724) in the validation cohort. There was no significant difference between the training cohort and the validation cohort. When validating the nomogram classified by race, the AUC was 0.694 (95% CI, 0.682-0.706) for the White cohort, 0.708 (95% CI, 0.673-0.743) for the Black cohort, and 0.653 (95% CI, 0.565-0.741) for the Chinese cohort. CONCLUSION The developed nomogram for predicting high-risk RS is available for different races in patients with HoR+/HER2- breast cancer, which could be used as qualified surrogates before ordering the 21-gene RS testing.
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Affiliation(s)
- Peng Wu
- School of Medicine, Sun Yat-sen University, Shenzhen, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China.
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.
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Paiva CE, Zonta MPM, Granero RC, Guimarães VS, Pimenta LM, Teixeira GR, Paiva BSR. The Magee 3 Equation Predicts Favorable Pathologic Response to Neoadjuvant Endocrine Therapy in Breast Cancer Patients. Cancers (Basel) 2024; 16:339. [PMID: 38254828 PMCID: PMC10813970 DOI: 10.3390/cancers16020339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Breast cancer (BC) remains a significant health care challenge, and treatment approaches continue to evolve. Among these, neoadjuvant endocrine therapy (NET) has gained prominence, particularly for postmenopausal, hormone-receptor positive, HER2-negative (HR+/HER2-) BC patients. Despite this, a significant gap exists in identifying patients who stand to benefit from NET. The objective of this study was to assess whether Magee equations (MEs) could serve as predictors of response to NET. METHODS This retrospective study included adult patients with invasive BC who underwent NET followed by curative surgery. Assessment of sociodemographic, clinical, and tumor-related variables was conducted. The ME1, ME2, ME3, and ME mean were analyzed to explore their predictive role for NET response. Receiver operating characteristic (ROC) curves were employed, along with the determination of optimal cutoff points. Logistic regression models were utilized to identify the most significant predictors of pathological response. RESULTS Among the 75 female participants, the mean age was 69.4 years, with the majority being postmenopausal (n = 72, 96%) and having an ECOG-PS of 0/1 (n = 63, 84%). Most patients were classified as luminal A (n = 41, 54.7%). ME3 emerged as a promising predictor, boasting an AUC of 0.734, with sensitivity of 90.62% and specificity of 57.50% when the threshold was ≤ 19.97. In univariate analysis, clinical staging (p = 0.002), molecular subtype (p = 0.001), and ME3 (continuous = 0.001, original 3-tier: p = 0.013, new 2-tier: <0.001) categories exhibited significant associations with pathological response. In the multivariate model, clinical staging and new 2-tier ME3 (<20 vs. ≥20) were included as significant variables. CONCLUSIONS Patients with ME3 < 20 have a higher likelihood of presenting a pathological response, offering a cost-effective alternative tool to Oncotype DX. Larger future studies with a prospective design are awaited to confirm our findings.
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Affiliation(s)
- Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil;
| | - Maria Paola Montesso Zonta
- Barretos School of Health Sciences Dr. Paulo Prata—FACISB, Barretos 14785-002, SP, Brazil; (M.P.M.Z.); (R.C.G.); (G.R.T.)
| | - Rafaela Carvalho Granero
- Barretos School of Health Sciences Dr. Paulo Prata—FACISB, Barretos 14785-002, SP, Brazil; (M.P.M.Z.); (R.C.G.); (G.R.T.)
| | - Vitor Souza Guimarães
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil;
| | - Layla Melo Pimenta
- Department of Pathology, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil;
| | - Gustavo Ramos Teixeira
- Barretos School of Health Sciences Dr. Paulo Prata—FACISB, Barretos 14785-002, SP, Brazil; (M.P.M.Z.); (R.C.G.); (G.R.T.)
- Department of Pathology, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil;
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Dong H, Su X, Li X, Fu P, Tan L. Adjuvant chemotherapy for pT1-3N0-1 breast cancer patients with HR+, HER2- subtype: a propensity-score matched study with competing risk analysis. J Cancer Res Clin Oncol 2023; 149:12637-12646. [PMID: 37442867 DOI: 10.1007/s00432-023-05124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To wholly evaluate the prognostic value of CHT for pT1-3N0-1 breast cancer patients with HR+, HER2- subtype using the Surveillance, Epidemiology, and End Results (SEER) database. METHOD A total of 126,102 eligible cases diagnosed between January 2010 and December 2018 were included in the SEER database. A propensity-score matched (PSM) study with competing risk analysis was conducted. The Kaplan-Meier method was used to visualize the survival disparities between chemotherapy (CHT) and no CHT groups. The cumulative incidences of different subgroups were compared by Fine-Gray's test. RESULTS Before PSM, patients in the CHT group had worse OS and CSS (both P < 0.001). After PSM, we were surprised that patients in the CHT group had a better OS than those in the no CHT group (HR 0.74, 95% CI 0.68-0.80, P < 0.001), while no significant survival disparities were observed for CSS (HR 1.00, 95% CI 0.89-1.12, P = 0.952). In the competing risk analysis, the OS disparities between the CHT and no CHT groups were mainly attributed to deaths of other causes (subdistribution HR [95% CI] 0.50 [0.44-0.57]). After adjusting for other competitive risk events, there was no significant difference in cumulative death risk of breast cancer between the CHT and no CHT groups (subdistribution HR [95% CI] 1.01 [0.90-0.1.13]). CONCLUSION The present study is the first, to our knowledge, to wholly evaluate the prognostic value of CHT for pT1-3N0-1 breast cancer patients with HR+, HER2- subtype using a propensity-score matched study with competing risk analysis. All pT1-3N0-1 breast cancer patients with HR+, HER2- subtype do not benefit from CHT. Genetic testing may be the only effective tool to determine the need for CHT at the present.
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Affiliation(s)
- Hong Dong
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xinyu Su
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xun Li
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Peng Fu
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Lun Tan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Mohamed A, Olsson LT, Geradts J. Differential distribution of actual and surrogate oncotype DX recurrence scores in breast cancer patients by age, menopausal status, race, and body mass index. Breast Cancer Res Treat 2023; 201:447-460. [PMID: 37453958 DOI: 10.1007/s10549-023-07025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The Oncotype DX Recurrence Score (RS) is a widely used prognostic tool for estrogen receptor-positive breast cancer patients. Multiple surrogate models can predict RS with good accuracy. In this study we aimed to determine whether the RS and two surrogate indices were differentially distributed by age, menopausal status, race, and body mass index (BMI). METHODS 516 breast cancer cases treated at a single institution were analyzed. Epidemiologic data, RS, tumor size, grade, and biomarker data were abstracted. Breast Cancer Prognostic Score (BCPS) and modified Magee equation 2 were used to calculate surrogate RS. Patients were stratified into different groups based on age, menopausal status, race, BMI, or a combination of strata. Mean and standard deviation were calculated for each group/subgroup. RESULTS Age below median (< 63) was associated with higher RS, especially in obese and Black patients. RS was also higher in obese and Black patients in the premenopausal subgroup. Black patients had a higher RS compared to White women in the premenopausal and non-obese subgroups. BMI < 30 was associated with higher RS, especially in older, postmenopausal, and Black patients. Some of these observations were replicated by the two surrogate models. The surrogate recurrence scores were higher in the younger age group, in non-obese older/postmenopausal women, and in younger/premenopausal obese individuals. CONCLUSIONS Higher RS was observed in younger and premenopausal breast cancer patients, especially among the Black and obese subgroups, and in non-obese patients, especially among Black and older/postmenopausal women, suggesting more aggressive disease in these subgroups. Some statistical differences could be replicated by both surrogate models, suggesting that they may have utility in breast cancer epidemiology studies that do not have access to Oncotype DX RS or patient outcome data.
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Affiliation(s)
- Anas Mohamed
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Mailstop 642, Greenville, NC, 27834, USA
| | - Linnea T Olsson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph Geradts
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Mailstop 642, Greenville, NC, 27834, USA.
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Liu Y, Han D, Parwani AV, Li Z. Applications of Artificial Intelligence in Breast Pathology. Arch Pathol Lab Med 2023; 147:1003-1013. [PMID: 36800539 DOI: 10.5858/arpa.2022-0457-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 02/19/2023]
Abstract
CONTEXT.— Increasing implementation of whole slide imaging together with digital workflow and advances in computing capacity enable the use of artificial intelligence (AI) in pathology, including breast pathology. Breast pathologists often face a significant workload, with diagnosis complexity, tedious repetitive tasks, and semiquantitative evaluation of biomarkers. Recent advances in developing AI algorithms have provided promising approaches to meet the demand in breast pathology. OBJECTIVE.— To provide an updated review of AI in breast pathology. We examined the success and challenges of current and potential AI applications in diagnosing and grading breast carcinomas and other pathologic changes, detecting lymph node metastasis, quantifying breast cancer biomarkers, predicting prognosis and therapy response, and predicting potential molecular changes. DATA SOURCES.— We obtained data and information by searching and reviewing literature on AI in breast pathology from PubMed and based our own experience. CONCLUSIONS.— With the increasing application in breast pathology, AI not only assists in pathology diagnosis to improve accuracy and reduce pathologists' workload, but also provides new information in predicting prognosis and therapy response.
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Affiliation(s)
- Yueping Liu
- From the Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China (Liu, Han)
| | - Dandan Han
- From the Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China (Liu, Han)
| | - Anil V Parwani
- The Department of Pathology, The Ohio State University, Columbus (Parwani, Li)
| | - Zaibo Li
- From the Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China (Liu, Han)
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7
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Bhargava R, Dabbs DJ. The Story of the Magee Equations: The Ultimate in Applied Immunohistochemistry. Appl Immunohistochem Mol Morphol 2023; 31:490-499. [PMID: 36165933 PMCID: PMC10396078 DOI: 10.1097/pai.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022]
Abstract
Magee equations (MEs) are a set of multivariable models that were developed to estimate the actual Onco type DX (ODX) recurrence score in invasive breast cancer. The equations were derived from standard histopathologic factors and semiquantitative immunohistochemical scores of routinely used biomarkers. The 3 equations use slightly different parameters but provide similar results. ME1 uses Nottingham score, tumor size, and semiquantitative results for estrogen receptor (ER), progesterone receptor, HER2, and Ki-67. ME2 is similar to ME1 but does not require Ki-67. ME3 includes only semiquantitative immunohistochemical expression levels for ER, progesterone receptor, HER2, and Ki-67. Several studies have validated the clinical usefulness of MEs in routine clinical practice. The new cut-off for ODX recurrence score, as reported in the Trial Assigning IndividuaLized Options for Treatment trial, necessitated the development of Magee Decision Algorithm (MDA). MEs, along with mitotic activity score can now be used algorithmically to safely forgo ODX testing. MDA can be used to triage cases for molecular testing and has the potential to save an estimated $300,000 per 100 clinical requests. Another potential use of MEs is in the neoadjuvant setting to appropriately select patients for chemotherapy. Both single and multi-institutional studies have shown that the rate of pathologic complete response (pCR) to neoadjuvant chemotherapy in ER+/HER2-negative patients can be predicted by ME3 scores. The estimated pCR rates are 0%, <5%, 14%, and 35 to 40% for ME3 score <18, 18 to 25, >25 to <31, and 31 or higher, respectively. This information is similar to or better than currently available molecular tests. MEs and MDA provide valuable information in a time-efficient manner and are available free of cost for anyone to use. The latter is certainly important for institutions in resource-poor settings but is also valuable for large institutions and integrated health systems.
