부산대학교 도서관

Breast cancer remains the leading cause of death and an estimated 20% of early breast cancer patients will experience a recurrence within 10 years of diagnosis. Due to early detection and little extra-mammary involvement, the utility of the traditional TNM (tumor size, nodal status, and presence of metastases) staging system is becoming limited and the diagnostic pathologist now relies on accurate and timely, predictive and prognostic, tissue-based genetic and genomic testing to delineate the underlying biology to guide individualized clinical treatment recommendations. Up until 2000, patients with breast tumors greater than one centimeter were all recommended treatment with chemotherapy resulting in overtreatment, heavy economic burden, and unnecessary adverse effects affecting the quality of life for these patients. Stratifying patients at high risk of recurrence from those with low risk of recurrence, for whom adjuvant chemotherapy is not beneficial, is critical for targeted and effective patient care. The Oncotype DX 21- gene Recurrence Score (RS) complements the traditional clinical and pathological parameters to guide clinical decision-making and is the first validated multigene diagnostic assay that predicts the likelihood of breast cancer recurrence and benefit of adjuvant chemotherapy in estrogen receptor (ER)-positive, node-positive or node-negative, early-stage, invasive breast cancer. There is high level of concordance between ER levels (as determined by immunohistochemistry [IHC]) and human epidermal growth factor 2 levels (as determined by fluorescence in situ hybridization) to those measured by Oncotype DX (as determined by quantitative reverse transcription polymerase chain reaction); discordances occurring primarily in cases considered ER-negative by IHC. Oncotype DX is accurate, precise, and reproducible, and is now the only multigene profile assay to be incorporated into most international guidelines. Utilization of the Oncotype DX Recurrence Score increases physician confidence in clinical decision-making, decreases cost, and increases quality-adjusted life expectancy. The role of the breast surgical pathologist is evolving in this era of more individualized and targeted therapy. The surgical pathologist has become a pivotal member of a multidisciplinary breast cancer diagnostic patient care team, not only using the traditional morphologic parameters for staging based on tumor size and lymph node involvement, but also coordinating timely specimen selection and preparation for performing prognostic and predictive tissue-based genetic testing. [ABSTRACT FROM AUTHOR]