Journal Article
. 2020 Mar;33(8).
doi: 10.1038/s41379-020-0521-4.

The healthcare value of the Magee Decision Algorithm™: use of Magee Equations™ and mitosis score to safely forgo molecular testing in breast cancer

Rohit Bhargava 1 Beth Z Clark 2 Gloria J Carter 2 Adam M Brufsky 3 David J Dabbs 2 
Affiliations
  • PMID: 32203092
  •     46 References
  •     1 citations

Abstract

Magee Equations™ are multivariable models that can estimate oncotype DX® Recurrence Score, and Magee Equation 3 has been shown to have chemopredictive value in the neoadjuvant setting as a standalone test. The current study tests the accuracy of Magee Decision Algorithm™ using a large in-house database. According to the algorithm, if all Magee Equation scores are <18, or 18-25 with a mitosis score of 1, then oncotype testing is not required as the actual oncotype recurrence score is expected to be ≤25 (labeled "do not send"). If all Magee Equation scores are 31 or higher, then also oncotype testing is not required as the actual score is expected to be >25 (also "do not send"). All other cases could be considered for testing (labeled "send"). Of the 2196 ER+, HER2-negative cases sent for oncotype testing, 1538 (70%) were classified as "do not send" and 658 (30%) as "send". The classification accuracy in the "do not send" group was 95.1%. Of the 75 (4.9%) discordant cases (expected score ≤25 by decision algorithm but the actual oncotype score >25), 26 received endocrine therapy alone. None of these 26 patients experienced distant recurrence (average follow-up of 73 months). The Magee Decision Algorithm accurately identifies cases that will not benefit from oncotype testing. Such cases constitute ~70% of the routine clinical oncotype requests, an estimated saving of $300,000 per 100 test requests. The occasional discordant cases (expected ≤25, but actual oncotype score >25) appears to have an excellent outcome on endocrine therapy alone.