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Affiliation(s)
- Rohit Bhargava
- Department of Pathology, UPMC Magee-Womens Hospital, Pittsburgh, PA
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8
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Lashen A, Toss MS, Fadhil W, Oni G, Madhusudan S, Rakha E. Evaluation oncotype DX ® 21-gene recurrence score and clinicopathological parameters: a single institutional experience. Histopathology 2023; 82:755-766. [PMID: 36631400 DOI: 10.1111/his.14863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
AIMS Oncotype DX recurrence score (RS) is a clinically validated assay, which predicts the likelihood of disease recurrence in oestrogen receptor-positive/HER2-negative (ER+/HER2-) breast cancer (BC). In this study we aimed to compare the performance of Oncotype DX against the conventional clinicopathological parameters using a large BC cohort diagnosed in a single institution. METHODS AND RESULTS A cohort (n = 430) of ER+/HER2- BC patients who were diagnosed at the Nottingham University Hospitals NHS Trust and had Oncotype DX testing was included. Correlation with the clinicopathological and other biomarkers, including the proliferation index, was analysed. The median Oncotype DX RS was 17.5 (range = 0-69). There was a significant association between high RS and grade 3 tumours. No grade 1 BC or grade 2 tumours with mitosis score 1 showed high RS. Low RS was significantly associated with special tumour types where none of the patients with classical lobular or tubular carcinomas had a high RS. There was an inverse association between RS and levels of ER and progesterone receptor (PR) expression and a positive linear correlation with Ki67 labelling index. Notably, six patients who developed recurrence had an intermediate RS; however, four of these six cases (67%) were identified as high-risk disease when the conventional clinical and molecular parameters were considered. CONCLUSION Oncotype DX RS is correlated strongly with the conventional clinicopathological parameters in BC. Some tumour features such as tumour grade, type, PR status and Ki67 index can be used as surrogate markers in certain scenarios.
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Affiliation(s)
- Ayat Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Wakkas Fadhil
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Georgette Oni
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Srinivasan Madhusudan
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.,Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Pathology Department, Hamad Medical Corporation, Doha, Qatar
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9
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Lashen AG, Toss MS, Ghannam SF, Makhlouf S, Green A, Mongan NP, Rakha E. Expression, assessment and significance of Ki67 expression in breast cancer: an update. J Clin Pathol 2023; 76:357-364. [PMID: 36813558 DOI: 10.1136/jcp-2022-208731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Ki67 expression is one of the most important and cost-effective surrogate markers to assess for tumour cell proliferation in breast cancer (BC). The Ki67 labelling index has prognostic and predictive value in patients with early-stage BC, particularly in the hormone receptor-positive, HER2 (human epidermal growth factor receptor 2)-negative (luminal) tumours. However, many challenges exist in using Ki67 in routine clinical practice and it is still not universally used in the clinical setting. Addressing these challenges can potentially improve the clinical utility of Ki67 in BC. In this article, we review the function, immunohistochemical (IHC) expression, methods for scoring and interpretation of results as well as address several challenges of Ki67 assessment in BC. The prodigious attention associated with use of Ki67 IHC as a prognostic marker in BC resulted in high expectation and overestimation of its performance. However, the realisation of some pitfalls and disadvantages, which are expected with any similar markers, resulted in an increasing criticism of its clinical use. It is time to consider a pragmatic approach and weigh the benefits against the weaknesses and identify factors to achieve the best clinical utility. Here we highlight the strengths of its performance and provide some insights to overcome the existing challenges.
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Affiliation(s)
- Ayat Gamal Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzan Fathy Ghannam
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histology, Suez Canal University, Ismailia, Egypt
| | - Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Andrew Green
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
| | - Nigel P Mongan
- School of Veterinary Medicine and Sciences, University of Nottingham, Nottingham, UK.,Department of Pharmacology, Weill Cornell Medicine, New York, New York, USA
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK .,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.,Pathology Department, Hamad Medical Corporation, Doha, Qatar
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10
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Turner BM, Finkelman BS, Hicks DG, Numbereye N, Moisini I, Dhakal A, Skinner K, Sanders MAG, Wang X, Shayne M, Schiffhauer L, Katerji H, Zhang H. The Rochester Modified Magee Algorithm (RoMMa): An Outcomes Based Strategy for Clinical Risk-Assessment and Risk-Stratification in ER Positive, HER2 Negative Breast Cancer Patients Being Considered for Oncotype DX ® Testing. Cancers (Basel) 2023; 15:cancers15030903. [PMID: 36765860 PMCID: PMC9913115 DOI: 10.3390/cancers15030903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Multigene genomic profiling has become the standard of care in the clinical risk-assessment and risk-stratification of ER+, HER2- breast cancer (BC) patients, with Oncotype DX® (ODX) emerging as the genomic profile test with the most support from the international community. The current state of the health care economy demands that cost-efficiency and access to testing must be considered when evaluating the clinical utility of multigene profile tests such as ODX. Several studies have suggested that certain lower risk patients can be identified more cost-efficiently than simply reflexing all ER+, HER2- BC patients to ODX testing. The Magee equationsTM use standard histopathologic data in a set of multivariable models to estimate the ODX recurrence score. Our group published the first outcome data in 2019 on the Magee equationsTM, using a modification of the Magee equationsTM combined with an algorithmic approach-the Rochester Modified Magee algorithm (RoMMa). There has since been limited published outcome data on the Magee equationsTM. We present additional outcome data, with considerations of the TAILORx risk-stratification recommendations. METHODS 355 patients with an ODX recurrence score, and at least five years of follow-up or a BC recurrence were included in the study. All patients received either Tamoxifen or an aromatase inhibitor. None of the patients received adjuvant systemic chemotherapy. RESULTS There was no significant difference in the risk of recurrence in similar risk categories (very low risk, low risk, and high risk) between the average Modified Magee score and ODX recurrence score with the chi-square test of independence (p > 0.05) or log-rank test (p > 0.05). Using the RoMMa, we estimate that at least 17% of individuals can safely avoid ODX testing. CONCLUSION Our study further reinforces that BC patients can be confidently stratified into lower and higher-risk recurrence groups using the Magee equationsTM. The RoMMa can be helpful in the initial clinical risk-assessment and risk-stratification of BC patients, providing increased opportunities for cost savings in the health care system, and for clinical risk-assessment and risk-stratification in less-developed geographies where multigene testing might not be available.
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Affiliation(s)
- Bradley M. Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
- Correspondence: ; Tel.: +1-(585)-275-2228; Fax: +1-(585)-341-6725
| | - Brian S. Finkelman
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - David G. Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Numbere Numbereye
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Ioana Moisini
- M. Health Fairview Ridges, Burnsville, MN 55337, USA
| | - Ajay Dhakal
- Department of Medical Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Kristin Skinner
- Department of Surgical Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Mary Ann G. Sanders
- Norton Healthcare, University of Louisville Department of Pathology, Louisville, KY 40292, USA
| | - Xi Wang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Michelle Shayne
- Department of Medical Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Linda Schiffhauer
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Hani Katerji
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Huina Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
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11
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Finkelman BS, Zhang H, Hicks DG, Turner BM. The Evolution of Ki-67 and Breast Carcinoma: Past Observations, Present Directions, and Future Considerations. Cancers (Basel) 2023; 15:808. [PMID: 36765765 PMCID: PMC9913317 DOI: 10.3390/cancers15030808] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The 1983 discovery of a mouse monoclonal antibody-the Ki-67 antibody-that recognized a nuclear antigen present only in proliferating cells represented a seminal discovery for the pathologic assessment of cellular proliferation in breast cancer and other solid tumors. Cellular proliferation is a central determinant of prognosis and response to cytotoxic chemotherapy in patients with breast cancer, and since the discovery of the Ki-67 antibody, Ki-67 has evolved as an important biomarker with both prognostic and predictive potential in breast cancer. Although there is universal recognition among the international guideline recommendations of the value of Ki-67 in breast cancer, recommendations for the actual use of Ki-67 assays in the prognostic and predictive evaluation of breast cancer remain mixed, primarily due to the lack of assay standardization and inconsistent inter-observer and inter-laboratory reproducibility. The treatment of high-risk ER-positive/human epidermal growth factor receptor-2 (HER2) negative breast cancer with the recently FDA-approved drug abemaciclib relies on a quantitative assessment of Ki-67 expression in the treatment decision algorithm. This further reinforces the urgent need for standardization of Ki-67 antibody selection and staining interpretation, which will hopefully lead to multidisciplinary consensus on the use of Ki-67 as a prognostic and predictive marker in breast cancer. The goals of this review are to highlight the historical evolution of Ki-67 in breast cancer, summarize the present literature on Ki-67 in breast cancer, and discuss the evolving literature on the use of Ki-67 as a companion diagnostic biomarker in breast cancer, with consideration for the necessary changes required across pathology practices to help increase the reliability and widespread adoption of Ki-67 as a prognostic and predictive marker for breast cancer in clinical practice.
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Affiliation(s)
| | | | | | - Bradley M. Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
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12
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Guo Q, Dong Z, Jiang L, Zhang L, Li Z, Wang D. Establishment and validation of an ultrasound-based nomogram with risk stratification for short disease-free survival in breast cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:134-147. [PMID: 36054346 DOI: 10.1002/jcu.23296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/07/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This retrospective study aimed to develop and validate an Ultrasound (US)-based nomogram to predict short disease-free survival (short-DFS, less than 120 months DFS) in breast cancer (BC). METHODS Nomogram was established based on a training data of 311 BC patients by multivariable logistic regression, and were assessed by discrimination, calibration, and clinical usefulness. Risk stratification was performed by X-tile. An independent testing data of 200 patients with BC was used for external validation. RESULTS Nine predictors including three US features and six clinical parameters were screened into the nomogram by Lasso (log λ = -3.594) in training data. Better performance was obtained in the training data (C-index: 0.942) and testing data (C-index: 0.914). Calibration analysis indicated optimal agreement between nomogram predictions and actual observations (p = 0.67). Decision curve analysis showed a great clinical benefit (Youden index: 0.634). Three risk levels are low-risk (<184.0), moderate-risk (184.0-345.3) and high-risk (>345.3). Our nomograms had larger area under the receiver operating characteristic (ROC) curves compared with Magee Equation and Nottingham Prognostic models (0.942 vs. 0.824, 0.790). CONCLUSION The US-based nomogram and the practical score system facilitate individualized prediction of short-DFS to optimize clinical decisions and improve prognosis in patients with BC.
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Affiliation(s)
- Qiang Guo
- Department of Ultrasound Medicine, Jinshan Branch of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhiwu Dong
- Department of Laboratory Medicine, Jinshan Branch of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Lixin Jiang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Lei Zhang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ziyao Li
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongmo Wang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Williams AD, Pawloski KR, Wen HY, Sevilimedu V, Thompson D, Morrow M, El-Tamer M. Use of a supervised machine learning model to predict Oncotype DX risk category in node-positive patients older than 50 years of age. Breast Cancer Res Treat 2022; 196:565-570. [PMID: 36269526 PMCID: PMC10328094 DOI: 10.1007/s10549-022-06763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/06/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE The use of the Oncotype DX recurrence score (RS) to predict chemotherapy benefit in patients with hormone receptor-positive/HER2 negative (HR+/HER2-) breast cancer has recently expanded to include postmenopausal patients with N1 disease. RS availability is limited in resource-poor settings, however, prompting the development of statistical models that predict RS using clinicopathologic features. We sought to assess the performance of our supervised machine learning model in a cohort of patients > 50 years of age with N1 disease. METHODS We identified patients > 50 years of age with pT1-2N1 HR+/HER2- breast cancer and applied the statistical model previously developed in a node-negative cohort, which uses age, pathologic tumor size, histology, progesterone receptor expression, lymphovascular invasion, and tumor grade to predict RS. We measured the model's ability to predict RS risk category (low: RS ≤ 25; high: RS > 25). RESULTS Our cohort included 401 patients, 60.6% of whom had macrometastases, with a median of 1 positive node. The majority of patients had a low-risk observed RS (85.8%). For predicting RS category, the model had specificity of 97.3%, sensitivity of 31.8%, a negative predictive value of 87.9%, and a positive predictive value of 70.0%. CONCLUSION Our model, developed in a cohort of node-negative patients, was highly specific for identifying cN1 patients > 50 years of age with a low RS who could safely avoid chemotherapy. The use of this model for identifying patients in whom genomic testing is unnecessary would help decrease the cost burden in resource-poor settings as reliance on RS for adjuvant treatment recommendations increases.
