Open AccessBreast cancer histopathology is predictive of low‐risk Oncotype Dx recurrence score
Author(s) -
Wilson Parker C.,
Chagpar Anees B.,
Cicek Ali F.,
Bossuyt Veerle,
Buza Natalia,
Mougalian Sarah,
Killelea Brigid K.,
Patel Natalie,
Harigopal Malini
Publication year - 2018
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.13117
Subject(s) - medicine , breast cancer , oncology , logistic regression , lymphovascular invasion , histology , histopathology , estrogen receptor , invasive lobular carcinoma , lymph node , cancer , pathology , invasive ductal carcinoma , metastasis
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.