Comparison of Local Recurrence Risk Estimates After Breast-Conserving Surgery for DCIS

DCIS Nomogram Versus Refined Oncotype DX Breast DCIS Score

Kimberly J. Van Zee, Emily C. Zabor, Rosemarie Di Donato, Bryan E. Harmon, Jana L. Fox, Monica Morrow, Hiram S. Cody, Susan A. Fineberg

Research output: Contribution to journalArticle

Abstract

Background: A ductal carcinoma in situ (DCIS) Nomogram integrating 10 clinicopathologic/treatment factors and a Refined DCIS Score (RDS) that incorporates a genomic assay and three clinicopathologic factors (Oncotype DX DCIS Score) are available to estimate DCIS 10-year local recurrence risk (LRR). This study compared these estimates. Methods: Patients 50 years of age or older with DCIS size 2.5 cm or smaller and a genomic assay available were identified. An RDS within 1–2% of the range of Nomogram LRR estimates obtained by assuming use and non-use of endocrine therapy (Nomogram ± ET) was defined as concordant. Assuming a 10-year risk threshold of 10% for recommending radiation, Nomogram ± ET and RDS estimates were compared, and threshold concordance was determined. Results: For 54 (92%) of 59 patients, the RDS and Nomogram ± ET LRR estimates were concordant. For the remaining 5 (8%) of the 59 patients, the RDS LRR estimates were lower than the Nomogram + ET estimates, with an absolute difference of 3–8%, and thus were discordant. For these five patients, the RDS estimates of 10-year LRR were lower than 10% (range 5–8%) and the Nomogram + ET estimates were 10% or higher (range 11–14%). These five patients with both discordant and threshold-discordant estimates all had close margins (≤ 2 mm). Conclusions: Among 92% of women 50 years of age or older with DCIS size 2.5 cm or smaller, free-of-charge online Nomogram 10-year LRR estimates were concordant with those obtained using the commercially available RDS (> $4600). Among the 8% with discordant risk estimates, the RDS appeared to underestimate the LRR and may lead to inappropriate omission of radiotherapy. Unless other data show a clinically significant advantage of the RDS (Oncotype DX DCIS Score), the study data suggest that for women 50 years of age or older with DCIS size 2.5 cm or smaller, its use is not warranted.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StatePublished - Jan 1 2019

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Nomograms
Carcinoma, Intraductal, Noninfiltrating
Segmental Mastectomy
Recurrence
Breast Carcinoma In Situ

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Comparison of Local Recurrence Risk Estimates After Breast-Conserving Surgery for DCIS : DCIS Nomogram Versus Refined Oncotype DX Breast DCIS Score. / Van Zee, Kimberly J.; Zabor, Emily C.; Di Donato, Rosemarie; Harmon, Bryan E.; Fox, Jana L.; Morrow, Monica; Cody, Hiram S.; Fineberg, Susan A.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

@article{e0767fbfe49040c8a0e4d9ad62db5d08,
title = "Comparison of Local Recurrence Risk Estimates After Breast-Conserving Surgery for DCIS: DCIS Nomogram Versus Refined Oncotype DX Breast DCIS Score",
abstract = "Background: A ductal carcinoma in situ (DCIS) Nomogram integrating 10 clinicopathologic/treatment factors and a Refined DCIS Score (RDS) that incorporates a genomic assay and three clinicopathologic factors (Oncotype DX DCIS Score) are available to estimate DCIS 10-year local recurrence risk (LRR). This study compared these estimates. Methods: Patients 50 years of age or older with DCIS size 2.5 cm or smaller and a genomic assay available were identified. An RDS within 1–2{\%} of the range of Nomogram LRR estimates obtained by assuming use and non-use of endocrine therapy (Nomogram ± ET) was defined as concordant. Assuming a 10-year risk threshold of 10{\%} for recommending radiation, Nomogram ± ET and RDS estimates were compared, and threshold concordance was determined. Results: For 54 (92{\%}) of 59 patients, the RDS and Nomogram ± ET LRR estimates were concordant. For the remaining 5 (8{\%}) of the 59 patients, the RDS LRR estimates were lower than the Nomogram + ET estimates, with an absolute difference of 3–8{\%}, and thus were discordant. For these five patients, the RDS estimates of 10-year LRR were lower than 10{\%} (range 5–8{\%}) and the Nomogram + ET estimates were 10{\%} or higher (range 11–14{\%}). These five patients with both discordant and threshold-discordant estimates all had close margins (≤ 2 mm). Conclusions: Among 92{\%} of women 50 years of age or older with DCIS size 2.5 cm or smaller, free-of-charge online Nomogram 10-year LRR estimates were concordant with those obtained using the commercially available RDS (> $4600). Among the 8{\%} with discordant risk estimates, the RDS appeared to underestimate the LRR and may lead to inappropriate omission of radiotherapy. Unless other data show a clinically significant advantage of the RDS (Oncotype DX DCIS Score), the study data suggest that for women 50 years of age or older with DCIS size 2.5 cm or smaller, its use is not warranted.",
author = "{Van Zee}, {Kimberly J.} and Zabor, {Emily C.} and {Di Donato}, Rosemarie and Harmon, {Bryan E.} and Fox, {Jana L.} and Monica Morrow and Cody, {Hiram S.} and Fineberg, {Susan A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-019-07537-y",
language = "English (US)",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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T1 - Comparison of Local Recurrence Risk Estimates After Breast-Conserving Surgery for DCIS