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Affiliation(s)
- Austin D Williams
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Hannah Y Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Donna Thompson
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Mahmoud El-Tamer
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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14
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Guo Q, Dong Z, Jiang L, Zhang L, Li Z, Wang D. Predictive Value of Ultrasound Characteristics for Disease-Free Survival in Breast Cancer. Diagnostics (Basel) 2022; 12:diagnostics12071587. [PMID: 35885493 PMCID: PMC9323735 DOI: 10.3390/diagnostics12071587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022] Open
Abstract
The main objective of this study was to determine the predictive value of US characteristics for disease-free survival (DFS) in BC patients. We retrospectively analyzed the ultrasonic images and clinical data of BC patients who had previously undergone breast surgery at least 10 years before study enrollment and divided them into a case group and a control group according to the cutoff value of 120 months for DFS. Correlation analysis was performed to identify US characteristics as independent predictors for DFS by multivariable logistic regression and Kaplan−Meier survival analysis. A total of 374 patients were collected, including 174 patients in the case group with short-DFS and 200 patients in the control group with long-DFS. Three US characteristics (size on US, mass shape, mass growth orientation) and two clinical factors (axillary lymph node (ALN), molecular subtypes) were identified as independent predictors for DFS (p < 0.05). The ROC curve showed good performance of the multivariate linear regression model with the area under the curve being 0.777. The US characteristics of large size, irregular shape, and nonparallel orientation were significantly associated with short-DFS, which is a promising supplementary for clinicians to optimize clinical decisions and improve prognosis in BC patients.
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Affiliation(s)
- Qiang Guo
- Department of Ultrasound Medicine, Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 201599, China
- Correspondence: ; Tel.: +86-18930817376
| | - Zhiwu Dong
- Department of Laboratory Medicine, Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 201599, China;
| | - Lixin Jiang
- Department of Ultrasound Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai 201599, China;
| | - Lei Zhang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China; (L.Z.); (Z.L.); (D.W.)
| | - Ziyao Li
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China; (L.Z.); (Z.L.); (D.W.)
| | - Dongmo Wang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China; (L.Z.); (Z.L.); (D.W.)
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15
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Mohamed A, Kousar A, Wong J, Vohra N, Muzaffar M, Geradts J. Pathobiologic Stratification of Oncotype DX Recurrence Scores and Comparative Validation of 3 Surrogate Models. Arch Pathol Lab Med 2022; 146:1258-1267. [PMID: 35119458 DOI: 10.5858/arpa.2021-0367-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The Oncotype DX Recurrence Score (RS) predicts recurrence and chemotherapy benefit in early-stage estrogen receptor positive breast cancer patients. Cost and unavailability are 2 major disadvantages of the assay. Multiple models have been developed to predict the RS. OBJECTIVE.— To predict RS based on histopathologic and biomarker features, and to measure concordance and correlation with RS of the following 3 algorithms: breast cancer prognostic score, Magee0, and Magee2. DESIGN.— Breast cancer cases with available RS were reviewed (n = 442). RS categories were stratified by pathologic and biomarker variables. Histopathologic and biomarker data were abstracted from pathology reports, and RS was calculated by each model. Correlation and concordance between models and RS were calculated. RESULTS.— Less than 5% of breast cancers with lobular features, low-grade tumors, carcinomas with high progesterone receptor content, or luminal A tumors had an RS greater than 25. Breast cancer prognostic score, Magee0, and Magee2 demonstrated correlation coefficients with RS of 0.63, 0.61, and 0.62, respectively. Two-step discordances were uncommon. When an RS of 25 was used to separate high-risk from non-high-risk cases, concordance rates of 86% to 88% were achieved. CONCLUSIONS.— High RS was observed only in a small percentage of pure or mixed lobular carcinomas, low-grade or luminal A tumors, and tumors with high progesterone receptor expression, suggesting that these cancers may not require Oncotype testing. All 3 surrogate models demonstrated comparable correlation and high concordance with the RS when a cutoff of 25 was used, suggesting their utility in cases where the actual RS is unavailable.
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Affiliation(s)
- Anas Mohamed
- From the Department of Pathology and Laboratory Medicine (Mohamed, Kousar, Geradts), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Aisha Kousar
- From the Department of Pathology and Laboratory Medicine (Mohamed, Kousar, Geradts), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Jan Wong
- Department of Surgery (Wong, Vohra), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Nasreen Vohra
- Department of Surgery (Wong, Vohra), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Mahvish Muzaffar
- The Department of Medical Oncology (Muzaffar), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Joseph Geradts
- From the Department of Pathology and Laboratory Medicine (Mohamed, Kousar, Geradts), East Carolina University Brody School of Medicine, Greenville, North Carolina
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16
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Pawloski KR, Gonen M, Wen HY, Tadros AB, Thompson D, Abbate K, Morrow M, El-Tamer M. Supervised machine learning model to predict oncotype DX risk category in patients over age 50. Breast Cancer Res Treat 2022; 191:423-430. [PMID: 34751852 PMCID: PMC9281430 DOI: 10.1007/s10549-021-06443-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/02/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Routine use of the oncotype DX recurrence score (RS) in patients with early-stage, estrogen receptor-positive, HER2-negative (ER+/HER2-) breast cancer is limited internationally by cost and availability. We created a supervised machine learning model using clinicopathologic variables to predict RS risk category in patients aged over 50 years. METHODS From January 2012 to December 2018, we identified patients aged over 50 years with T1-2, ER+/HER2-, node-negative tumors. Clinicopathologic data and RS results were randomly split into training and validation cohorts. A random forest model with 500 trees was developed on the training cohort, using age, pathologic tumor size, histology, progesterone receptor (PR) expression, lymphovascular invasion (LVI), and grade as predictors. We predicted risk category (low: RS ≤ 25, high: RS > 25) using the validation cohort. RESULTS Of the 3880 tumors identified, 1293 tumors comprised the validation cohort in patients of median (IQR) age 62 years (56-68) with median (IQR) tumor size 1.2 cm (0.8-1.7). Most tumors were invasive ductal (80.3%) of low-intermediate grade (80.5%) without LVI (80.9%). PR expression was ≤ 20% in 27.3% of tumors. Specificity for identifying RS ≤ 25 was 96.3% (95% CI 95.0-97.4) and the negative predictive value was 92.9% (95% CI 91.2-94.4). Sensitivity and positive predictive value for predicting RS > 25 was lower (48.3 and 65.1%, respectively). CONCLUSION Our model was highly specific for identifying eligible patients aged over 50 years for whom chemotherapy can be omitted. Following external validation, it may be used to triage patients for RS testing, if predicted to be high risk, in resource-limited settings.
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Affiliation(s)
- Kate R. Pawloski
- Memorial Sloan Kettering Cancer Center, Breast Service, Department of Surgery, New York, NY, USA
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, Biostatistics Service, Department of Epidemiology and Biostatistics, New York, NY, USA
| | - Hannah Y. Wen
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, NY, USA
| | - Audree B. Tadros
- Memorial Sloan Kettering Cancer Center, Breast Service, Department of Surgery, New York, NY, USA
| | - Donna Thompson
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, NY, USA
| | - Kelly Abbate
- Memorial Sloan Kettering Cancer Center, Breast Service, Department of Surgery, New York, NY, USA
| | - Monica Morrow
- Memorial Sloan Kettering Cancer Center, Breast Service, Department of Surgery, New York, NY, USA
| | - Mahmoud El-Tamer
- Memorial Sloan Kettering Cancer Center, Breast Service, Department of Surgery, New York, NY, USA
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17
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Finkelman BS, Meindl A, LaBoy C, Griffin B, Narayan S, Brancamp R, Siziopikou KP, Pincus JL, Blanco LZ. Correlation of manual semi-quantitative and automated quantitative Ki-67 proliferative index with OncotypeDXTM recurrence score in invasive breast carcinoma. Breast Dis 2021; 41:55-65. [PMID: 34397396 DOI: 10.3233/bd-201011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ki-67 immunohistochemistry (IHC) staining is a widely used cancer proliferation assay; however, its limitations could be improved with automated scoring. The OncotypeDXTM Recurrence Score (ORS), which primarily evaluates cancer proliferation genes, is a prognostic indicator for breast cancer chemotherapy response; however, it is more expensive and slower than Ki-67. OBJECTIVE To compare manual Ki-67 (mKi-67) with automated Ki-67 (aKi-67) algorithm results based on manually selected Ki-67 "hot spots" in breast cancer, and correlate both with ORS. METHODS 105 invasive breast carcinoma cases from 100 patients at our institution (2011-2013) with available ORS were evaluated. Concordance was assessed via Cohen's Kappa (κ). RESULTS 57/105 cases showed agreement between mKi-67 and aKi-67 (κ 0.31, 95% CI 0.18-0.45), with 41 cases overestimated by aKi-67. Concordance was higher when estimated on the same image (κ 0.53, 95% CI 0.37-0.69). Concordance between mKi-67 score and ORS was fair (κ 0.27, 95% CI 0.11-0.42), and concordance between aKi-67 and ORS was poor (κ 0.10, 95% CI -0.03-0.23). CONCLUSIONS These results highlight the limits of Ki-67 algorithms that use manual "hot spot" selection. Due to suboptimal concordance, Ki-67 is likely most useful as a complement to, rather than a surrogate for ORS, regardless of scoring method.
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Affiliation(s)
- Brian S Finkelman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda Meindl
- Department of Pathology, Great Lakes Pathologists, West Allis, WI, USA
| | - Carissa LaBoy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brannan Griffin
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Suguna Narayan
- Department of Pathology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Ryan Brancamp
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kalliopi P Siziopikou
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Pincus
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis Z Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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18
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Concordance between results of inexpensive statistical models and multigene signatures in patients with ER+/HER2- early breast cancer. Mod Pathol 2021; 34:1297-1309. [PMID: 33558657 DOI: 10.1038/s41379-021-00743-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/20/2022]
Abstract
Multigene signatures (MGS) are used to guide adjuvant chemotherapy (aCT) decisions in patients diagnosed with estrogen receptor (ER)-positive HER2-negative early breast cancer. We used results from three MGS (Oncotype DX® (ODX), MammaPrint® (MP) or Prosigna®) and assessed the concordance between high or low risk of recurrence and the predicted risk of recurrence based on statistical models. In addition, we looked at the impact of MGS results on final aCT administration during the multidisciplinary meeting (MDM). We retrospectively included 129 patients with ER-positive HER2-negative early breast cancer for which MGS testing was performed after MDM at University Hospitals Leuven between May 2013 and April 2019 in case there was doubt about aCT recommendation. Tumor tissue was analyzed either by ODX (N = 44), MP (N = 28), or Prosigna® (N = 57). Eight statistical models were computed: Magee equations (ME), Memorial Sloan Kettering simplified risk score (MSK-SRS), Breast Cancer Recurrence Score Estimator (BCRSE), OncotypeDXCalculator (ODXC), new Adjuvant! Online (nAOL), Mymammaprint.com (MyMP), PREDICT, and SiNK. Concordance, negative percent agreement, and positive percent agreement were calculated. Of 129 cases, 53% were MGS low and 47% MGS high risk. Concordances of 100.0% were observed between risk results obtained by ODX and ME. For MP, BCRSE demonstrated the best concordance, and for Prosigna® the average of ME. Concordances of <50.0% were observed between risk results obtained by ODX and nAOL, ODX and MyMP, ODX and SiNK, MP and MSK-SRS, MP and nAOL, MP and MyMP, MP and SiNK, and Prosigna® and ODXC. Integration of MGS results during MDM resulted in change of aCT recommendation in 47% of patients and a 15% relative and 9% absolute reduction. In conclusion, statistical models, especially ME and BCRSE, can be useful in selecting ER-positive HER2-negative early breast cancer patients who may need MGS testing resulting in enhanced cost-effectiveness and reduced delay in therapeutic decision-making.
