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Concordance of breast cancer biomarker status between routine immunohistochemistry/in situ hybridization and Oncotype DX qRT-PCR with investigation of discordance, a study of 591 cases.
Hum Pathol. 2020 10; 104:54-65.HP

Abstract

Patients with estrogen receptor (ER)+/human epidermal growth factor receptor (HER)2-, lymph node- breast cancer with high recurrence risk benefit from adjuvant chemotherapy in addition to hormonal therapy. This study compares ER, progesterone receptor (PR), and HER2 status between routine immunohistochemistry (IHC)/in situ hybridization (ISH) and Oncotype DX (ODX) in 591 cases. ODX recurrence score (RS) and clinicopathologic features were compared between ER/PR-concordant and discordant cases. Hematoxylin and eosin (H&E) slides from ER discordant cases were reexamined. Concordance was high between ODX and IHC for ER status (580/591, 98.1%) and moderate for PR status (512/591, 86.6%). All 11 ER discordant cases were ER+ by IHC but ER- by ODX and high risk by ODX. Histologically, all of these cases were grade III invasive ductal carcinoma (IDC), except one case diagnosed as IDC with apocrine features. Although this case was grade I and ER/PR+ by IHC, this patient received chemotherapy because of high RS. Of 79 PR discordant cases, 60 were PR+ by IHC but PR- by ODX. Five hundred eighty-four cases had available HER2 data, with high negative agreement (580/582, 99.7%). However, both HER2+ cases by ISH were HER2- by ODX. Mean RS was higher for ER discordant than concordant cases (48.0 versus 17.1, P < 0.0001) and for PR discordant (IHC+/ODX-) than concordant cases (27.2 versus 16.7, P < 0.0001) with no significant differences in recurrence or metastasis. Overall, detection was more sensitive by IHC, and high RS of discordant cases suggests possible risk overestimation. Therapeutic decisions for discordant cases should continue to be based on clinicopathologic correlation and not oncotype alone.

Authors+Show Affiliations

Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA; Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA. Electronic address: hns21@case.edu.Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32758491

Citation

Sechrist, Haley, et al. "Concordance of Breast Cancer Biomarker Status Between Routine Immunohistochemistry/in Situ Hybridization and Oncotype DX qRT-PCR With Investigation of Discordance, a Study of 591 Cases." Human Pathology, vol. 104, 2020, pp. 54-65.
Sechrist H, Glasgow A, Bomeisl P, et al. Concordance of breast cancer biomarker status between routine immunohistochemistry/in situ hybridization and Oncotype DX qRT-PCR with investigation of discordance, a study of 591 cases. Hum Pathol. 2020;104:54-65.
Sechrist, H., Glasgow, A., Bomeisl, P., Gilmore, H., & Harbhajanka, A. (2020). Concordance of breast cancer biomarker status between routine immunohistochemistry/in situ hybridization and Oncotype DX qRT-PCR with investigation of discordance, a study of 591 cases. Human Pathology, 104, 54-65. https://doi.org/10.1016/j.humpath.2020.07.022
Sechrist H, et al. Concordance of Breast Cancer Biomarker Status Between Routine Immunohistochemistry/in Situ Hybridization and Oncotype DX qRT-PCR With Investigation of Discordance, a Study of 591 Cases. Hum Pathol. 2020;104:54-65. PubMed PMID: 32758491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concordance of breast cancer biomarker status between routine immunohistochemistry/in situ hybridization and Oncotype DX qRT-PCR with investigation of discordance, a study of 591 cases. AU - Sechrist,Haley, AU - Glasgow,Akisha, AU - Bomeisl,Philip, AU - Gilmore,Hannah, AU - Harbhajanka,Aparna, Y1 - 2020/08/03/ PY - 2020/05/13/received PY - 2020/07/20/revised PY - 2020/07/23/accepted PY - 2020/8/8/pubmed PY - 2021/3/30/medline PY - 2020/8/8/entrez KW - Breast cancer KW - Concordance KW - Estrogen receptor KW - HER2 KW - Immunohistochemistry KW - Oncotype DX KW - Progesterone receptor SP - 54 EP - 65 JF - Human pathology JO - Hum Pathol VL - 104 N2 - Patients with estrogen receptor (ER)+/human epidermal growth factor receptor (HER)2-, lymph node- breast cancer with high recurrence risk benefit from adjuvant chemotherapy in addition to hormonal therapy. This study compares ER, progesterone receptor (PR), and HER2 status between routine immunohistochemistry (IHC)/in situ hybridization (ISH) and Oncotype DX (ODX) in 591 cases. ODX recurrence score (RS) and clinicopathologic features were compared between ER/PR-concordant and discordant cases. Hematoxylin and eosin (H&E) slides from ER discordant cases were reexamined. Concordance was high between ODX and IHC for ER status (580/591, 98.1%) and moderate for PR status (512/591, 86.6%). All 11 ER discordant cases were ER+ by IHC but ER- by ODX and high risk by ODX. Histologically, all of these cases were grade III invasive ductal carcinoma (IDC), except one case diagnosed as IDC with apocrine features. Although this case was grade I and ER/PR+ by IHC, this patient received chemotherapy because of high RS. Of 79 PR discordant cases, 60 were PR+ by IHC but PR- by ODX. Five hundred eighty-four cases had available HER2 data, with high negative agreement (580/582, 99.7%). However, both HER2+ cases by ISH were HER2- by ODX. Mean RS was higher for ER discordant than concordant cases (48.0 versus 17.1, P < 0.0001) and for PR discordant (IHC+/ODX-) than concordant cases (27.2 versus 16.7, P < 0.0001) with no significant differences in recurrence or metastasis. Overall, detection was more sensitive by IHC, and high RS of discordant cases suggests possible risk overestimation. Therapeutic decisions for discordant cases should continue to be based on clinicopathologic correlation and not oncotype alone. SN - 1532-8392 UR - https://www.unboundmedicine.com/medline/citation/32758491/Concordance_of_breast_cancer_biomarker_status_between_routine_immunohistochemistry/in_situ_hybridization_and_Oncotype_DX_qRT_PCR_with_investigation_of_discordance_a_study_of_591_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(20)30146-5 DB - PRIME DP - Unbound Medicine ER -