Assessment of Ki67 in breast cancer: recommendations from the International Ki67 in Breast Cancer working group.
Mitch Dowsett, Torsten O Nielsen, +19 authors, International Ki-67 in Breast Cancer Working Group.
J Natl Cancer Inst, 2011 Oct 01; 103(22). PMID: 21960707    Free PMC article.
Highly Cited.
Interobserver agreement among pathologists for semiquantitative hormone receptor scoring in breast carcinoma.
David A Cohen, David J Dabbs, +6 authors, Rohit Bhargava.
Am J Clin Pathol, 2012 Nov 20; 138(6). PMID: 23161712
An international Ki67 reproducibility study.
Mei-Yin C Polley, Samuel C Y Leung, +16 authors, International Ki67 in Breast Cancer Working Group of the Breast International Group and North American Breast Cancer Group.
J Natl Cancer Inst, 2013 Nov 10; 105(24). PMID: 24203987    Free PMC article.
Highly Cited.
A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.
Soonmyung Paik, Steven Shak, +12 authors, Norman Wolmark.
N Engl J Med, 2004 Dec 14; 351(27). PMID: 15591335
Highly Cited.
Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.
Soonmyung Paik, Gong Tang, +11 authors, Norman Wolmark.
J Clin Oncol, 2006 May 25; 24(23). PMID: 16720680
Highly Cited.
Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +27 authors, George W Sledge.
N Engl J Med, 2018 Jun 05; 379(2). PMID: 29860917    Free PMC article.
Highly Cited.
Breast-cancer-specific mortality in patients treated based on the 21-gene assay: a SEER population-based study.
Valentina I Petkov, Dave P Miller, +21 authors, Steven Shak.
NPJ Breast Cancer, 2017 Jul 20; 2. PMID: 28721379    Free PMC article.
Highly Cited.
Histopathologic variables predict Oncotype DX recurrence score.
Melina B Flanagan, David J Dabbs, +2 authors, Rohit Bhargava.
Mod Pathol, 2008 Mar 25; 21(10). PMID: 18360352
Prediction of the Oncotype DX recurrence score: use of pathology-generated equations derived by linear regression analysis.
Molly E Klein, David J Dabbs, +4 authors, Rohit Bhargava.
Mod Pathol, 2013 Mar 19; 26(5). PMID: 23503643    Free PMC article.
Magee Equation 3 predicts pathologic response to neoadjuvant systemic chemotherapy in estrogen receptor positive, HER2 negative/equivocal breast tumors.
Daniel J Farrugia, Alessandra Landmann, +13 authors, Rohit Bhargava.
Mod Pathol, 2017 May 27; 30(8). PMID: 28548119
Breast Cancers With Magee Equation Score of Less Than 18, or 18-25 and Mitosis Score of 1, Do Not Require Oncotype DX Testing: A Value Study.
Rohit Bhargava, Beth Z Clark, David J Dabbs.
Am J Clin Pathol, 2018 Nov 06; 151(3). PMID: 30395177    Free PMC article.
Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up.
C W Elston, I O Ellis.
Histopathology, 1991 Nov 01; 19(5). PMID: 1757079
Highly Cited.
Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications.
T Sørlie, C M Perou, +14 authors, A L Børresen-Dale.
Proc Natl Acad Sci U S A, 2001 Sep 13; 98(19). PMID: 11553815    Free PMC article.
Highly Cited.
Repeated observation of breast tumor subtypes in independent gene expression data sets.
Therese Sorlie, Robert Tibshirani, +13 authors, David Botstein.
Proc Natl Acad Sci U S A, 2003 Jun 28; 100(14). PMID: 12829800    Free PMC article.
Highly Cited.
Comparing Breast Cancer Multiparameter Tests in the OPTIMA Prelim Trial: No Test Is More Equal Than the Others.
John M S Bartlett, Jane Bayani, +18 authors, OPTIMA TMG.
J Natl Cancer Inst, 2016 May 01; 108(9). PMID: 27130929    Free PMC article.
OPTIMA prelim: a randomised feasibility study of personalised care in the treatment of women with early breast cancer.
Robert C Stein, Janet A Dunn, +14 authors, OPTIMA Trial Management Group.
Health Technol Assess, 2016 Feb 13; 20(10). PMID: 26867046    Free PMC article.
Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer.
Prudence A Francis, Olivia Pagani, +34 authors, SOFT and TEXT Investigators and the International Breast Cancer Study Group.
N Engl J Med, 2018 Jun 05; 379(2). PMID: 29863451    Free PMC article.
Highly Cited.
Adjuvant ovarian suppression in premenopausal breast cancer.
Prudence A Francis, Meredith M Regan, +28 authors, International Breast Cancer Study Group.
N Engl J Med, 2014 Dec 17; 372(5). PMID: 25495490    Free PMC article.
Highly Cited.
Clinical and Genomic Risk to Guide the Use of Adjuvant Therapy for Breast Cancer.
Joseph A Sparano, Robert J Gray, +27 authors, George W Sledge.
N Engl J Med, 2019 Jun 04; 380(25). PMID: 31157962    Free PMC article.
Highly Cited.
Routine pathologic parameters can predict Oncotype DX recurrence scores in subsets of ER positive patients: who does not always need testing?
K H Allison, P L Kandalaft, +2 authors, A M Gown.
Breast Cancer Res Treat, 2011 Mar 04; 131(2). PMID: 21369717
Can features evaluated in the routine pathologic assessment of lymph node-negative estrogen receptor-positive stage I or II invasive breast cancer be used to predict the Oncotype DX recurrence score?
Jena Auerbach, Mimi Kim, Susan Fineberg.
Arch Pathol Lab Med, 2010 Nov 04; 134(11). PMID: 21043825
Impact of progesterone receptor semiquantitative immunohistochemical result on Oncotype DX recurrence score: a quality assurance study of 1074 cases.