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Developing a clinical-pathologic model to predict genomic risk of recurrence in patients with hormone receptor positive, human epidermal growth factor receptor-2 negative, node negative breast cancer. Cancer Treat Res Commun 2021; 28:100401. [PMID: 34091374 DOI: 10.1016/j.ctarc.2021.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Patients with hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative, node negative (NN) breast cancer may be offered a gene expression profiling (GEP) test to determine recurrence risk and benefit of adjuvant chemotherapy. We developed a clinical-pathologic (CP) model to predict genomic recurrence risk and examined its performance characteristics. METHODS Patients diagnosed with HR-positive, HER2-negative, NN breast cancer with a tumour size < 30 mm and who underwent a GEP test [OncotypeDX or Prosigna] in Alberta from October 2017 through March 2019 were identified. Patients were classified as low or high genomic risk. Multivariable logistic regression analysis was performed to examine the associations of CP factors with genomic risk. A CP model was developed using coefficients of regression and sensitivity analyses were performed. RESULTS A total of 366 patients were eligible (135 were tested using OncotypeDX and 231 with Prosigna). Of these, 64 (17.5%) patients were classified as high genomic risk. On multivariable logistic regression, tumour size > 20 mm (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.84-6.98; P<0.001), low expression of progesterone receptor (OR, 3.46; 95% CI, 1.76-6.82; P<0.001), and histological grade III (OR, 7.24; 95% CI, 3.82-13.70; P<0.001) predicted high genomic risk. A CP model using these variables was developed to provide a score of 0-4. A CP cut-point of 0, identified 56% of genomic low risk patients with a specificity of 98.4%. CONCLUSIONS A CP model could be used to narrow the population of breast cancer patients undergoing GEP testing.
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20
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Magee Equations™ and response to neoadjuvant chemotherapy in ER+/HER2-negative breast cancer: a multi-institutional study. Mod Pathol 2021; 34:77-84. [PMID: 32661297 DOI: 10.1038/s41379-020-0620-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/29/2020] [Indexed: 11/09/2022]
Abstract
Magee Equations™ (ME) are multivariable models that can estimate oncotype DX® recurrence score. One of the equations, Magee Equation 3 (ME3) which utilizes only semi-quantitative receptor results has been shown to provide chemopredictive value in the neoadjuvant setting in a single institutional study. This multi-institutional study (seven institutions contributed cases) was undertaken to examine the validity of ME3 in predicting response to neoadjuvant chemotherapy in estrogen receptor positive, HER2-negative breast cancers. Stage IV cases were excluded. The primary endpoint was the pathologic complete response (pCR) rate in different categories of ME3 scores calculated based on receptor results in the pre-therapy core biopsy. A total of 166 cases met the inclusion criteria. The patient age ranged from 24 to 83 years (median 53 years). The average pre-therapy tumor size was 3.9 cm, and axillary lymph nodes were confirmed positive by pre-therapy core biopsy in 85 of 166 cases (51%). The pCR rate according to ME3 scores was 0% (0 of 64) in ME3 < 18, 0% (0 of 46) in ME3 18-25, 14% (3 of 21) in ME3 > 25 to <31, and 40% (14 of 35) in ME3 score 31 or higher (p value: <0.0001). There were no distant recurrences and no deaths in the 17 patients with pCR. In the remaining 149 cases with residual disease, ME3 score of >25 was significantly associated with shorter distant recurrence-free survival and showed a trend for shorter breast cancer-specific survival. The results of this multi-institutional study are similar to previously published data from a single institution (PMID: 28548119) and confirm the chemo-predictive value of ME3 in the neoadjuvant setting. In addition, ME3 may provide prognostic information in patients with residual disease which should be further evaluated.
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21
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Nichols BS, Chelales E, Wang R, Schulman A, Gallagher J, Greenup RA, Geradts J, Harter J, Marcom PK, Wilke LG, Ramanujam N. Quantitative assessment of distant recurrence risk in early stage breast cancer using a nonlinear combination of pathological, clinical and imaging variables. JOURNAL OF BIOPHOTONICS 2020; 13:e201960235. [PMID: 32573935 PMCID: PMC8521784 DOI: 10.1002/jbio.201960235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
Use of genomic assays to determine distant recurrence risk in patients with early stage breast cancer has expanded and is now included in the American Joint Committee on Cancer staging manual. Algorithmic alternatives using standard clinical and pathology information may provide equivalent benefit in settings where genomic tests, such as OncotypeDx, are unavailable. We developed an artificial neural network (ANN) model to nonlinearly estimate risk of distant cancer recurrence. In addition to clinical and pathological variables, we enhanced our model using intraoperatively determined global mammographic breast density (MBD) and local breast density (LBD). LBD was measured with optical spectral imaging capable of sensing regional concentrations of tissue constituents. A cohort of 56 ER+ patients with an OncotypeDx score was evaluated. We demonstrated that combining MBD/LBD measurements with clinical and pathological variables improves distant recurrence risk prediction accuracy, with high correlation (r = 0.98) to the OncotypeDx recurrence score.
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Affiliation(s)
- Brandon S. Nichols
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Roujia Wang
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Amanda Schulman
- Department of Surgery, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer Gallagher
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Rachel A. Greenup
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Joseph Geradts
- Department of Population Sciences, City of Hope, Duarte, California
| | - Josephine Harter
- Department of Pathology, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul K. Marcom
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lee G. Wilke
- Department of Surgery, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
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Glasgow A, Sechrist H, Bomeisl P, Gilmore H, Harbhajanka A. Correlation between modified Magee equation-2 and Oncotype-Dx recurrence scores using both traditional and TAILORx cutoffs and the clinical application of the Magee Decision Algorithm: a single institutional review. Breast Cancer 2020; 28:321-328. [PMID: 32951186 DOI: 10.1007/s12282-020-01163-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/11/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Oncotype Dx (ODX) is used to predict recurrence risk for estrogen-positive (ER +), HER2-negative and lymph node negative breast cancer, however, due to the cost its use may be limited in low-resource areas. The aim of this study is to assess the concordance between the modified Magee Equation-2 (MME-2) and ODX recurrence scores (RS). The secondary aim is to apply the Magee Decision Algorithm (MDA) using the MME-2 to determine which patients are unlikely to benefit from ODX testing. METHODS All newly diagnosed ER + , HER2 negative, lymph node negative breast cancer patients with available ODX-RS from 2008-2018 were included. The original pathology reports were reviewed and chart review was performed. The MME-2 scores were calculated and correlated with the ODX-RS. The MDA was applied to our cohort to assess which patients would not benefit from ODX testing. RESULTS A total of 579 patients were included. There was an overall moderate correlation between ODX-RS and MME-2 score (Pearson correlation coefficient = 0.635). The overall concordance between ODX and MME-2 scores was similar when using both the traditional and TAILORx cutoffs (63.3% vs. 63.7%, respectively). Applying the MDA, for patients with MME-2 scores < 18, 96.8% of patients had the expected ODX-RS of < 25. For patients with MME-2 RS > 30, 90% had the expected ODX-RS of > 25. Concordance was highest in the high-risk category using both cutoffs. For patients with MME-2 18-25 and a mitotic score of 1, 88.8% had the expected ODX-RS of > 25. CONCLUSION There is a moderate correlation between MME-2 score and ODX-RS. The overall concordance was similar for both traditional and TAILORx cutoffs. The strongest concordance was found in the high-risk category for both cutoffs. The MME-2 can be used to identify patients unlikely to benefit from ODX testing using the MDA.
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Affiliation(s)
- Akisha Glasgow
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA.
| | - Haley Sechrist
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Phillip Bomeisl
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | - Hannah Gilmore
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | - Aparna Harbhajanka
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
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23
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Escott CE, Zaenger D, Switchencko JM, Lin JY, Abugideiri M, Arciero CA, Pfister NT, Xu KM, Meisel JL, Subhedar P, Torres M, Curran WJ, Patel PR. The Influence of Histologic Grade on Outcomes of Elderly Women With Early Stage Breast Cancer Treated With Breast Conserving Surgery With or Without Radiotherapy. Clin Breast Cancer 2020; 20:e701-e710. [PMID: 32665190 DOI: 10.1016/j.clbc.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Two large randomized trials, CALGB 9343 and PRIME II, support omission of radiotherapy after breast conserving surgery (BCS) in elderly women with favorable-risk early stage breast cancer intending to take endocrine therapy. However, patients with grade 3 histology were underrepresented on these trials. We hypothesized that high-grade disease may be unsuitable for treatment de-escalation and report the oncologic outcomes for elderly women with favorable early stage breast cancer treated with BCS with or without radiotherapy. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database was queried for women between 70 and 79 years of age with invasive ductal carcinoma diagnosed between 1998 and 2007. This cohort was narrowed to women with T1mic-T1c, N0, estrogen receptor-positive, invasive ductal carcinoma treated with BCS with or without external beam radiation (EBRT). The primary endpoints were 5- and 10-year cause-specific survival (CSS). Univariate and multivariate analyses were performed. Propensity-score matching of T-stage, year of diagnosis, and age was utilized to reduce selection bias while comparing treatment arms within the grade 3 subgroup. RESULTS A total of 12,036 women met inclusion criteria, and the median follow-up was 9.4 years. EBRT was omitted in 22% of patients, including 21% with grade 3 disease. Patients in the EBRT cohort were slightly younger (median, 74 vs. 75 years; P < .01) and had fewer T1a tumors (11% vs. 13%; P = .02). Histologic grades 1, 2, and 3 comprised 36%, 50%, and 14% of the cohort, respectively, and there were no differences in EBRT utilization by grade. Utilization of EBRT decreased following the publication of the CALGB trial in 2004 decreasing from 82% to 85% in 1998 to 2000 to 73% to 75% in 2005 to 2007 (P < .01). Unadjusted outcomes showed that in grade 1 disease, there were no differences in CSS with or without EBRT at 5 (99%) and 10 years (95%-96%). EBRT was associated with an improvement in CSS in grade 2 histology at 5 years (97% vs. 98%) and 10 years (92% vs. 95%) (P = .004). The benefit was more pronounced in grade 3 disease with CSS increasing from 93% to 96% at 5 years and from 87% to 92% at 10 years (P = .02) with EBRT. In the grade 3 subgroup, propensity-score matching confirmed EBRT was associated with superior CSS compared with surgery alone (hazard ratio, 0.58; 95% confidence interval, 0.34-0.98; P = .043). CONCLUSION In this database analysis, omission of radiotherapy after BCS in elderly women with favorable-risk, early stage, grade 3 breast cancer was associated with inferior CSS. Further prospective data in this patient population are needed to confirm our findings and conclusions.
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Affiliation(s)
- Chase E Escott
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | - David Zaenger
- Department of Radiation Oncology, Carolina Regional Cancer Center, Myrtle Beach, SC
| | - Jeffrey M Switchencko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jolinta Y Lin
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mustafa Abugideiri
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Cletus A Arciero
- Department of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Neil T Pfister
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Karen M Xu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jane L Meisel
- Department of Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Preeti Subhedar
- Department of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mylin Torres
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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24
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de Lima MAG, Clemons M, Van Katwyk S, Stober C, Robertson SJ, Vandermeer L, Fergusson D, Thavorn K. Cost analysis of using Magee scores as a surrogate of Oncotype DX for adjuvant treatment decisions in women with early breast cancer. J Eval Clin Pract 2020; 26:889-892. [PMID: 31287198 DOI: 10.1111/jep.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most common cancer in women worldwide. Most current guidelines recommend using multigene profiling assays to aid the decision on the addition of chemotherapy to adjuvant hormone therapy for women who present with early-stage, hormone receptor-positive, HER2-negative disease. One of these assays is the Oncotype DX, which predicts the disease recurrence risk and adjuvant chemotherapy benefits. Given its high cost, there is an economic incentive to evaluate its surrogates, such as the Magee equations. We assessed health system costs associated with the use of the Magee scores. A probabilistic decision tree was used to calculate the difference in mean health system costs based on data obtained from a randomized trial and the published literature. Costs were calculated from a perspective of Canada's publicly funded health care system. A series of sensitivity analysis was conducted to assess the robustness of the study findings. The Magee equations were associated with a total cost savings of C$100 per patient (95% CI, -C$3068 to C$5022) compared with standard of care. The difference in costs was highly sensitive to the extent that the Magee scores could reduce the frequency of adjuvant chemotherapy and Oncotype DX requests.