T2 - DCIS Nomogram Versus Refined Oncotype DX Breast DCIS Score

AU - Van Zee, Kimberly J.

AU - Zabor, Emily C.

AU - Di Donato, Rosemarie

AU - Harmon, Bryan E.

AU - Fox, Jana L.

AU - Morrow, Monica

AU - Cody, Hiram S.

AU - Fineberg, Susan A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: A ductal carcinoma in situ (DCIS) Nomogram integrating 10 clinicopathologic/treatment factors and a Refined DCIS Score (RDS) that incorporates a genomic assay and three clinicopathologic factors (Oncotype DX DCIS Score) are available to estimate DCIS 10-year local recurrence risk (LRR). This study compared these estimates. Methods: Patients 50 years of age or older with DCIS size 2.5 cm or smaller and a genomic assay available were identified. An RDS within 1–2% of the range of Nomogram LRR estimates obtained by assuming use and non-use of endocrine therapy (Nomogram ± ET) was defined as concordant. Assuming a 10-year risk threshold of 10% for recommending radiation, Nomogram ± ET and RDS estimates were compared, and threshold concordance was determined. Results: For 54 (92%) of 59 patients, the RDS and Nomogram ± ET LRR estimates were concordant. For the remaining 5 (8%) of the 59 patients, the RDS LRR estimates were lower than the Nomogram + ET estimates, with an absolute difference of 3–8%, and thus were discordant. For these five patients, the RDS estimates of 10-year LRR were lower than 10% (range 5–8%) and the Nomogram + ET estimates were 10% or higher (range 11–14%). These five patients with both discordant and threshold-discordant estimates all had close margins (≤ 2 mm). Conclusions: Among 92% of women 50 years of age or older with DCIS size 2.5 cm or smaller, free-of-charge online Nomogram 10-year LRR estimates were concordant with those obtained using the commercially available RDS (> $4600). Among the 8% with discordant risk estimates, the RDS appeared to underestimate the LRR and may lead to inappropriate omission of radiotherapy. Unless other data show a clinically significant advantage of the RDS (Oncotype DX DCIS Score), the study data suggest that for women 50 years of age or older with DCIS size 2.5 cm or smaller, its use is not warranted.

AB - Background: A ductal carcinoma in situ (DCIS) Nomogram integrating 10 clinicopathologic/treatment factors and a Refined DCIS Score (RDS) that incorporates a genomic assay and three clinicopathologic factors (Oncotype DX DCIS Score) are available to estimate DCIS 10-year local recurrence risk (LRR). This study compared these estimates. Methods: Patients 50 years of age or older with DCIS size 2.5 cm or smaller and a genomic assay available were identified. An RDS within 1–2% of the range of Nomogram LRR estimates obtained by assuming use and non-use of endocrine therapy (Nomogram ± ET) was defined as concordant. Assuming a 10-year risk threshold of 10% for recommending radiation, Nomogram ± ET and RDS estimates were compared, and threshold concordance was determined. Results: For 54 (92%) of 59 patients, the RDS and Nomogram ± ET LRR estimates were concordant. For the remaining 5 (8%) of the 59 patients, the RDS LRR estimates were lower than the Nomogram + ET estimates, with an absolute difference of 3–8%, and thus were discordant. For these five patients, the RDS estimates of 10-year LRR were lower than 10% (range 5–8%) and the Nomogram + ET estimates were 10% or higher (range 11–14%). These five patients with both discordant and threshold-discordant estimates all had close margins (≤ 2 mm). Conclusions: Among 92% of women 50 years of age or older with DCIS size 2.5 cm or smaller, free-of-charge online Nomogram 10-year LRR estimates were concordant with those obtained using the commercially available RDS (> $4600). Among the 8% with discordant risk estimates, the RDS appeared to underestimate the LRR and may lead to inappropriate omission of radiotherapy. Unless other data show a clinically significant advantage of the RDS (Oncotype DX DCIS Score), the study data suggest that for women 50 years of age or older with DCIS size 2.5 cm or smaller, its use is not warranted.

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