Beth Z Clark, David J Dabbs, Kristine L Cooper, Rohit Bhargava.
Appl Immunohistochem Mol Morphol, 2012 Oct 13; 21(4). PMID: 23060300
Estimating the OncotypeDX score: validation of an inexpensive estimation tool.
Anne A Eaton, Catherine E Pesce, +5 authors, Mahmoud El-Tamer.
Breast Cancer Res Treat, 2016 Dec 09; 161(3). PMID: 27928699    Free PMC article.
A Validated Model for Identifying Patients Unlikely to Benefit From the 21-Gene Recurrence Score Assay.
Michele M Gage, Martin Rosman, +6 authors, Lorraine Tafra.
Clin Breast Cancer, 2015 Jun 15; 15(6). PMID: 26072275    Free PMC article.
Selecting Patients for Oncotype DX Testing Using Standard Clinicopathologic Information.
Susan J Robertson, Greg R Pond, +8 authors, Mark Clemons.
Clin Breast Cancer, 2019 Sep 26; 20(1). PMID: 31551182
Adjust cut-off values of immunohistochemistry models to predict risk of distant recurrence in invasive breast carcinoma patients.
Yen-Ying Chen, Ling-Ming Tseng, +2 authors, Chih-Yi Hsu.
J Chin Med Assoc, 2016 Sep 07; 79(12). PMID: 27595437
The oncotype DX recurrence score is correlated with a composite index including routinely reported pathobiologic features.
Joseph Geradts, Sarah M Bean, Rex C Bentley, William T Barry.
Cancer Invest, 2010 Sep 30; 28(9). PMID: 20873988
Algorithms for prediction of the Oncotype DX recurrence score using clinicopathologic data: a review and comparison using an independent dataset.
Michael R Harowicz, Timothy J Robinson, +4 authors, Maciej A Mazurowski.
Breast Cancer Res Treat, 2017 Jan 09; 162(1). PMID: 28064383    Free PMC article.
Using the Modified Magee Equation to Identify Patients Unlikely to Benefit From the 21-Gene Recurrence Score Assay (Oncotype DX Assay).
Yanjun Hou, Gary Tozbikian, Debra L Zynger, Zaibo Li.
Am J Clin Pathol, 2017 Apr 28; 147(6). PMID: 28449064
Comparison of Oncotype DX With Modified Magee Equation Recurrence Scores in Low-Grade Invasive Carcinoma of Breast.
Yanjun Hou, Debra L Zynger, Xiaoxian Li, Zaibo Li.
Am J Clin Pathol, 2017 Sep 14; 148(2). PMID: 28898988
Prediction of Oncotype DX and TAILORx risk categories using histopathological and immunohistochemical markers by classification and regression tree (CART) analysis.
Helen Ingoldsby, Mark Webber, +3 authors, Grace Callagy.
Breast, 2013 May 07; 22(5). PMID: 23643806
Comprehensive Histologic Scoring to Maximize the Predictability of Pathology-generated Equation of Breast Cancer Oncotype DX Recurrence Score.
Thaer Khoury, Xiao Huang, +3 authors, Mateusz Opyrchal.
Appl Immunohistochem Mol Morphol, 2016 Jan 26; 24(10). PMID: 26808126    Free PMC article.
Optimizing the Use of Gene Expression Profiling in Early-Stage Breast Cancer.
Hyun-Seok Kim, Christopher B Umbricht, +22 authors, Leslie Cope.
J Clin Oncol, 2016 Dec 22; 34(36). PMID: 27998227    Free PMC article.
Nomogram update based on TAILORx clinical trial results - Oncotype DX breast cancer recurrence score can be predicted using clinicopathologic data.
Amila Orucevic, John L Bell, +2 authors, Robert E Heidel.
Breast, 2019 May 31; 46. PMID: 31146185
Oncotype DX breast cancer recurrence score can be predicted with a novel nomogram using clinicopathologic data.
Amila Orucevic, John L Bell, Alison P McNabb, Robert E Heidel.
Breast Cancer Res Treat, 2017 Mar 01; 163(1). PMID: 28243897    Free PMC article.
Applying new Magee equations for predicting the Oncotype Dx recurrence score.
Maher Sughayer, Rolla Alaaraj, Ahmad Alsughayer.
Breast Cancer, 2018 Apr 25; 25(5). PMID: 29691722
A lower Allred score for progesterone receptor is strongly associated with a higher recurrence score of 21-gene assay in breast cancer.
Ping Tang, Jianmin Wang, +9 authors, Gary Lyman.
Cancer Invest, 2010 Aug 10; 28(9). PMID: 20690804
Risk stratification of ER-positive breast cancer patients: A multi-institutional validation and outcome study of the Rochester Modified Magee algorithm (RoMMa) and prediction of an Oncotype DX® recurrence score <26.
Bradley M Turner, Mary Ann Gimenez-Sanders, +6 authors, David G Hicks.
Cancer Med, 2019 Jun 15; 8(9). PMID: 31199586    Free PMC article.
Use of modified Magee equations and histologic criteria to predict the Oncotype DX recurrence score.
Bradley M Turner, Kristin A Skinner, +6 authors, David G Hicks.
Mod Pathol, 2015 May 02; 28(7). PMID: 25932962
Comparison of Magee and Oncotype DX Recurrence Scores in estrogen receptor positive breast cancers.
Ann E Walts, James M Mirocha, Shikha Bose.
Breast J, 2018 Sep 20; 24(6). PMID: 30230113
Pathologist's health-care value in the triage of Oncotype DX® testing: a value-based pathology study of tumour biology with outcomes.
David J Dabbs, Beth Z Clark, +5 authors, Rohit Bhargava.
Histopathology, 2018 Jun 20; 73(4). PMID: 29920746
Multigene prognostic tests in breast cancer: past, present, future.
Balázs Győrffy, Christos Hatzis, +3 authors, Lajos Pusztai.
Breast Cancer Res, 2015 Apr 08; 17. PMID: 25848861    Free PMC article.
Highly Cited. Review.
Concordance between results of inexpensive statistical models and multigene signatures in patients with ER+/HER2- early breast cancer.
Laurence Slembrouck, Isabelle Vanden Bempt, +12 authors, Giuseppe Floris.
Mod Pathol, 2021 Feb 10;. PMID: 33558657