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Affiliation(s)
- Mariana A G de Lima
- Institute of Cancer of the State of São Paulo, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mark Clemons
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Division of Medical Oncology, Department of Medicine and University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sasha Van Katwyk
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Carol Stober
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Susan J Robertson
- Eastern Ontario Regional Laboratory Association, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Vandermeer
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dean Fergusson
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Institute of Clinical and Evaluative Sciences (ICES uOttawa), University of Ottawa, Ottawa, ON, Canada
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25
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Prediction of Oncotype DX recurrence score using deep multi-layer perceptrons in estrogen receptor-positive, HER2-negative breast cancer. Breast Cancer 2020; 27:1007-1016. [PMID: 32385567 DOI: 10.1007/s12282-020-01100-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
Oncotype DX (ODX) is a multi-gene expression signature designed for estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients to predict the recurrence score (RS) and chemotherapy (CT) benefit. The aim of our study is to develop a prediction tool for the three RS's categories based on deep multi-layer perceptrons (DMLP) and using only the morphoimmunohistological variables. We performed a retrospective cohort of 320 patients who underwent ODX testing from three French hospitals. Clinico-pathological characteristics were recorded. We built a supervised machine learning classification model using Matlab software with 152 cases for the training and 168 cases for the testing. Three classifiers were used to learn the three risk categories of the ODX, namely the low, intermediate, and high risk. Experimental results provide the area under the curve (AUC), respectively, for the three risk categories: 0.63 [95% confidence interval: (0.5446, 0.7154), p < 0.001], 0.59 [95% confidence interval: (0.5031, 0.6769), p < 0.001], 0.75 [95% confidence interval: (0.6184, 0.8816), p < 0.001]. Concordance rate between actual RS and predicted RS ranged from 53 to 56% for each class between DMLP and ODX. The concordance rate of low and intermediate combined risk group was 85%.We developed a predictive machine learning model that could help to define patient's RS. Moreover, we integrated histopathological data and DMLP results to select tumor for ODX testing. Thus, this process allows more relevant use of histopathological data, and optimizes and enhances this information.
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26
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Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL, Hayes DF, Lakhani SR, Chavez-MacGregor M, Perlmutter J, Perou CM, Regan MM, Rimm DL, Symmans WF, Torlakovic EE, Varella L, Viale G, Weisberg TF, McShane LM, Wolff AC. Estrogen and Progesterone Receptor Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update. Arch Pathol Lab Med 2020; 144:545-563. [PMID: 31928354 DOI: 10.5858/arpa.2019-0904-sa] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE.— To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS.— A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS.— The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
| | | | | | | | | | | | | | - Sunil R Lakhani
- University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | | | - Meredith M Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Emina E Torlakovic
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Giuseppe Viale
- IEO, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- University of Milan, Milan, Italy
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27
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Saigosoom N, Sa-Nguanraksa D, O-Charoenrat E, Thumrongtaradol T, O-Charoenrat P. The Evaluation of Magee Equation 2 in Predicting Response and Outcome in Hormone Receptor-Positive and HER2-Negative Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. Cancer Manag Res 2020; 12:2491-2499. [PMID: 32308485 PMCID: PMC7152538 DOI: 10.2147/cmar.s237423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Magee Equations have been developed as accurate tools for predicting response and clinical outcomes in breast cancer patients treated with adjuvant systemic therapy using basic clinicopathological parameters. This study aims to evaluate the alternative application of Magee Equation 2 score in predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in hormone receptor (HR)-positive, HER2-negative breast cancer. Patients and Methods Patients with HR-positive, HER2-negative breast cancer who received NAC from January 2010 to May 2018 at Siriraj Hospital, Mahidol University, Thailand, were recruited. Pre-treatment status of HR and HER2 was used to calculate the Magee Equation 2 scores. The pCR rates among different clinicopathological parameters were analyzed. Survival analysis was performed by Log-rank test. Kaplan-Meier survival curves were analyzed. Results A total of 215 patients were eligible. The pCR rates for low, intermediate, and high scores were 4.8%, 3.6%, and 23.8%, respectively. Patients with high scores had significantly higher size reduction and pCR rates compared to those with intermediate or low scores (p<0.001). Those with high scores had higher rates of locoregional recurrence and death. The patients with high score had significantly lower overall survival (p=0.034). Conclusion Among patients with HR-positive and HER2-negative breast cancer treated with NAC, Magee Equation 2 might be used as a tool for predicting the pCR and clinical outcome.
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Affiliation(s)
- Napat Saigosoom
- Division of Head, Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Doonyapat Sa-Nguanraksa
- Division of Head, Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Eng O-Charoenrat
- Faculty of Medical Sciences, University College London, London WC1E 6BT, UK
| | - Thanawat Thumrongtaradol
- Division of Head, Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Pornchai O-Charoenrat
- Division of Head, Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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28
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Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL, Hayes DF, Lakhani SR, Chavez-MacGregor M, Perlmutter J, Perou CM, Regan MM, Rimm DL, Symmans WF, Torlakovic EE, Varella L, Viale G, Weisberg TF, McShane LM, Wolff AC. Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update. J Clin Oncol 2020; 38:1346-1366. [PMID: 31928404 DOI: 10.1200/jco.19.02309] [Citation(s) in RCA: 678] [Impact Index Per Article: 169.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Sunil R Lakhani
- University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | | | - Meredith M Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Emina E Torlakovic
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Giuseppe Viale
- IEO, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- University of Milan, Milan, Italy
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29
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Zhang Y, Zhou Y, Mao F, Yao R, Sun Q. Ki-67 index, progesterone receptor expression, histologic grade and tumor size in predicting breast cancer recurrence risk: A consecutive cohort study. Cancer Commun (Lond) 2020; 40:181-193. [PMID: 32291973 PMCID: PMC7170660 DOI: 10.1002/cac2.12024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/09/2020] [Accepted: 03/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background The 21‐gene recurrence score (RS) assay has been recommended by major guidelines for treatment decision in hormone receptor (HR)‐positive early breast cancer (EBC). However, the genomic assay is not accessible and affordable worldwide. Alternatively, an increasing number of studies have shown that traditional immunohistochemistry (IHC) can partially or even completely replace the role of the 21‐gene genomic assay. Here, we developed and validated a predictive model (IHC3 model) combining the Ki‐67 index, progesterone receptor (PR) expression, histologic grade, and tumor size to predict the recurrence risk of HR‐positive EBC. Methods The data from 389 patients (development set) with HR‐positive, human epidermal growth factor receptor 2‐negative, lymph node non‐metastasized invasive breast cancer were used to construct the IHC3 model based on the Surexam® 21‐gene RS and the TAILORx clinical trial criteria. An additional 146 patients with the same characteristics constituted the validation set. The predictive accuracy of the IHC3 model was compared with that of Orucevic et al.’s nomogram. Invasive disease‐free survival (IDFS) was analyzed in the IHC3 predictive low‐recurrence risk (pLR) group and the predictive high‐recurrence risk (pHR) group. The Pearson chi‐square test, Fisher exact test, and log‐rank test were used for analysis. Results The pLR and pHR group could be easily stratified using the decision tree model without network dependence. The accuracies of the IHC3 model were 86.1% in the development set and 87.7% in the validation set. The predictive accuracy of the IHC3 model and Orucevic et al.’s nomogram for the whole cohort was 86.5% and 86.9%, respectively. After a 52‐month of median follow‐up, a significant difference was found in IDFS between of the IHC3 pLR and the pHR groups (P = 0.001) but not in the IDFS between the low‐ and high‐recurrence risk groups according to the Surexam® 21‐gene RS and the TAILORx clinical trial criteria (P = 0.556) or 21‐gene binary RS group (P = 0.511). Conclusions The proposed IHC3 model could reliably predict low and high recurrence risks in most HR‐positive EBC patients. This easy‐to‐use predictive model may be a reliable replacement for the 21‐gene genomic assay in patients with EBC who have no access to or cannot afford the 21‐gene genomic assay.
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Affiliation(s)
- Yanna Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Ru Yao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
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30
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Soran A, Tane K, Sezgin E, Bhargava R. The Correlation of Magee Equations TM and Oncotype DX ® Recurrence Score From Core Needle Biopsy Tissues in Predicting Response to Neoadjuvant Chemotherapy in ER+ and HER2- Breast Cancer. Eur J Breast Health 2020; 16:117-123. [PMID: 32285033 DOI: 10.5152/ejbh.2020.5338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/09/2020] [Indexed: 01/03/2023]
Abstract
Objective Oncotype DX® recurrence score (RS) can be predicted from Magee EquationsTM (MS) postoperatively. The aim of this study is to investigate correlation of MS with RS from pretreatment core needle biopsy (CNB) tissues, and their clinical usefulness in prediction of response to neoadjuvant chemotherapy (NCT) in estrogen receptor-positive and human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer (BC). Materials and Methods Pretreatment CNB tissue samples from 60 patients with ER+/HER2- invasive BC were analyzed for MS and RS correlation. MS and RS were categorized as follows: low (<18), intermediate (18-30), and high (≥ 31). Percentage Tumor size Reduction (%TR) was used to assess tumor response to NCT, and substantial %TR was defined as at least 50% reduction (≥50%TR). Correlation between MS and RS, and predictive factors for the ≥50%TR achievement were assessed. Results MS and RS represented a strong correlation (Spearman's correlation; r=0.58, p<0.0001) as a continuous variable. As a categorical variable, the concordance between MS and RS was 43.3%, and it increased to 80% (r=0.61, p=0.003) with the exclusion of the intermediate risk categories. Although, there was pathologic complete response (pCR), MS showed the highest predictive power for the ≥50% TR achievement, none of the factors were statistically significant (p≥0.07). Conclusion Our study demonstrated that there was a strong correlation between MS and RS from pretreatment biopsy tissue samples in ER+ and HER2- invasive BC.
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Affiliation(s)
- Atilla Soran
- Division of Breast Surgery and Lymphedema Program, Magee-Womens Hospital of University of Pittsburgh Medical Center, Suite 2601, 300 Halket Street, Pittsburgh, PA, USA
| | - Kaori Tane
- Division of Breast Surgery and Lymphedema Program, Magee-Womens Hospital of University of Pittsburgh Medical Center, Suite 2601, 300 Halket Street, Pittsburgh, PA, USA.,Division of Breast Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, İzmir Institute of Technology, İzmir, Turkey
| | - Rohit Bhargava
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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31
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Bhargava R, Clark BZ, Carter GJ, Brufsky AM, Dabbs DJ. The healthcare value of the Magee Decision Algorithm™: use of Magee Equations™ and mitosis score to safely forgo molecular testing in breast cancer. Mod Pathol 2020; 33:1563-1570. [PMID: 32203092 PMCID: PMC7384988 DOI: 10.1038/s41379-020-0521-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/21/2022]
Abstract
Magee Equations™ are multivariable models that can estimate oncotype DX® Recurrence Score, and Magee Equation 3 has been shown to have chemopredictive value in the neoadjuvant setting as a standalone test. The current study tests the accuracy of Magee Decision Algorithm™ using a large in-house database. According to the algorithm, if all Magee Equation scores are <18, or 18-25 with a mitosis score of 1, then oncotype testing is not required as the actual oncotype recurrence score is expected to be ≤25 (labeled "do not send"). If all Magee Equation scores are 31 or higher, then also oncotype testing is not required as the actual score is expected to be >25 (also "do not send"). All other cases could be considered for testing (labeled "send"). Of the 2196 ER+, HER2-negative cases sent for oncotype testing, 1538 (70%) were classified as "do not send" and 658 (30%) as "send". The classification accuracy in the "do not send" group was 95.1%. Of the 75 (4.9%) discordant cases (expected score ≤25 by decision algorithm but the actual oncotype score >25), 26 received endocrine therapy alone. None of these 26 patients experienced distant recurrence (average follow-up of 73 months). The Magee Decision Algorithm accurately identifies cases that will not benefit from oncotype testing. Such cases constitute ~70% of the routine clinical oncotype requests, an estimated saving of $300,000 per 100 test requests. The occasional discordant cases (expected ≤25, but actual oncotype score >25) appears to have an excellent outcome on endocrine therapy alone.
