Correlation of Oncotype DX RecurrenceScore with Histomorphology and Immunohistochemistryin over 500 Patients

Oncotype Dx is used to determine the recurrence risk (RR) in patients with estrogen receptor positive (ER+) and lymph nodenegative (LN−) breast cancer. The RR is divided into low (0–17), intermediate (18–30), and high (31) to predict chemotherapybenefit. Our goal was to determine the association between histomorphology, immunohistochemistry, and RR. We retrospectivelyidentified 536 patients with ER+ and LN−breast cancers that underwent Oncotype testing from 2006 to 2013. Tumor size rangedfrom 0.2 cm to 6.5 cm (mean = 1.3 cm) and was uniform in all 3 categories. The carcinomas were as follows: ductal = 63.2%, lobular= 11.1%, and mixed = 35.7%. The RR correlated with the Nottingham grade. Increasing RR was inversely related to PR positivity butdirectly to Her2 positivity. Of the morphologic parameters, a tubular(lobular) morphology correlated only with low-intermediatescores and anaplastic type with intermediate-high scores. Other morphologies like micropapillary and mucinous were uniformlydistributed in each category. Carcinomas with comedo intraductal carcinoma were more likely associated with high RR. Forty-fourpatients with either isolated tumor cells or micrometastases were evenly distributed amongst the 3 RR. While there was only 1 ERdiscrepancy between our immunohistochemistry (3+ 80%) and Oncotype, up to 8% of PR+ cases (mean = 15%, median = 5%) and2% of HER2+ cases were undervalued by Oncotype.