title: The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer.
abstract: BACKGROUND
  Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER(+), HER2(-) early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.
  
  
  METHODS
  We prospectively recruited 75 ER(+), HER2(-) breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.
  
  
  RESULTS
  The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.
  
  
  CONCLUSIONS
  The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.
authors.affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Exner
authors.affiliation: Clinical Institute of Pathology, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Z
authors.initials: Z
authors.lastname: Bago-Horvath
authors.affiliation: Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Bartsch
authors.affiliation: Department of Statistics and Intelligent Systems, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Mittlboeck
authors.affiliation: Netherlands Cancer Institute, Department of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands.
authors.forename: V P
authors.initials: VP
authors.lastname: Retèl
authors.affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Fitzal
authors.affiliation: Clinical Institute of Pathology, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Rudas
authors.affiliation: Department of Gynaecology and Obstetrics, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Singer
authors.affiliation: Department of Gynaecology and Obstetrics, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Pfeiler
authors.affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Gnant
authors.affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Jakesz
authors.affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Dubsky
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics*; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics*; D011960:Receptors, Estrogen / Q000235:genetics*; D012306:Risk; D059467:Transcriptome / Q000235:genetics*
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human