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Affiliation(s)
- Rohit Bhargava
- Departments of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
| | - Beth Z. Clark
- 0000 0004 0455 1723grid.411487.fDepartments of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA USA
| | - Gloria J. Carter
- 0000 0004 0455 1723grid.411487.fDepartments of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA USA
| | - Adam M. Brufsky
- 0000 0004 0455 1723grid.411487.fDepartments of Medical Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA USA
| | - David J. Dabbs
- 0000 0004 0455 1723grid.411487.fDepartments of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA USA ,0000 0001 2188 0957grid.410445.0Present Address: John A. Burns University of Hawaii Cancer Center, Honolulu, HI USA
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Orucevic A, Bell JL, King M, McNabb AP, Heidel RE. Nomogram update based on TAILORx clinical trial results - Oncotype DX breast cancer recurrence score can be predicted using clinicopathologic data. Breast 2019; 46:116-125. [DOI: 10.1016/j.breast.2019.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022] Open
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Turner BM, Gimenez-Sanders MA, Soukiazian A, Breaux AC, Skinner K, Shayne M, Soukiazian N, Ling M, Hicks DG. Risk stratification of ER-positive breast cancer patients: A multi-institutional validation and outcome study of the Rochester Modified Magee algorithm (RoMMa) and prediction of an Oncotype DX ® recurrence score <26. Cancer Med 2019; 8:4176-4188. [PMID: 31199586 PMCID: PMC6675710 DOI: 10.1002/cam4.2323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/25/2019] [Accepted: 05/18/2019] [Indexed: 12/15/2022] Open
Abstract
The skyrocketing cost of health-care demands that we question when to use multigene assay testing in the planning of treatment for breast cancer patients. A previously published algorithmic model gave recommendations for which cases to send out for Oncotype DX® (ODX) testing. This study is a multi-institutional validation of that algorithmic model in 620 additional estrogen receptor positive breast cancer cases, with outcome data on 310 cases, named in this study as the Rochester Modified Magee algorithm (RoMMa). RoMMa correctly predicted 85% (140/164) and 100% (17/17) of cases to have a low- or high-risk ODX recurrence score, respectively, consistent with the original publication. Applying our own risk stratification criteria, in patients who received appropriate hormonal therapy, only one of the 45 (2.0%) patients classified as low risk by our original algorithm have been associated with a breast cancer recurrence over 5-10 years of follow-up. Eight of 116 (7.0%) patients classified as low risk by ODX have been associated with a breast cancer recurrence with up to 11 years of follow-up. In addition, 524 of 537 (98%) cases from our total population (n = 903) with an average modified Magee score ≤18 had an ODX recurrence score <26. Patients with an average modified Magee score ≤18 or >30 may not need to be sent out for ODX testing. By avoiding these cases sending out for ODX testing, the potential cost savings to the health-care system in 2018 are estimated to have been over $100,000,000.
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Affiliation(s)
- Bradley M Turner
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York
| | | | | | - Andrea C Breaux
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky
| | - Kristin Skinner
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Michelle Shayne
- Department of Medical Oncology, University of Rochester, Rochester, New York
| | - Nyrie Soukiazian
- Drexel University College of Medicine Graduate School of Biomedical and Professional Studies, Philadelphia, Pennsylvania
| | - Marilyn Ling
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - David G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
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Natsuhara KH, Losk K, King TA, Lin NU, Camuso K, Golshan M, Pochebit S, Brock JE, Bunnell CA, Freedman RA. Impact of Genomic Assay Testing and Clinical Factors on Chemotherapy Use After Implementation of Standardized Testing Criteria. Oncologist 2019; 24:595-602. [PMID: 30076279 PMCID: PMC6516114 DOI: 10.1634/theoncologist.2018-0154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND For clinically appropriate early-stage breast cancer patients, reflex criteria for Oncotype DX ordering ("the intervention") were implemented at our comprehensive cancer center, which reduced time-to-adjuvant chemotherapy initiation. Our objective was to evaluate Oncotype DX ordering practices and chemotherapy use before and after implementation of the intervention. MATERIALS AND METHODS We examined medical records for 498 patients who had definitive breast cancer surgery at our center. The post-intervention cohort consisted of 232 consecutive patients who had Oncotype DX testing after reflex criteria implementation. This group was compared to a retrospective cohort of 266 patients who were diagnosed and treated prior to reflex criteria implementation, including patients who did and did not have Oncotype DX ordered. Factors associated with Oncotype DX ordering pre- and post-intervention were examined. We used multivariate logistic regression to evaluate factors associated with chemotherapy receipt among patients with Oncotype DX testing. RESULTS The distribution of Oncotype DX scores, the proportion of those having Oncotype DX testing (28.9% vs. 34.1%) and those receiving chemotherapy (14.3% vs. 19.4%), did not significantly change between pre- and post-intervention groups. Age ≤65 years, stage II, grade 2, 1-3+ nodes, and tumor size >2 cm were associated with higher odds of Oncotype DX testing. Among patients having Oncotype DX testing, node status and Oncotype DX scores were significantly associated with chemotherapy receipt. CONCLUSION Our criteria for reflex Oncotype DX ordering appropriately targeted patients for whom Oncotype DX would typically be ordered by providers. No significant change in the rate of Oncotype DX ordering or chemotherapy use was observed after reflex testing implementation. IMPLICATIONS FOR PRACTICE This study demonstrates that implementing multidisciplinary consensus reflex criteria for Oncotype DX ordering maintains a stable Oncotype DX ordering rate and chemotherapy rate, mirroring what was observed in a specific clinical practice, while decreasing treatment delays due to additional testing. These reflex criteria appropriately capture patients who would likely have had Oncotype DX ordered by their providers and for whom the test results are predicted to influence management. This intervention serves as a potential model for other large integrated, multidisciplinary oncology centers to institute processes targeting patient populations most likely to benefit from genomic assay testing, while mitigating treatment delays.
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Affiliation(s)
| | - Katya Losk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tari A King
- Surgical Oncology, Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kristen Camuso
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mehra Golshan
- Surgical Oncology, Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Stephen Pochebit
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jane E Brock
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Craig A Bunnell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Soukiazian A, Hicks DG, Turner BM. Reconsidering "low-risk" criteria for breast cancer recurrence in hormone positive patients. Breast J 2019; 25:545-547. [PMID: 30972823 DOI: 10.1111/tbj.13275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - David G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Bradley M Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
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Robertson SJ, Ibrahim MFK, Stober C, Hilton J, Kos Z, Mazzarello S, Ramsay T, Fergusson D, Vandermeer L, Mallick R, Arnaout A, Dent SF, Segal R, Sehdev S, Gertler S, Hutton B, Clemons M. Does integration of Magee equations into routine clinical practice affect whether oncologists order the Oncotype DX test? A prospective randomized trial. J Eval Clin Pract 2019; 25:196-204. [PMID: 30672056 DOI: 10.1111/jep.13094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The three Magee Equations provide an estimate of the Oncotype DX recurrence score using commonly available clinicopathologic information (tumour size, grade, oestrogen receptor, progesterone receptor, HER2, and Ki67). We assessed whether integration of Magee Equations into routine clinical practice affected the frequency of Oncotype DX requests. METHODS Patients with newly diagnosed, node negative, hormone receptor positive, and HER2 negative invasive breast cancer were randomized to undergo a Magee calculation or not. At the first clinic assessment, the oncologist was provided with all routinely available clinicopathologic information (including Ki67) either with or without the results of Magee Equations. Primary outcome was frequency of Oncotype DX ordering. Secondary outcomes included frequency of chemotherapy use, time to commencement of radiotherapy, or systemic therapy. Physician comfort with systemic therapy choices and the use of Ki67 and Magee Equations was also assessed. RESULTS Data from 175 randomized patients was available, 84 patients (48%) with and 91 (52%) without calculated Magee Equations. Oncotype DX was ordered in 10 (12.05%) and 13 (14.44%) (RR 0.83, 0.39-1.80; P = 0.64) in the Magee and no Magee groups, respectively. There were no statistically or clinically significant differences between the randomized groups for any of the secondary outcomes. Availability of both Ki67 and Magee Equations was associated with increased physician comfort around systemic treatment decisions. CONCLUSIONS In a practice where Ki67 is routinely available, addition of Magee Equations into routine clinic practice was not associated with a reduction in Oncotype DX use. Availability of both Ki67 and Magee Equations did however increase physician comfort with systemic therapy decisions.
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Affiliation(s)
- Susan J Robertson
- Eastern Ontario Regional Laboratory Association and Department of Pathology and Laboratory Medicine, The University of Ottawa, Ottawa, Canada
| | - Mohammed F K Ibrahim
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada
| | - Carol Stober
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - John Hilton
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada.,Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zuzana Kos
- Eastern Ontario Regional Laboratory Association and Department of Pathology and Laboratory Medicine, The University of Ottawa, Ottawa, Canada
| | - Sasha Mazzarello
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Canada
| | - Lisa Vandermeer
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Angel Arnaout
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Canada.,Division of Surgical Oncology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Susan F Dent
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada
| | - Roanne Segal
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada
| | - Sandeep Sehdev
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada
| | - Stan Gertler
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Canada
| | - Mark Clemons
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, Canada.,Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Canada
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Bhargava R, Clark BZ, Dabbs DJ. Breast Cancers With Magee Equation Score of Less Than 18, or 18-25 and Mitosis Score of 1, Do Not Require Oncotype DX Testing: A Value Study. Am J Clin Pathol 2019; 151:316-323. [PMID: 30395177 PMCID: PMC6360636 DOI: 10.1093/ajcp/aqy148] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives To investigate use of Magee equations (MEs) to determine which breast cancer cases can be excluded from Oncotype DX testing. Methods A prospective value study was carried out using data from pathology reports. Results If all three MEs scores were less than 18 or 31 or higher, the cases were labeled do not send for testing. If any or all scores were 18 to 25, cases were labeled do not send if mitosis score was 1. Of the total 205 cases, 146 (71%) were labeled do not send; of these, the correct call was made in 143 (98%) cases. Two of the three discordant cases had associated nontumor factors, likely resulting in higher scores. Conclusions Cases with ME scores less than 18, or 18 to 25 and mitosis score 1, do not require Oncotype DX testing, an estimated saving of US$280,000 per 100 clinical requests.
