Using MammaPrint on core needle biopsy to guide the need for axillary staging during breast surgery

Abstract

BackgroundAt present, the only opportunity to omit axillary staging is with Choosing Wisely criteria for women ages >70 y with cT1 2N0 estrogen receptor–positive/human epidermal growth factor receptor 2–negative breast cancer. However, many women are diagnosed when pathologic node status–negative, raising the question of additional opportunities to omit sentinel lymph node biopsy. We sought to investigate the association between MammaPrint, a genomic test that estimates estrogen receptor–positive breast cancer recurrence risk, and pathologic node status, with the aim that low-risk MammaPrint could be considered for omission of sentinel lymph node biopsy if associated with pathologic node status–negative. MethodsA single-institution database was queried for all women with cT1 2N0 estrogen receptor–positive/human epidermal growth factor receptor 2–negative invasive breast cancer with breast surgery as their first treatment and MammaPrint performed from 2020 to 2021. Patient and tumor factors, including MammaPrint score, were compared with axillary node status for correlation. ResultsA total of 668 women met inclusion criteria, with a median age of 66 y. MammaPrint was low-risk luminal A in 481 (72%) and high-risk luminal B in 187 (28%). At the time of breast surgery, 588 (88%) had sentinel lymph node biopsy, 27 (4%) had axillary lymph node dissection, and 53 (7.9%) had no axillary staging. Most women in both the pathologic node status–negative and pathologic node status–positive cohorts had low-risk MammaPrint (355 [73.3%] pathologic node status–negative vs 91 [69.5%] pathologic node status–positive), and women with low-risk MammaPrint did not have a significantly lower risk of pathologic node status–positive (P = .377). ConclusionLow-risk MammaPrint does not predict lower risk of pathologic node status–positive breast cancer. Based on our results, genomic testing does not appear to provide additional personalization for the ability to omit sentinel lymph node biopsy for patients outside of the Choosing Wisely guidelines.