Prediction of Low versus High Recurrence Scores in Estrogen Receptor–Positive, Lymph Node–Negative Invasive Breast Cancer on the Basis of Radiologic-Pathologic Features: Comparison with Oncotype DX Test Recurrence Scores

Abstract

Purpose To review mammographic, ultrasonographic (US), and magnetic resonance (MR) imaging features and pathologic characteristics of estrogen receptor (ER)-positive, lymph node-negative invasive breast cancer and to determine the relationship of these characteristics to Oncotype DX (Genomic Health, Redwood City, Calif) test recurrence scores (ODRS) for breast cancer recurrence. Materials and Methods This institutional review board-approved retrospective study was performed in a single large academic medical center. The study population included patients with ER-positive, lymph node-negative invasive breast cancer who underwent genomic testing from January 1, 2009, to December 31, 2013. Imaging features of the tumor were classified according to the Breast Imaging Reporting and Data System lexicon by breast imagers who were blinded to the ODRS. Mammography was performed in 86% of patients, US was performed in 84%, and MR imaging was performed in 33%, including morphologic and kinetic evaluation. Images from each imaging modality were evaluated. Each imaging finding, progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status, and tumor grade were then individually correlated with ODRS. Analysis of variance was used to determine differences for each imaging feature. Regression analysis was used to calculate prediction of recurrence on the basis of imaging features combined with histopathologic features. Results The 319 patients had a mean age ± standard deviation of 55 years ± 8.7 (range, 31-82 years). Imaging features with a positive correlation with ODRS included a well-circumscribed oval mass (P = .024) at mammography, vascularity (P = .047) and posterior enhancement (P = .004) at US, and lobulated mass (P = .002) at MR imaging. Recurrence scores were predicted by using these features in combination with PR and HER2 status and tumor grade by using the threshold of more than 30 as a high recurrence score. With a regression tree, there was correlation (r = 0.79) with 89% sensitivity and 83% specificity. Conclusion On the basis of preliminary data, information obtained routinely for breast cancer diagnosis can reliably be used to predict the ODRS with high sensitivity and specificity. (©) RSNA, 2016.

The 21-gene recurrence score in special histologic subtypes of breast cancer with favorable prognosis

“…None of the morphologic features we examined in our series, including tumor grade, biopsy site changes, cellular stroma, or inflammatory cells, were associated with RS ≥ 18. We found that higher RS was associated with lower PR expression by IHC and lower PR mRNA scores ( P ≤ 0.007), in agreement with the literature [32, 33, 36–38]. This finding suggests that low PR expression by IHC may be used to guide the use of the 21-gene RS assay for the favorable subtypes of breast carcinoma, but larger series are needed.…”

Apparent diffusion coefficient in estrogen receptor‐positive and lymph node‐negative invasive breast cancers at 3.0T DW‐MRI: A potential predictor for an oncotype Dx test recurrence score

“…However, as reported, there was a markedly low interobserver agreement and a wide variability in predicting the RS, based on the imaging characteristics alone (regardless of years of experience as breast imagers), suggesting that imaging findings alone cannot consistently predict the risk of recurrence or whether chemotherapy is needed. More recently, Dialani et al reported that oval shape on mammograms, the presence of vascularity and posterior acoustics on ultrasound images, and lobulated shape on MR images, in combination with low ER positivity, PR negativity, and HER2 positivity, were associated with high recurrence scores.…”

“…Correlating genomic information with image findings is a new field of research, and the overlap between imaging features and genomic characteristics in breast cancer is not well established. The ability to estimate the likelihood of recurrence on the basis of molecular profile and imaging findings could become an important noninvasive tool for stratifying patients according to prognosis, allowing clinicians to make personalized tailored treatment decisions for an individual patient . Our goal was to measure lesion ADC value at 3T and to assess correlation with ODxRS scores.…”

Role of dynamic contrast‐enhanced MRI in evaluating the association between contralateral parenchymal enhancement and survival outcome in ER‐positive, HER2‐negative, node‐negative invasive breast cancer

“…Most patients with hormone receptor (HR)‐positive, lymph node‐negative breast cancers have a favorable prognosis, and therefore, at least 85% of patients would be overtreated if adjuvant chemotherapy was offered to everyone . Recently, several multigene markers have been developed for predicting prognosis and effectiveness of treatment in breast cancer . These include the 70‐gene MammaPrint microarray assay, the 21‐gene Oncotype DX assay, and the 50‐gene PAM50 assay .…”