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Affiliation(s)
- Rohit Bhargava
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth Z Clark
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David J Dabbs
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
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Zarella MD, Heintzelman RC, Popnikolov NK, Garcia FU. BCL-2 expression aids in the immunohistochemical prediction of the Oncotype DX breast cancer recurrence score. BMC Clin Pathol 2018; 18:14. [PMID: 30574014 PMCID: PMC6299556 DOI: 10.1186/s12907-018-0082-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023] Open
Abstract
Background The development of molecular techniques to estimate the risk of breast cancer recurrence has been a significant addition to the suite of tools available to pathologists and breast oncologists. It has previously been shown that immunohistochemistry can provide a surrogate measure of tumor recurrence risk, effectively providing a less expensive and more rapid estimate of risk without the need for send-out. However, concordance between gene expression-based and immunohistochemistry-based approaches has been modest, making it difficult to determine when one approach can serve as an adequate substitute for the other. We investigated whether immunohistochemistry-based methods can be augmented to provide a useful therapeutic indicator of risk. Methods We studied whether the Oncotype DX breast cancer recurrence score can be predicted from routinely acquired immunohistochemistry of breast tumor histology. We examined the effects of two modifications to conventional scoring measures based on ER, PR, Ki-67, and Her2 expression. First, we tested a mathematical transformation that produces a more diagnostic-relevant representation of the staining attributes of these markers. Second, we considered the expression of BCL-2, a complex involved in regulating apoptosis, as an additional prognostic marker. Results We found that the mathematical transformation improved concordance rates over the conventional scoring model. By establishing a measure of prediction certainty, we discovered that the difference in concordance between methods was even greater among the most certain cases in the sample, demonstrating the utility of an accompanying measure of prediction certainty. Including BCL-2 expression in the scoring model increased the number of breast cancer cases in the cohort that were considered high certainty, effectively expanding the applicability of this technique to a greater proportion of patients. Conclusions Our results demonstrate an improvement in concordance between immunohistochemistry-based and gene expression-based methods to predict breast cancer recurrence risk following two simple modifications to the conventional scoring model.
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Affiliation(s)
- Mark D Zarella
- 1Department of Pathology & Laboratory Medicine, Drexel University, 245 N 15th St, Philadelphia, PA 19102 USA
| | - Rebecca C Heintzelman
- 2Cancer Treatment Centers of America, Eastern Regional Medical Center, Department of Pathology & Laboratory Medicine, 1331 E. Wyoming Ave, Philadelphia, PA 19124 USA
| | - Nikolay K Popnikolov
- 1Department of Pathology & Laboratory Medicine, Drexel University, 245 N 15th St, Philadelphia, PA 19102 USA
| | - Fernando U Garcia
- 2Cancer Treatment Centers of America, Eastern Regional Medical Center, Department of Pathology & Laboratory Medicine, 1331 E. Wyoming Ave, Philadelphia, PA 19124 USA
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Kim I, Choi HJ, Ryu JM, Lee SK, Yu JH, Kim SW, Nam SJ, Lee JE. A predictive model for high/low risk group according to oncotype DX recurrence score using machine learning. Eur J Surg Oncol 2018; 45:134-140. [PMID: 30348602 DOI: 10.1016/j.ejso.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oncotype DX(ODX) is a 21-gene breast cancer recurrence score(RS) assay that aids in decision-making for chemotherapy in early-stage hormone receptor-positive(HR+)breast cancer. We developed a prediction tool using machine learning for high- or low-risk ODX criteria (i.e., RS < 11 for low-risk; RS > 25 for high-risk). METHODS We performed a retrospective review of 301 breast cancer patients who underwent surgery between April 2011 and July 2017 and then an ODX test at Samsung Medical Center in Seoul, Korea. Among them, 208 cases were defined as the modeling group and 76 cases were defined as the validation group. We built a supervised machine learning classification model using the Azure ML platform. RESULTS For the high RS group, accuracy was 0.903 through Two-class Decision Jungle method in test set. For the low RS group, the accuracy was 0.726 when the Two-class Neural Network method was applied. The AUC of the ROC curve was 0.917 in the high RS group and 0.744 in the low RS group in test set. In addition, we conducted an internal validation using 76 patients who underwent ODX testing between January 2017 and July 2017. The accuracy of validation was 0.880 in the high RS group and 0.790 in the low RS group. CONCLUSION We developed a predictive model using machine learning that could represent a useful and easy-to-access tool for the selection of high ODX RS patients. After additional evaluation with large data and external validation, worldwide use of our model could be expected.
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Affiliation(s)
- Isaac Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Hee Jun Choi
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jong Han Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
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Allison KH. Ancillary Prognostic and Predictive Testing in Breast Cancer: Focus on Discordant, Unusual, and Borderline Results. Surg Pathol Clin 2018; 11:147-176. [PMID: 29413654 DOI: 10.1016/j.path.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ancillary testing in breast cancer has become standard of care to determine what therapies may be most effective for individual patients with breast cancer. Single-marker tests are required on all newly diagnosed and newly metastatic breast cancers. Markers of proliferation are also used, and include both single-marker tests like Ki67 as well as panel-based gene expression tests, which have made more recent contributions to prognostic and predictive testing in breast cancers. This review focuses on pathologist interpretation of these ancillary test results, with a focus on expected versus unexpected results and troubleshooting borderline, unusual, or discordant results.
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Affiliation(s)
- Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Lane 235, Stanford, CA 94305, USA.
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Wilson PC, Chagpar AB, Cicek AF, Bossuyt V, Buza N, Mougalian S, Killelea BK, Patel N, Harigopal M. Breast cancer histopathology is predictive of low-risk Oncotype Dx recurrence score. Breast J 2018; 24:976-980. [PMID: 30230117 DOI: 10.1111/tbj.13117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/11/2017] [Accepted: 11/16/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Oncotype Dx is a genetic test that has been incorporated into the 2017 AJCC breast cancer staging system for ER positive, HER2-negative, lymph node-negative patients to predict the risk of recurrence. Recent data suggest that immunohistochemistry (ER, PR, HER2, and Ki-67) and histologic subtype may identify patients that will not benefit from Oncotype Dx testing. METHODS A total of 371 patients underwent Oncotype Dx testing at our institution from 2012 to 2016. Oncotype recurrence score was categorized as low- (ORS = 0-10), intermediate- (11-25), or high risk (26-100). Invasive carcinomas were categorized based on histologic subtype as "favorable" (mucinous, tubular, cribriform, tubulolobular, and lobular) and "unfavorable" (ductal, mixed ductal and lobular, and micropapillary carcinoma). All cases were estrogen receptor positive and HER2-negative. Clinical and histologic predictors of low-risk ORS were assessed in univariate and multivariate logistic regression. RESULTS A total of 371 patients were categorized by ORS as low risk (n = 85, 22.9%), intermediate risk (n = 244, 65.8%), and high risk (n = 42, 11.3%). The histologic subtypes with the highest percentage of high-risk ORS were invasive micropapillary (n = 4/17, 23.5%), pleomorphic lobular (n = 2/10, 20%), and ductal carcinoma (n = 28/235, 11.9%). Low-grade invasive carcinomas with favorable histology rarely had a high-risk ORS (n = 1/97, 1%). In a simple multivariable model, favorable histologic subtype (OR = 2.39, 95% CI: 1.10 to 5.15, P = 0.026), and histologic grade (OR = 1.76, 95% CI: 1.07 to 2.90, P = 0.025) were the only significant predictors of an ORS less than 11 in estrogen receptor positive, HER2-negative, and lymph node-negative patients. CONCLUSION We question the utility of performing Oncotype Dx in subtypes of invasive carcinoma that are associated with excellent prognosis. We propose that immunohistochemistry for ER, PR, and HER2 is sufficient for patients with low-grade invasive carcinomas and can be used as a surrogate for Oncotype Dx.
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Affiliation(s)
- Parker C Wilson
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ali F Cicek
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah Mougalian
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Brigid K Killelea
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Natalie Patel
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Malini Harigopal
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Walts AE, Mirocha JM, Bose S. Comparison of Magee and Oncotype DX Recurrence Scores in estrogen receptor positive breast cancers. Breast J 2018; 24:951-956. [DOI: 10.1111/tbj.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Ann E. Walts
- Department of Pathology & Laboratory Medicine; Cedars-Sinai Medical Center; Los Angeles CA
| | - James M. Mirocha
- Department of Biostatistics; Cedars-Sinai Medical Center; Los Angeles CA
| | - Shikha Bose
- Department of Pathology & Laboratory Medicine; Cedars-Sinai Medical Center; Los Angeles CA
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Tumor grade and progesterone receptor status predict 21-gene recurrence score in early stage invasive breast carcinoma. Breast Cancer Res Treat 2018; 172:671-677. [DOI: 10.1007/s10549-018-4955-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/03/2018] [Indexed: 12/20/2022]
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44
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Dabbs DJ, Clark BZ, Serdy K, Onisko A, Brufsky AM, Smalley S, Perkins S, Bhargava R. Pathologist's health-care value in the triage of Oncotype DX ® testing: a value-based pathology study of tumour biology with outcomes. Histopathology 2018; 73:692-700. [PMID: 29920746 DOI: 10.1111/his.13690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
Abstract
AIMS Pathologists provide expert tissue assessment of breast cancer, yet their value to guide the appropriate use of breast cancer gene expression profile tests (GEPT) is underutilised. The specific aims of this study are to report morpho-immunohistological characteristics of breast tumours with Oncotype DX® (ODx) recurrence scores (RS) of 10 or fewer (ultra-low risk) and 25 or fewer (low risk) in order to determine if pathologists can identify prospectively patient tumours that do not require ODx testing. METHODS AND RESULTS Oncotype DX® cases with RS < 10 from 2005 to 2010 comprised 441 of 2594 (17%) of clinical cases; this cohort had 5 years' follow-up and was treated with endocrine therapy alone. Tumours were analysed for tumour type, Nottingham grade, mitosis score (MS) semi-quantitative (H-score) hormone receptor content and Magee equation 3. Knowledge derived from this data set was used to develop algorithms in order to identify prospectively tumours with RS of 10 or fewer or 25 or fewer. Thirty-four per cent of tumours were low-grade special types, while the remainder were enriched with high hormone receptor content with MS of 1. These algorithmic selection criteria identified correctly all patient cases below the chemotherapy cut-point, i.e. RS < 25, indicating that these oncotype test orders were an unnecessary cost. CONCLUSIONS This unique study demonstrates that (i) pathologists add great value to triage breast cancer for GEPT; and (ii) can identify prospectively low-grade tumour biology with high sensitivity and high specificity for those cases which do not require chemotherapy (RS < 25) using MS and hormone receptor content.
