Anyone reporting Magee equations for breast cases?

[ygdrasil]

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Our oncologists order Oncotype DX on a lot of cases that I don't think require it, especially low grade ER+ breast tumors. In talking to them, they really like to have a recurrence risk to bring to the table when discussing chemo with patients.

This study was mentioned in the most recent CAP Today, and it purports to create an accurate (or, anyway, concordant with Oncotype DX result) recurrence score based off of ER/PR status, tumor grade, HER2 status, and tumor size.

Anyone using this in practice?

 

[schrute]

No; not sure why the oncologists can't or wouldn't just do such scoring themselves...they don't need a pathologist to translate ER/PR/HER2 positivity or negativity into some prediction. That's ridiculous.
I think that goes way beyond what is necessary for diagnostic purposes (in terms of what I'm willing to spend my time doing anyway...which is not calculating "recurrence score=13.424+5.420*(nuclear grade)+ 5.538*(mitotic count)0.045*(ER H-score)0.030*(PR H-score)+9.486*(0 for negative/equivocal and1 for HER2 positive)...Jesus.

 

[deleted314957]

Our oncologists order Oncotype DX on a lot of cases that I don't think require it, especially low grade ER+ breast tumors. In talking to them, they really like to have a recurrence risk to bring to the table when discussing chemo with patients.

This study was mentioned in the most recent CAP Today, and it purports to create an accurate (or, anyway, concordant with Oncotype DX result) recurrence score based off of ER/PR status, tumor grade, HER2 status, and tumor size.

Anyone using this in practice?

Like the typical non-laboratorian, these clinician/oncologists are just awed by what seem like such a sophisticated test and just can't believe that something simpler ( and cheaper) is just as good.
Hell, after 30 years you can pretty much look at an H&E and tell.

 

[ygdrasil]

Like the typical non-laboratorian, these clinician/oncologists are just awed by what seem like such a sophisticated test and just can't believe that something simpler ( and cheaper) is just as good.
Hell, after 30 years you can pretty much look at an H&E and tell.

Exactly. And the reason oncotype has become such a pet peeve is my conviction that they derive 90%+ of their prognostic power from ER, PR, Her2 and proliferation oncogenes, the latter of which we assess via grading and/or Ki67 (which we're not doing routinely, but I know others are).

And, Schrute, I agree that it seems stupid, and we already have a huge documentation burden that is only growing. On the other hand, it would take me only a few minutes to build a spreadsheet to crank out the data. Well, it might take me more than a few minutes, but that's because my informatics assessment by the Clinical Competence Committee would probably only be a 2. But the average proficient lab professional could slap one up in a few minutes.

 

[schrute]

but that's because my informatics assessment by the Clinical Competence Committee would probably only be a 2.

lmao.

 

[Ziehl-Neelsen]

Interesting. The paper sounds like a natural extension of that group's previous paper from 2008 (http://www.ncbi.nlm.nih.gov/pubmed/18360352). I've been bringing the paper from 2008 to tumor boards for a long time now and annoying a lot of surgeons and oncologists. Now I can bring 2 papers...

 

[gbwillner]

Our oncologists order Oncotype DX on a lot of cases that I don't think require it, especially low grade ER+ breast tumors. In talking to them, they really like to have a recurrence risk to bring to the table when discussing chemo with patients.

This study was mentioned in the most recent CAP Today, and it purports to create an accurate (or, anyway, concordant with Oncotype DX result) recurrence score based off of ER/PR status, tumor grade, HER2 status, and tumor size.

Anyone using this in practice?

Not sure of the problem, honestly.
ER+ tumors are exactly the ones where Oncotype has shown the ability to predict recurrence, so that's why your oncologist is ordering it. This is not an atypical, or inappropriate request IMHO.

 

[2121115]

Not sure of the problem, honestly.
ER+ tumors are exactly the ones where Oncotype has shown the ability to predict recurrence, so that's why your oncologist is ordering it. This is not an atypical, or inappropriate request IMHO.

Exactly, as long as they are node negative. But in reality, even if the nodes haven't been sampled the oncologists order it here anyway for "clinically negative" nodes (i.e. not enlarged).