Use of modified Magee equations and histologic criteria to predict the Oncotype DX recurrence score.
Oncotype DX (Genomic Health, Redwood City, CA, USA, current list price $4,350.00) is a multigene quantitative reverse transcription-polymerase chain reaction-based assay that estimates the risk of distant recurrence and predicts chemotherapy benefit for patients with estrogen receptor (ER)-positive breast cancers. Studies have suggested that standard histologic variables can provide similar information. Klein and Dabbs et al have shown that Oncotype DX recurrence scores can be estimated by incorporating standard histologic variables into equations (Magee equations). Using a simple modification of the Magee equation, we predict the Oncotype DX recurrence score in an independent set of 283 cases. The Pearson correlation coefficient (r) for the Oncotype DX and average modified Magee recurrence scores was 0.6644 (n=283; P<0.0001). 100% of cases with an average modified Magee recurrence score>30 (n=8) or an average modified Magee recurrence score<9 (with an available Ki-67, n=5) would have been correctly predicted to have a high or low Oncotype DX recurrence score, respectively. 86% (38/44) of cases with an average modified Magee recurrence score≤12, and 89% (34/38) of low grade tumors (NS<6) with an ER and PR≥150, and a Ki-67<10%, would have been correctly predicted to have a low Oncotype DX recurrence score. Using an algorithmic approach to eliminate high and low risk cases, between 5% and 23% of cases would potentially not have been sent by our institution for Oncotype DX testing, creating a potential cost savings between $56,550.00 and $282,750.00. The modified Magee recurrence score along with histologic criteria may be a cost-effective alternative to the Oncotype DX in risk stratifying certain breast cancer patients. The information needed is already generated by many pathology laboratories during the initial assessment of primary breast cancer, and the equations are free.
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Bradley M
BM
Turner
Department of Surgical Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Kristin A
KA
Skinner
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Ping
P
Tang
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Mary C
MC
Jackson
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Nyrie
N
Soukiazian
Department of Medical Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Michelle
M
Shayne
Department of Medical Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Alissa
A
Huston
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Marilyn
M
Ling
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
David G
DG
Hicks
D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology*; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000235:genetics / Q000473:pathology*; D011379:Prognosis; D012306:Risk; D018570:Risk Assessment