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Affiliation(s)
| | | | - Kate Serdy
- Department of Pathology, Pittsburgh, PA, USA
| | | | - Adam M Brufsky
- Department of Medical Oncology, Magee-Women's Hospital of University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | | | - Stephen Perkins
- Commercial and Medicare Services, UPMC Health Plan, Pittsburgh, PA, USA
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Whitney J, Corredor G, Janowczyk A, Ganesan S, Doyle S, Tomaszewski J, Feldman M, Gilmore H, Madabhushi A. Quantitative nuclear histomorphometry predicts oncotype DX risk categories for early stage ER+ breast cancer. BMC Cancer 2018; 18:610. [PMID: 29848291 PMCID: PMC5977541 DOI: 10.1186/s12885-018-4448-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Gene-expression companion diagnostic tests, such as the Oncotype DX test, assess the risk of early stage Estrogen receptor (ER) positive (+) breast cancers, and guide clinicians in the decision of whether or not to use chemotherapy. However, these tests are typically expensive, time consuming, and tissue-destructive. Methods In this paper, we evaluate the ability of computer-extracted nuclear morphology features from routine hematoxylin and eosin (H&E) stained images of 178 early stage ER+ breast cancer patients to predict corresponding risk categories derived using the Oncotype DX test. A total of 216 features corresponding to the nuclear shape and architecture categories from each of the pathologic images were extracted and four feature selection schemes: Ranksum, Principal Component Analysis with Variable Importance on Projection (PCA-VIP), Maximum-Relevance, Minimum Redundancy Mutual Information Difference (MRMR MID), and Maximum-Relevance, Minimum Redundancy - Mutual Information Quotient (MRMR MIQ), were employed to identify the most discriminating features. These features were employed to train 4 machine learning classifiers: Random Forest, Neural Network, Support Vector Machine, and Linear Discriminant Analysis, via 3-fold cross validation. Results The four sets of risk categories, and the top Area Under the receiver operating characteristic Curve (AUC) machine classifier performances were: 1) Low ODx and Low mBR grade vs. High ODx and High mBR grade (Low-Low vs. High-High) (AUC = 0.83), 2) Low ODx vs. High ODx (AUC = 0.72), 3) Low ODx vs. Intermediate and High ODx (AUC = 0.58), and 4) Low and Intermediate ODx vs. High ODx (AUC = 0.65). Trained models were tested independent validation set of 53 cases which comprised of Low and High ODx risk, and demonstrated per-patient accuracies ranging from 75 to 86%. Conclusion Our results suggest that computerized image analysis of digitized H&E pathology images of early stage ER+ breast cancer might be able predict the corresponding Oncotype DX risk categories. Electronic supplementary material The online version of this article (10.1186/s12885-018-4448-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jon Whitney
- Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH, 44106-7207, USA.
| | | | - Andrew Janowczyk
- Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH, 44106-7207, USA
| | - Shridar Ganesan
- Department of Medicine, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Scott Doyle
- SUNY at the University at Buffalo, 3435 Main Street, Buffalo, NY, USA
| | - John Tomaszewski
- SUNY at the University at Buffalo, 3435 Main Street, Buffalo, NY, USA
| | - Michael Feldman
- Department of Pathology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hannah Gilmore
- Department of Pathology, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH, 44106-7207, USA
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Applying new Magee equations for predicting the Oncotype Dx recurrence score. Breast Cancer 2018; 25:597-604. [PMID: 29691722 DOI: 10.1007/s12282-018-0860-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breast cancer is one of the most prevalent cancers in women. Oncotype Dx is a multi-gene assay frequently used to predict the recurrence risk for estrogen receptor-positive early breast cancer, with values < 18 considered low risk; ≥ 18 and ≤ 30, intermediate risk; and > 30, high risk. Patients at a high risk for recurrence are more likely to benefit from chemotherapy treatment. METHODS In this study, clinicopathological parameters for 37 cases of early breast cancer with available Oncotype Dx results were used to estimate the recurrence score using the three new Magee equations. Correlation studies with Oncotype Dx results were performed. Applying the same cutoff points as Oncotype Dx, patients were categorized into low-, intermediate- and high-risk groups according to their estimated recurrence scores. RESULTS Pearson correlation coefficient (R) values between estimated and actual recurrence score were 0.73, 0.66, and 0.70 for Magee equations 1, 2 and 3, respectively. The concordance values between actual and estimated recurrence scores were 57.6%, 52.9%, and 57.6% for Magee equations 1, 2 and 3, respectively. Using standard pathologic measures and immunohistochemistry scores in these three linear Magee equations, most low and high recurrence risk cases can be predicted with a strong positive correlation coefficient, high concordance and negligible two-step discordance. CONCLUSIONS Magee equations are user-friendly and can be used to predict the recurrence score in early breast cancer cases.
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Park KU, Chen Y, Chitale D, Choi S, Ali H, Nathanson SD, Bensenhaver J, Proctor E, Petersen L, Loutfi R, Simonds A, Kuklinski M, Doyle T, Dabak V, Cole K, Davis M, Newman L. Utilization of the 21-Gene Recurrence Score in a Diverse Breast Cancer Patient Population: Development of a Clinicopathologic Model to Predict High-Risk Scores and Response to Neoadjuvant Chemotherapy. Ann Surg Oncol 2018; 25:1921-1927. [PMID: 29679201 DOI: 10.1245/s10434-018-6440-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The 21-gene expression profile [Oncotype DX Recurrence Score (RS)] stratifies benefit from adjuvant chemotherapy in hormone receptor (HR)-positive, HER2/neu-negative, node-negative breast cancer. It is not routinely applied to predict neoadjuvant chemotherapy (NACT) response; data in diverse patient populations also are limited. We developed a statistical model based on standard clinicopathologic features to identify high-risk cases (RS > 30) and then evaluated ability of predicted high RS to predict for NACT downstaging. METHODS Primary surgery patients with Oncotype DX RS testing 2012-2016 were identified from a prospectively-maintained database. A RS predictive model was created and applied to a dataset of comparable NACT patients. Response was defined as tumor size decrease ≥ 1 cm. RESULTS Of 394 primary surgery patients-60.4% white American; 31.0% African American-RS distribution was similar for both groups. No single feature reliably identified high RS patients; however, a model accounting for age, HR expression, proliferative index (MIB1/Ki67), histology, and tumor size was generated, with receiver operator area under the curve 0.909. Fifty-six NACT patients were identified (25 African American). Of 21 cases with all relevant clinicopathology, 14 responded to NACT and the model generated high-risk RS in 14 (100%); conversely, of 16 cases generating high-risk RS, only 2 did not respond. CONCLUSIONS Predictive modelling can identify high RS patients; this model also can identify patients likely to experience primary tumor downstaging with NACT. Until this model is validated in other datasets, we recommend that Oncotype-eligible patients undergo primary surgery with decisions regarding chemotherapy made in the adjuvant setting.
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Affiliation(s)
- Ko Un Park
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Yalei Chen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Sarah Choi
- Wayne State Medical School, Detroit, MI, USA
| | - Haythem Ali
- Department of Internal Medicine, Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | | | | | - Erica Proctor
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Lindsay Petersen
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Randa Loutfi
- Department of Internal Medicine, Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Alyson Simonds
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Marcia Kuklinski
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Doyle
- Department of Internal Medicine, Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Vrushali Dabak
- Department of Internal Medicine, Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Kim Cole
- Department of Pathology, Henry Ford Health System, Detroit, MI, USA
| | - Melissa Davis
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Lisa Newman
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
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Will oncotype DX DCIS testing guide therapy? A single-institution correlation of oncotype DX DCIS results with histopathologic findings and clinical management decisions. Mod Pathol 2018; 31:562-568. [PMID: 29243740 DOI: 10.1038/modpathol.2017.172] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/09/2017] [Accepted: 10/14/2017] [Indexed: 12/31/2022]
Abstract
Given the increased detection rates of ductal carcinoma in situ (DCIS) and the limited overall survival benefit from adjuvant breast irradiation after breast-conserving surgery, there is interest in identifying subsets of patients who have low rates of ipsilateral breast tumor recurrence such that they might safely forgo radiation. The Oncotype DCIS score is a reverse transcription-PCR (RT-PCR)-based assay that was validated to predict which DCIS cases are most likely to recur. Clinically, these results may be used to assist in selecting which patients with DCIS might safely forgo radiation therapy after breast-conserving surgery; however, little is currently published on how this test is being used in practice. Our study examines traditional histopathologic features used in predicting DCIS risk with Oncotype DCIS results and how these results affect clinical decision-making at our academic institution. Histopathologic features and management decisions for 37 cases with Oncotype DCIS results over the past 4 years were collected. Necrosis, high nuclear grade, biopsy site change, estrogen receptor and progesterone receptor positivity <90% on immunohistochemistry, and Van Nuys Prognostic Index score of 8 or greater were significant predictors of an intermediate-high recurrence score on multivariate regression analysis (P<0.02). Low Oncotype DCIS scores and low nuclear grade were associated with lower rate of radiation therapy (P<0.008). There were seven cases (19%) with Oncotype DCIS results that we considered unexpected in relation to the histopathologic findings (ie, high nuclear grade with comedonecrosis and a low Oncotype score, or hormone receptor discrepancies). Overall, pathologic features correlate with Oncotype DCIS scores but unexpected results do occur, making individual recommendations sometimes challenging.
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Khoury T. Delay to Formalin Fixation (Cold Ischemia Time) Effect on Breast Cancer Molecules. Am J Clin Pathol 2018; 149:275-292. [PMID: 29471352 DOI: 10.1093/ajcp/aqx164] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The gold standard of examining breast biomarkers, including estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER2)/Ki-67, is to perform these assays on formalin-fixed, paraffin-embedded tissue. However, preanalytical variables may confound these assays. One of these factors is delay to formalin fixation (DFF). The purpose of this review is to evaluate each study that investigated the effect of DFF on breast biomarkers and other molecules. METHODS Thirteen primary research articles were identified by the literature search. The credibility of the studies was judged based on the degree of controlling other confounding factors. Nine studies had a prospective design with a high number of controlled variables. RESULTS Most of the studies concluded that DFF had an effect on ER/PR/HER2. Some of these studies showed that DFF had negative effect on other markers used either clinically or for research purposes. CONCLUSIONS The vast majority of the studies agree that DFF has negative effect on breast biomarkers.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
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50
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Thakur SS, Li H, Chan AMY, Tudor R, Bigras G, Morris D, Enwere EK, Yang H. The use of automated Ki67 analysis to predict Oncotype DX risk-of-recurrence categories in early-stage breast cancer. PLoS One 2018; 13:e0188983. [PMID: 29304138 PMCID: PMC5755729 DOI: 10.1371/journal.pone.0188983] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/16/2017] [Indexed: 12/18/2022] Open
Abstract
Ki67 is a commonly used marker of cancer cell proliferation, and has significant prognostic value in breast cancer. In spite of its clinical importance, assessment of Ki67 remains a challenge, as current manual scoring methods have high inter- and intra-user variability. A major reason for this variability is selection bias, in that different observers will score different regions of the same tumor. Here, we developed an automated Ki67 scoring method that eliminates selection bias, by using whole-slide analysis to identify and score the tumor regions with the highest proliferative rates. The Ki67 indices calculated using this method were highly concordant with manual scoring by a pathologist (Pearson’s r = 0.909) and between users (Pearson’s r = 0.984). We assessed the clinical validity of this method by scoring Ki67 from 328 whole-slide sections of resected early-stage, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. All patients had Oncotype DX testing performed (Genomic Health) and available Recurrence Scores. High Ki67 indices correlated significantly with several clinico-pathological correlates, including higher tumor grade (1 versus 3, P<0.001), higher mitotic score (1 versus 3, P<0.001), and lower Allred scores for estrogen and progesterone receptors (P = 0.002, 0.008). High Ki67 indices were also significantly correlated with higher Oncotype DX risk-of-recurrence group (low versus high, P<0.001). Ki67 index was the major contributor to a machine learning model which, when trained solely on clinico-pathological data and Ki67 scores, identified Oncotype DX high- and low-risk patients with 97% accuracy, 98% sensitivity and 80% specificity. Automated scoring of Ki67 can thus successfully address issues of consistency, reproducibility and accuracy, in a manner that integrates readily into the workflow of a pathology laboratory. Furthermore, automated Ki67 scores contribute significantly to models that predict risk of recurrence in breast cancer.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Automation, Laboratory/methods
- Automation, Laboratory/statistics & numerical data
- Breast Neoplasms/chemistry
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Cell Proliferation
- Cohort Studies
- Female
- Humans
- Image Processing, Computer-Assisted/methods
- Image Processing, Computer-Assisted/statistics & numerical data
- Immunohistochemistry/methods
- Immunohistochemistry/statistics & numerical data
- Ki-67 Antigen/analysis
- Machine Learning
- Middle Aged
- Neoplasm Recurrence, Local/chemistry
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Reproducibility of Results
- Retrospective Studies
- Risk Factors
- Selection Bias
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Affiliation(s)
- Satbir Singh Thakur
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Translational Laboratories, Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Haocheng Li
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Angela M. Y. Chan
- Translational Laboratories, Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Roxana Tudor
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Gilbert Bigras
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Don Morris
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Translational Laboratories, Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Emeka K. Enwere
- Translational Laboratories, Tom Baker Cancer Center, Calgary, Alberta, Canada
- * E-mail: (EKE); (HY)
| | - Hua Yang
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (EKE); (HY)
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