title: Agreement on indication for systemic therapy between biopsied tissue and surgical excision specimens in breast cancer patients.
abstract: OBJECTIVE
  In breast cancer therapy, the indication for systemic therapy is typically based on prognostic markers from the surgical excision specimen. If such is unavailable, for instance prior to tumor ablation therapy, the indication for adjuvant systemic therapy may be assessed from pretreatment biopsies. The effect of differences in tumor characteristics between biopsy and excision specimen on agreement in indication for systemic therapy is, however, largely unknown. The aim of this study is to determine the agreement in eligibility for systemic therapy between preoperative and postoperative assessment. Secondly, to identify which patient-, tumor- or lymph node characteristics may influence this agreement.
  
  
  METHODS
  In this retrospective study, 300 consecutive female patients with primary invasive breast carcinoma on biopsy were included. Indication for systemic therapy was determined separately from biopsied tissue and from excision specimens using national guidelines based on adjuvant! online. Agreement was assessed, and patient-, tumor- and lymph node characteristics affecting agreement analyzed.
  
  
  RESULTS
  Agreement in tumor characteristics between biopsy and excision specimen varied from high (ER-status: 99%), to lower (tumor grade: 62%, tumor size: 59%, and lymph node status: 67%). Without preoperative sentinel node biopsy (SNB), agreement on systemic therapy exists in 77% of patients (kappa = 0,547). Positive pretreatment indication for systemic therapy was highly indicative of the postoperative indication (PPV = 94%). Negative indication was, however, only indicative in 67% of patients. Conversely, with preoperative SNB, agreement on negative indication was raised to 89%. Agreement was especially high for ER-negative status, tumor grade 3, tumor size >2 cm, lymph node positivity at biopsy and a negative preoperative SNB.
  
  
  CONCLUSIONS
  A positive indication for systemic therapy from biopsy is highly indicative for a positive indication from the excision specimen. When the indication is negative, additional stratification using preoperative SNB raises the agreement. Still, discordance occurs in 1 out of 10 patients.
authors.affiliation: Department of Radiology, Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Alexander M Th
authors.initials: AM
authors.lastname: Schmitz
authors.affiliation: Department of Pathology, Diakonessen Hospital, Utrecht, The Netherlands.
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Oudejans
authors.affiliation: Department of Radiology, Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Kenneth G A
authors.initials: KG
authors.lastname: Gilhuijs
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D003663:Decision Trees; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011300:Preoperative Care; D011960:Receptors, Estrogen / Q000378:metabolism; D047368:Tumor Burden
chemical_list: D011960:Receptors, Estrogen