Are indeterminate-risk ER positive, HER2 negative breast cancer patients disadvantaged by having OSNA?
Association of Breast Surgery ePoster Library. Lennon H. 05/15/17; 166319; P104
Ms. Hannah Lennon
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Abstract
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Introduction:
One-Step nucleic acid amplification (OSNA) provides intra-operative assessment of the sentinel node, but has a higher detection rate of micrometastases compared to standard histology. We investigated whether this higher detection of micrometastases affected the number of patients eligible for Oncotype Dx, and therefore the rate of chemotherapy.
Methods:
Retrospective analysis of case records was performed for all patients undergoing OSNA between October 2015 and April 2016 at our breast centre. Receptor status, node status and NPI were collected along with subsequent MDT outcomes and treatment.
Results:
187 patients were analysed, 146 (78.1%) were ER+ve and HER2-ve. Of these, 80 (54.8%) had no metastases, 39 (26.7%) had micrometastases and 27 (18.5%) macrometastases. Of those with micrometastases, 20 (51%) had NPI ≥3.4 and would therefore otherwise have been eligible for Oncotype Dx, of these 5 had Oncotype Dx via a physician access programme and 1 had chemotherapy. Of the remaining 15, 5 (33%) had chemotherapy.
Conclusions:
OSNA identified micrometastes in 27% of ER+ve, Her2-ve patients. Previous work in our unit has shown that only 25 of 105 (24%) patients who had Oncotype Dx received chemotherapy suggesting that 9% of patients in this series may have undergone 'unnecessary chemotherapy'.
We believe that ER +ve, Her 2-ve tumours of indeterminate prognosis and with micrometastases should be eligible for Oncotype Dx.
One-Step nucleic acid amplification (OSNA) provides intra-operative assessment of the sentinel node, but has a higher detection rate of micrometastases compared to standard histology. We investigated whether this higher detection of micrometastases affected the number of patients eligible for Oncotype Dx, and therefore the rate of chemotherapy.
Methods:
Retrospective analysis of case records was performed for all patients undergoing OSNA between October 2015 and April 2016 at our breast centre. Receptor status, node status and NPI were collected along with subsequent MDT outcomes and treatment.
Results:
187 patients were analysed, 146 (78.1%) were ER+ve and HER2-ve. Of these, 80 (54.8%) had no metastases, 39 (26.7%) had micrometastases and 27 (18.5%) macrometastases. Of those with micrometastases, 20 (51%) had NPI ≥3.4 and would therefore otherwise have been eligible for Oncotype Dx, of these 5 had Oncotype Dx via a physician access programme and 1 had chemotherapy. Of the remaining 15, 5 (33%) had chemotherapy.
Conclusions:
OSNA identified micrometastes in 27% of ER+ve, Her2-ve patients. Previous work in our unit has shown that only 25 of 105 (24%) patients who had Oncotype Dx received chemotherapy suggesting that 9% of patients in this series may have undergone 'unnecessary chemotherapy'.
We believe that ER +ve, Her 2-ve tumours of indeterminate prognosis and with micrometastases should be eligible for Oncotype Dx.
Introduction:
One-Step nucleic acid amplification (OSNA) provides intra-operative assessment of the sentinel node, but has a higher detection rate of micrometastases compared to standard histology. We investigated whether this higher detection of micrometastases affected the number of patients eligible for Oncotype Dx, and therefore the rate of chemotherapy.
Methods:
Retrospective analysis of case records was performed for all patients undergoing OSNA between October 2015 and April 2016 at our breast centre. Receptor status, node status and NPI were collected along with subsequent MDT outcomes and treatment.
Results:
187 patients were analysed, 146 (78.1%) were ER+ve and HER2-ve. Of these, 80 (54.8%) had no metastases, 39 (26.7%) had micrometastases and 27 (18.5%) macrometastases. Of those with micrometastases, 20 (51%) had NPI ≥3.4 and would therefore otherwise have been eligible for Oncotype Dx, of these 5 had Oncotype Dx via a physician access programme and 1 had chemotherapy. Of the remaining 15, 5 (33%) had chemotherapy.
Conclusions:
OSNA identified micrometastes in 27% of ER+ve, Her2-ve patients. Previous work in our unit has shown that only 25 of 105 (24%) patients who had Oncotype Dx received chemotherapy suggesting that 9% of patients in this series may have undergone 'unnecessary chemotherapy'.
We believe that ER +ve, Her 2-ve tumours of indeterminate prognosis and with micrometastases should be eligible for Oncotype Dx.
One-Step nucleic acid amplification (OSNA) provides intra-operative assessment of the sentinel node, but has a higher detection rate of micrometastases compared to standard histology. We investigated whether this higher detection of micrometastases affected the number of patients eligible for Oncotype Dx, and therefore the rate of chemotherapy.
Methods:
Retrospective analysis of case records was performed for all patients undergoing OSNA between October 2015 and April 2016 at our breast centre. Receptor status, node status and NPI were collected along with subsequent MDT outcomes and treatment.
Results:
187 patients were analysed, 146 (78.1%) were ER+ve and HER2-ve. Of these, 80 (54.8%) had no metastases, 39 (26.7%) had micrometastases and 27 (18.5%) macrometastases. Of those with micrometastases, 20 (51%) had NPI ≥3.4 and would therefore otherwise have been eligible for Oncotype Dx, of these 5 had Oncotype Dx via a physician access programme and 1 had chemotherapy. Of the remaining 15, 5 (33%) had chemotherapy.
Conclusions:
OSNA identified micrometastes in 27% of ER+ve, Her2-ve patients. Previous work in our unit has shown that only 25 of 105 (24%) patients who had Oncotype Dx received chemotherapy suggesting that 9% of patients in this series may have undergone 'unnecessary chemotherapy'.
We believe that ER +ve, Her 2-ve tumours of indeterminate prognosis and with micrometastases should be eligible for Oncotype Dx.
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