TEST:

Oncotype DX Breast Recurrence Score®Test

ER-Predict represents a robust assay with potential utility in early stage HR-positive/HER2-negative breast cancer. Its consistent ability to identify high-risk patients supports further investigation as a decision-support tool to guide treatment intensification in clinically low-risk HR-positive/HER2-negative disease.

Among patients ≥65 years of age who underwent BCS for early-stage estrogen-receptor positive breast cancer, Oncotype DX RS did not further refine recurrence risk estimates for radiotherapy decision-making beyond the findings of landmark radiotherapy omission trials. While the number of patients with Oncotype DX RS > 25 who omitted radiotherapy was limited in this study, this subgroup did not exhibit a significantly higher risk than their low-molecular-risk counterparts, suggesting that risk score need not necessarily disqualify select patients who seek to forego adjuvant radiotherapy. Prospective analyses with larger sample sizes will further elucidate the role of molecular assays in guiding radiotherapy decision making across risk strata.

NPI, using a threshold of 3.4 as recommended by NICE, may assist in identifying patients for whom Oncotype DX testing could be considered. Ki-67 may provide additional prognostic context when interpreted alongside NPI. These markers may contribute to broader risk stratification frameworks but should be viewed as complementary to genomic testing.

This case highlights a rare instance of necrosis in a metastatic lymph node, possibly induced by FNA. Immunohistochemistry is essential to confirm the diagnosis and avoid misinterpretation as a granulomatous or infectious process.

These findings show that AI applied to routine histopathology can serve as a practical and scalable tool for guiding chemotherapy decisions in hormone receptor-positive, HER2-negative, early breast cancer. This approach has the potential to reduce unnecessary chemotherapy and broaden access to precision oncology, particularly in resource-limited settings where genomic testing remains unavailable or unaffordable.

P3, N=314, Active, not recruiting, AstraZeneca | Trial completion date: Dec 2027 --> Apr 2028

The agreement between clinicians and GPT-4o in pretest recommendations was modest but improved post-test, highlighting the importance of multigene testing and the potential of large language models in clinical decision making.

In this data set, ODX demonstrated utility in guiding ACT decision making and supporting personalized treatment by reducing both overtreatment and undertreatment. In resource-constrained settings, surrogate markers such as Ki-67, PR expression, and histologic grade may serve as practical tools to guide risk-adapted clinical decisions.

P3, N=5018, Active, not recruiting, National Cancer Institute (NCI) | Trial completion date: Oct 2032 --> Jan 2027

P3, N=2288, Not yet recruiting, Fudan University

Sensitivity analyses supported the robustness of the analysis. Compared to no testing, the full testing strategy of genetic and genomic testing was more effective at a lower cost or was cost-effective, supporting the goal to increase the survival and the quality-of-life of women with breast cancer along the cancer care continuum.